Abstract 12880: A Clinical Index of Myocardial Afterload Can Replace Wall Stress Calculations

Introduction: Afterload at the myocardial level is a principal determinant of LV chamber and myocardial wall function, generated by interplay of LV pressure, volume, and mass. Quantitation has relied on wall stress indices which require additional measurements and calculations as well as incorrect assumptions. Unfamiliar to most clinicians, they have largely fallen out of use, but the role of myocardial afterload in contemporary heart failure pathophysiology and therapy merits reevaluation given the roles of EF and myocardial strains in prognostic indices and treatment guidelines. Hypothesis: A simple clinical afterload index using variables fundamental to wall stress indices (systolic pressure(mmHg) * LV volume(ml))/LV mass(g)) or PV/M correlates closely with stress indices and relates similarly to LV EF and myocardial strains. Methods: In 277 normals (54% female, mean age 50.9±12.9 yrs) and small cohorts with dilated non-ischemic cardiomyopathy(35), aortic stenosis(12) and cancer chemotherapy(43), each with matched controls, we used CMR LV volumes, mass and brachial systolic pressure during imaging to compare end-systolic PV/M to stress indices and systolic pressure alone using correlations and correlation standard errors(SEs). Results: There were extremely close correlations (r= 0.97-0.99, all p< 0.001) with minimal SEs between PV/M and Arts and Alters stress indices with similar slopes in all groups and in normal subgroups by age and gender. Negative correlations with EF, global strains and strain rates were also present and extremely similar in all groups. But Mirsky’s stress index and brachial pressure performed less well. Conclusions: A simple clinical afterload index correlates closely with wall stress indices and similarly with LV ejection fraction and strains. It can support efficient reassessment of the role of afterload at the myocardial level in research and potentially, in clinical practice.

Fréquence de l’association artériopathie oblitérante des membres inférieurs et coronaropathie : résultats d’une étude transversale monocentrique à l’est algérien

Introduction. Patients with both Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD) have a worse cardiovascular prognosis. It therefore seems interesting to detect this association, in particular by measuring the ankle-brachial systolic pressure index (ABI) which is a simple, inexpensive, and non-invasive way with a significant diagnostic input that can detect silent but threatening lesions. It can also identify a subgroup of patients with coronary artery disease at a higher cardiovascular risk requiring a more specific management. Aims. Estimate the frequency of peripheral artery disease (PAD) in patients with Coronary Artery Disease CAD who were recruited at the department of cardiology at the university hospital of Constantine. This the study also aims to detect the risk factors of this association. Patients and methods. Our study is descriptive, cross-sectional, single-centered in cardiovascular exploration units of the regional military university hospital of Constantine. The included subjects had at least one significant coronary lesion in a major coronary artery using radial Coronary angiography. Guided medical history and a cardiovascular clinical examination preceded the measurement of the ABI for each patient. PAD was defined by an ABI of less than 0.90 in one of the four distal arteries of the two lower limbs. Data were analyzed and processed by Epi-Info Statistics V7. Results. 300 coronary patients, the average age of 61 years, mostly males, took part in the study. The frequency of the combination of PAD and coronary artery disease was 34.7% using the ABI, asymptomatic in 18% of cases. independent factors of the association were : Age≥ 65 [aOR 3,67, P <0,0001], tobacco [aOR 4,10, P<0,002], diabetes [aOR 3,48, P<0,0001] , AHT [aOR 3,30, P<0,0001], dyslipidemia [aOR 2.32, P<0,009], inactivity [aOR 2,14, P<0,015] , stroke [aOR 6,4, P<0,015] and severe coronary impairment [aOR 2,36, P<0,015]. Conclusion. ABI, in addition to being an early detection tool for PAD, its dissemination in medical practice would help in the approach and refinement of vascular risk in coronary heart patients.

Relationship between symptomatic lower limb peripheral artery disease and calcified carotid artery plaque detected on panoramic images of neurologically asymptomatic males

Objective: Males with peripheral arterial disease (PAD) are at high risk of ischaemic stroke given that atherogenic risk factors for both diseases are similar. We hypothesized that neurologically asymptomatic males diagnosed with PAD would demonstrate calcified carotid artery plaques (CCAP) on panoramic images (PI) significantly more often than similarly aged males not having PAD. Methods: Investigators implemented a retrospective cross-sectional study. Subjects were male patients over age 50 diagnosed with PAD by ankle-brachial systolic pressure index results of [Formula: see text]0.9. Controls negative for PAD had an ankle-brachial systolic pressure index > 0.9. Predictor variable was a diagnosis of PAD and outcome variable was presence of CCAP. Prevalence of CCAP amongst the PAD+ patients was compared to prevalence of CCAP among PAD- patients. Descriptive and bivariate statistics were computed and p-value was set at 0.05. Results: Final sample size consisted of 234 males (mean age 72.68 ± 9.09); 116 subjects and 118 controls. Among the PAD+ cohort, CCAP+ prevalence rate (57.76%) was significantly (p = 0.001) greater than the CCAP+ rate (36.44%) of the PAD- (control). There was no significant difference in atherogenic “risk factors” in the PAD+ cohort between CCAP+ and CCAP– subjects. Conclusion: We demonstrated that CCAP, a “risk factor” for future stroke and “risk indicator” of future myocardial infarction is seen significantly more often detected on the PIs of older male patients with PAD than among those without. Dentists treating patients with PAD must be uniquely vigilant for the presence of CCAPs on their patients’ PI.

Consistency of Toe Systolic Pressures, Brachial Systolic Pressures, and Toe-Brachial Indices in People with and without Diabetes

Background & Aims: Toe Systolic Blood Pressures (TSPs) and Toe-Brachial Indices (TBIs) have been identified as useful adjuncts in the identification of pedal ischemia, peripheral artery occlusive diseases, and risk for either nonhealing of lower extremity wounds or for amputation. Valid measurement of TSPs and TBIs is therefore essential. However, it could be jeopardized by rater, instrument, and intratestee inconsistency. These three sources of inconsistency were examined in this research. Methods: Five publications addressing TSP and TBI consistency were identified and their results were analyzed using intraclass correlation coefficients. Results: Moderate variability in TSPs was found across all studies; greater variability was evidenced in brachial systolic pressure, particularly for people who had diabetes; and TBI values also exhibited considerable variability, but little difference between people who did and did not have diabetes. Conclusion: These findings provide qualified evidence of consistency regarding measurement of TSPs but challenge TBI as a valid and useful indicator in screening, prognostic, and monitoring contexts, particularly for people who have diabetes. However, there is a prospect that TBI assessment could be improved by adherence to standardized protocols and by obtaining multiple measurements from toes and arms on a single occasion as well as on different occasions.

High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

Background: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. Methods: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than −15 mmHg. Results: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. Conclusion: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.