Henni Samir, Hersant Jeanne, Ammi Myriam, Mortaki Fatima-Ezzahra, Picquet Jean, Feuilloy Mathieu, Abraham Pierre
Vascular Medicine, University Hospital Center, Angers, France.
UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France.
Front Physiol. 2019 Feb 21;10:136. doi: 10.3389/fphys.2019.00136. eCollection 2019.
Exercise oximetry allows operator-independent recordings of microvascular blood flow impairments during exercise and can be used during upper arm provocative maneuvers. To study the test-retest reliability of upper-limb oximetry during the Roos test in patients with suspected thoracic outlet syndrome (TOS). Forty-two patients (28 men, 14 women; mean age: 40.8 years) were examined via transcutaneous oxygen pressure (TcpO2) recordings during two consecutive Roos tests in the standing position. The minimal decrease from rest of oxygen pressure (DROPmin) value was recorded after each maneuver was performed on both arms. The area under the receiver operating characteristic (ROC) curve defined the DROPmin diagnostic performance in the presence of symptoms during the tests. The Mann-Whitney -test was used to compare the DROPmin in the symptomatic vs. asymptomatic arms. The test-retest reliability was analyzed with Bland-Altman representations. The results are presented as means ± standard deviations (SD) or medians [25-75 percentiles]. The symptoms by history were different from the symptoms expressed during the Roos maneuvers in one-third of the patients. The DROPmin measurements were -19 [-36; -7] mmHg and -8 [-16; -5] mmHg in the symptomatic ( = 108) and asymptomatic ( = 60) arms, respectively. When TOS observed on ultrasound imaging was the endpoint, the area under the ROC curve (AUC) was 0.725 ± 0.058, with an optimal cutoff point of -15 mmHg. This value provided 67% sensitivity and 78% specificity for the presence TOS via ultrasound. When symptoms occurring during the test represented the endpoint, the AUC was 0.698 ± 0.04, with a cutoff point of -10 mmHg. This provided 62% sensitivity and 66% specificity for the presence of pain in the ipsilateral arm during the test. The test-retest reliability of DROPmin proved to be good but not perfect, partly because of unreliability of the provocation maneuvers. To the best of our knowledge, this study is the first to investigate microvascular responses during the Roos maneuver in patients with suspected TOS. The presence of symptoms was significantly associated with ischemia. TcpO2 facilitated the recording of both macrovascular and microvascular responses to the Roos test. The Roos maneuver should probably be performed at least twice in patients with suspected TOS.
运动血氧测定法可实现与操作者无关的运动期间微血管血流障碍记录，并且可在上臂激发动作期间使用。为研究疑似胸廓出口综合征（TOS）患者在Roos试验期间上肢血氧测定法的重测信度。42例患者（28例男性，14例女性；平均年龄：40.8岁）在站立位连续两次Roos试验期间通过经皮氧分压（TcpO2）记录进行检查。在双臂进行每次动作后记录氧分压从静息状态的最小下降值（DROPmin）。受试者工作特征（ROC）曲线下面积定义了试验期间出现症状时DROPmin的诊断性能。采用Mann-Whitney检验比较有症状与无症状手臂的DROPmin。用Bland-Altman图分析重测信度。结果以均值±标准差（SD）或中位数[25-75百分位数]表示。三分之一患者的病史症状与Roos动作期间表现出的症状不同。有症状（n = 108）和无症状（n = 60）手臂的DROPmin测量值分别为-19 [-36；-7] mmHg和-8 [-16；-5] mmHg。以超声成像观察到的TOS为终点时，ROC曲线下面积（AUC）为0.725±0.058，最佳截断点为-15 mmHg。该值对超声检查发现TOS的敏感性为67%，特异性为78%。以试验期间出现的症状为终点时，AUC为0.698±0.04，截断点为-10 mmHg。这对试验期间患侧手臂疼痛的存在提供了62%的敏感性和66%的特异性。DROPmin的重测信度被证明良好但并不完美，部分原因是激发动作的不可靠性。据我们所知，本研究是首次调查疑似TOS患者在Roos动作期间的微血管反应。症状的存在与缺血显著相关。TcpO2有助于记录对Roos试验的大血管和微血管反应。对于疑似TOS患者，Roos动作可能应至少进行两次。
