Miossec Annaïg, Tollenaere Quentin, Lanéelle Damien, Guilcher Antoine, Métairie Antoine, Le Pabic Estelle, Carel Awenig, Le Faucheur Alexis, Mahé Guillaume
Vascular Medicine Unit, CHU Rennes, Rennes, France.
Vascular Medicine Unit, CHU Caen Normandie, Caen, France.
Front Cardiovasc Med. 2021 Apr 20;8:608008. doi: 10.3389/fcvm.2021.608008. eCollection 2021.
Arterial Doppler waveform recordings are commonly used to assess lower extremity arterial disease (LEAD) severity. However, little is known about the relationship between arterial Doppler waveform profiles and patients' walking capacity. The purpose of this study was to assess whether arterial Doppler waveforms are independently associated with maximal walking distance (MWD) in patients experiencing exertional limb symptoms. This cross-sectional study included suspected LEAD patients experiencing exertional limb symptoms. In both lower extremities, arterial Doppler waveforms and ankle-brachial index (ABI) values were obtained from the pedis and tibial posterior arteries. Each arterial flow measurement was ranked using the Saint-Bonnet classification system. Treadmill stress testing (3.2 km/h, 10% slope) coupled with exercise oximetry (Exercise-TcPO2) were used to determine MWD. Delta from rest oxygen pressure (DROP) was calculated. Following treadmill stress testing, post-exercise ABI values were recorded. Univariate and multivariate analyses were used to determine the clinical variables associated with MWD. 186 patients experiencing exertional limb symptoms (62 ± 12 years and 26.8 ± 4.5 kg/m) were included between May 2016 and June 2019. Median [25th; 75th] treadmill MWD was 235 [125;500]m. Better arterial Doppler waveforms were associated with better walking distance ( = 0.0012). Whereas, median MWD was 524 [185;525]m in the group that yielded the best Doppler waveforms, it was 182 [125,305]m in the group with the poorest Doppler waveforms ( = 0.0012). MWD was significantly better ( = 0.006) in the patients with the best ABIs. However, arterial Doppler waveforms alone were significantly associated with MWD ( = 0.0009) in the multivariate model. When exercise variables (post-exercise ABI or DROP) were incorporated into the multivariate model, these were the only variables to be associated with MWD. Of the various clinical parameters at rest, Doppler flow waveform profiles were associated with MWD in suspected LEAD patients. A stronger link was however found between exercise variables and MWD.
动脉多普勒波形记录常用于评估下肢动脉疾病（LEAD）的严重程度。然而，关于动脉多普勒波形特征与患者步行能力之间的关系，人们了解甚少。本研究的目的是评估在出现运动性肢体症状的患者中，动脉多普勒波形是否与最大步行距离（MWD）独立相关。这项横断面研究纳入了有运动性肢体症状的疑似LEAD患者。在双下肢，从足背动脉和胫后动脉获取动脉多普勒波形和踝臂指数（ABI）值。每个动脉血流测量值都使用圣博内分类系统进行排序。采用跑步机压力测试（3.2 km/h，10%坡度）并结合运动血氧饱和度测定（运动时经皮氧分压）来确定MWD。计算静息氧压差值（DROP）。在跑步机压力测试后，记录运动后的ABI值。采用单因素和多因素分析来确定与MWD相关的临床变量。2016年5月至2019年6月期间纳入了186例有运动性肢体症状的患者（年龄62±12岁，体重指数26.8±4.5 kg/m²）。跑步机MWD的中位数[第25百分位数；第75百分位数]为235[125；500]米。较好的动脉多普勒波形与较好的步行距离相关（P = 0.0012）。在多普勒波形最佳的组中，MWD中位数为524[185；525]米，而在多普勒波形最差的组中为182[125，305]米（P = 0.0012）。ABI最佳的患者的MWD明显更好（P = 0.006）。然而，在多因素模型中，仅动脉多普勒波形就与MWD显著相关（P = 0.0009）。当将运动变量（运动后ABI或DROP）纳入多因素模型时，这些是与MWD相关的唯一变量。在静息状态下的各种临床参数中，多普勒血流波形特征与疑似LEAD患者的MWD相关。然而，在运动变量与MWD之间发现了更强的联系。
