动脉僵硬度可预测慢性肢体严重缺血患者的截肢和死亡。
Arterial stiffness predicts amputation and death in patients with chronic limb-threatening ischemia.
机构信息
Department of Vascular Surgery, Hospital Felício Rocho, Belo Horizonte, Brazil; Postgraduate Department, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil; Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Postgraduate Department, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil.
出版信息
J Vasc Surg. 2021 Dec;74(6):2014-2022.e4. doi: 10.1016/j.jvs.2021.05.052. Epub 2021 Jun 26.
OBJECTIVE
Arterial stiffness indices predict cardiovascular outcomes in patients with coronary or kidney disease; however, there is little data on the prognostic value of arterial stiffness in patients with advanced peripheral arterial disease. We determined whether arterial stiffness indices predict the outcomes of major amputation or death in patients with chronic limb-threatening ischemia (CLTI).
METHODS
Arterial stiffness was prospectively measured using brachial oscillometry in patients with CLTI. After measuring arterial stiffness, patients were followed in 6-month intervals for up to 3 years and evaluated for limb preservation, occurrence of major amputation, or death. Hemodynamic variables and arterial stiffness indices were used to define predictors of amputation or death.
RESULTS
A total of 136 patients presented with CLTI, and 134 (99%) of these patients required limb revascularization. At the end of follow-up (mean, 14 months), 24 patients (18%) were alive with a major amputation, and mortality was 7% (9 patients); 33 patients (24%) progressed to the combined outcome of major amputation or death. Patients having amputation and/or death (n = 33; 24%) initially presented with elevated pulse wave velocity (PWV) (13.41 ± 1.21 m/s vs 11.54 ± 1.65 m/s; P < .001), elevated augmentation index corrected to 75 beats per minute (40.42 ± 6.65% vs 27.12 ± 9.19%; P < .001), and high augmentation pressure (AP) (29.98 ± 4.32 mm Hg vs 13.40 ± 7.05 mm Hg; P < .001) compared with patients with preserved limbs. The initial ankle-brachial index (ABI) was lower in patients having amputation and/or death (0.43 ± 0.94 vs 0.62 ± 0.12; P < .001). Multivariable analysis identified PWV (odds ratio [OR], 2.62; P = .013), AP (OR, 1.56; P < .001), and ABI (OR, 0.01; P < .001) as predictors of amputation or death. ROC analysis identified patients with PWV ≤12.7 m/s (hazard ratio, 4.71; P < .001), AP ≤22.15 mm Hg (hazard ratio, 13.03; P < .001), or ABI >0.52 with an increased rate of limb preservation.
CONCLUSIONS
PWV and AP, measurements of arterial stiffness, as well as the ABI, predict amputation or death in patients with CLTI.
目的
动脉僵硬度指数可预测冠心病或肾病患者的心血管结局；然而，关于动脉僵硬度在晚期外周动脉疾病患者中的预后价值的数据较少。我们确定了动脉僵硬度指数是否可预测慢性肢体威胁性缺血（CLTI）患者的主要截肢或死亡结局。
方法
前瞻性地使用臂动脉搏动测量仪测量 CLTI 患者的动脉僵硬度。测量动脉僵硬度后，以 6 个月为间隔对患者进行随访，最长可达 3 年，并评估肢体保存、发生主要截肢或死亡的情况。血流动力学变量和动脉僵硬度指数用于定义截肢或死亡的预测因素。
结果
共有 136 例患者出现 CLTI，其中 134 例（99%）需要肢体血运重建。在随访结束时（平均 14 个月），24 例（18%）患者存活但有重大截肢，死亡率为 7%（9 例）；33 例（24%）患者进展为重大截肢或死亡的联合结局。发生截肢和/或死亡的患者（n=33；24%）最初的脉搏波速度（PWV）升高（13.41±1.21 m/s 比 11.54±1.65 m/s；P<0.001）、校正至 75 次/分的增强指数升高（40.42±6.65%比 27.12±9.19%；P<0.001）和高增强压（AP）升高（29.98±4.32 mm Hg 比 13.40±7.05 mm Hg；P<0.001），与肢体保存的患者相比。发生截肢和/或死亡的患者初始踝臂指数（ABI）较低（0.43±0.94 比 0.62±0.12；P<0.001）。多变量分析确定 PWV（比值比 [OR]，2.62；P=0.013）、AP（OR，1.56；P<0.001）和 ABI（OR，0.01；P<0.001）是截肢或死亡的预测因素。ROC 分析确定 PWV≤12.7 m/s（危险比，4.71；P<0.001）、AP≤22.15 mm Hg（危险比，13.03；P<0.001）或 ABI>0.52 的患者肢体保存率增加。
结论
动脉僵硬度的 PWV 和 AP 以及 ABI 测量值可预测 CLTI 患者的截肢或死亡。
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