Zahner Greg J, Gruendl Magdalena A, Spaulding Kimberly A, Schaller Melinda S, Hills Nancy K, Gasper Warren J, Grenon S Marlene
Department of Surgery, University of California, San Francisco, Calif.
Department of Surgery, University of California, San Francisco, Calif; Vascular Surgery Section, Veterans Affairs Medical Center, San Francisco, Calif.
J Vasc Surg. 2017 Nov;66(5):1518-1526. doi: 10.1016/j.jvs.2017.06.068. Epub 2017 Jul 26.
Arterial stiffness and peripheral artery disease (PAD) are both associated with an elevated risk of major adverse cardiac events; however, the association between arterial stiffness and PAD is less well characterized. The goal of this study was to examine the association between parameters of radial artery tonometry, a noninvasive measure of arterial stiffness, and PAD.
We conducted a cross-sectional study of 134 vascular surgery outpatients (controls, 33; PAD, 101) using arterial applanation tonometry. Central augmentation index (AIX) normalized to 75 beats/min and peripheral AIX were measured using radial artery pulse wave analysis. Pulse wave velocity was recorded at the carotid and femoral arteries. PAD was defined as symptomatic claudication with an ankle-brachial index of <0.9 or a history of peripheral revascularization. Controls had no history of atherosclerotic vascular disease and an ankle-brachial index ≥0.9.
Among the 126 participants with high-quality tonometry data, compared with controls (n = 33), patients with PAD (n = 93) were older, with higher rates of hypertension, hyperlipidemia, diabetes, and smoking (P < .05). Patients with PAD also had greater arterial stiffness as measured by central AIX, peripheral AIX, and pulse wave velocity (P < .05). In a multivariable model, a significantly increased odds of PAD was associated with each 10-unit increase in central AIX (odds ratio, 2.1; 95% confidence interval, 1.1-3.9; P = .03) and peripheral AIX (odds ratio, 1.9; 95% confidence interval, 1.2-3.2; P = .01). In addition, central and peripheral AIX were highly correlated (r = 0.76; P < .001).
In a cross-sectional analysis, arterial stiffness as measured by the AIX is independently associated with PAD, even when adjusting for several atherosclerotic risk factors. Further prospective data are needed to establish whether radial artery tonometry could be a tool for risk stratification in the PAD population.
动脉僵硬度与外周动脉疾病（PAD）均与主要不良心脏事件风险升高相关；然而，动脉僵硬度与PAD之间的关联尚未得到充分描述。本研究的目的是探讨桡动脉张力测量参数（一种无创测量动脉僵硬度的方法）与PAD之间的关联。
我们对134例血管外科门诊患者（对照组33例；PAD患者101例）进行了一项横断面研究，采用动脉压平张力测量法。使用桡动脉脉搏波分析测量标准化至75次/分钟的中心增强指数（AIX）和外周AIX。记录颈动脉和股动脉的脉搏波速度。PAD定义为有症状的间歇性跛行，踝臂指数<0.9或有外周血运重建史。对照组无动脉粥样硬化性血管疾病史且踝臂指数≥0.9。
在126例有高质量张力测量数据的参与者中，与对照组（n = 33）相比，PAD患者（n = 93）年龄更大，高血压、高脂血症、糖尿病和吸烟发生率更高（P <.05）。通过中心AIX、外周AIX和脉搏波速度测量，PAD患者的动脉僵硬度也更高（P <.05）。在多变量模型中，中心AIX每增加10个单位（比值比，2.1；95%置信区间，1.1 - 3.9；P =.03）和外周AIX每增加10个单位（比值比，1.9；95%置信区间，1.2 - 3.2；P =.01），PAD的发生几率显著增加。此外，中心AIX和外周AIX高度相关（r = 0.76；P <.001）。
在横断面分析中，即使在调整了多种动脉粥样硬化风险因素后，通过AIX测量的动脉僵硬度仍与PAD独立相关。需要进一步的前瞻性数据来确定桡动脉张力测量是否可作为PAD人群风险分层的工具。
