一项用于外周动脉疾病患者下肢肌肉灌注对比增强双功超声评估的运动负荷试验。
An exercise stress test for contrast-enhanced duplex ultrasound assessment of lower limb muscle perfusion in patients with peripheral arterial disease.
作者信息
Prior Steven J, Chrencik Matthew T, Christensen Eric, Kundi Rishi, Ryan Alice S, Addison Odessa, Lal Brajesh K
机构信息
Department of Kinesiology, University of Maryland School of Public Health, College Park, MD; Department of Veterans Affairs and Baltimore Veterans Affairs Medical Center Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD; Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore, MD.
Department of Surgery, Division of Vascular Surgery, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, MD.
出版信息
J Vasc Surg. 2024 Feb;79(2):397-404. doi: 10.1016/j.jvs.2023.10.005. Epub 2023 Oct 14.
OBJECTIVE
The aim of the present study was to develop a standardized contrast-enhanced duplex ultrasound (CE-DUS) protocol to assess lower-extremity muscle perfusion before and after exercise and determine relationships of perfusion with clinical and functional measures.
METHODS
CE-DUS (EPIQ 5G, Philips) was used before and immediately after a 10-minute, standardized bout of treadmill walking to compare microvascular perfusion of the gastrocnemius muscle in older (55-82 years) patients with peripheral arterial disease (PAD) (n = 15, mean ankle-brachial index, 0.78 ± 0.04) and controls (n = 13). Microvascular blood volume (MBV) and microvascular flow velocity (MFV) were measured at rest and immediately following treadmill exercise, and the Modified Physical Performance Test (MPPT) was used to assess mobility function.
RESULTS
In the resting state (pre-exercise), MBV in patients with PAD was not significantly different than normal controls (5.17 ± 0.71 vs 6.20 ± 0.83 arbitrary units (AU) respectively; P = .36); however, after exercise, MBV was ∼40% lower in patients with PAD compared with normal controls (5.85 ± 1.13 vs 9.53 ± 1.31 AU, respectively; P = .04). Conversely, MFV was ∼60% higher in patients with PAD compared with normal controls after exercise (0.180 ± 0.016 vs 0.113 ± 0.018 AU, respectively; P = .01). There was a significant between-group difference in the exercise-induced changes in both MBV and MFV (P ≤ .05). Both basal and exercise MBV directly correlated with MPPT score in the patients with PAD (r = 0.56-0.62; P < .05).
CONCLUSIONS
This standardized protocol for exercise stress testing of the lower extremities quantifies calf muscle perfusion and elicits perfusion deficits in patients with PAD. This technique objectively quantifies microvascular perfusion deficits that are related to reduced mobility function and could be used to assess therapeutic efficacy in patients with PAD.
目的
本研究的目的是制定一种标准化的对比增强双功超声（CE-DUS）方案，以评估运动前后下肢肌肉灌注情况，并确定灌注与临床及功能指标之间的关系。
方法
在进行10分钟标准化跑步机步行前后，使用CE-DUS（飞利浦EPIQ 5G）比较老年（55 - 82岁）外周动脉疾病（PAD）患者（n = 15，平均踝臂指数为0.78 ± 0.04）和对照组（n = 13）腓肠肌的微血管灌注情况。在静息状态和跑步机运动后立即测量微血管血容量（MBV）和微血管流速（MFV），并使用改良身体性能测试（MPPT）评估运动功能。
结果
在静息状态（运动前），PAD患者的MBV与正常对照组无显著差异（分别为5.17 ± 0.71和6.20 ± 0.83任意单位（AU）；P = 0.36）；然而，运动后，PAD患者的MBV比正常对照组低约40%（分别为5.85 ± 1.13和9.53 ± 1.31 AU；P = 0.04）。相反，运动后PAD患者的MFV比正常对照组高约60%（分别为·180 ± 0.016和0.113 ± 0.018 AU；P = 0.01）。运动引起的MBV和MFV变化在组间存在显著差异（P ≤ 0.05）。在PAD患者中，基础和运动后的MBV均与MPPT评分直接相关（r = 0.56 - 0.62；P < 0.05）。
结论
这种用于下肢运动应激测试的标准化方案可量化小腿肌肉灌注，并揭示PAD患者的灌注缺陷。该技术客观地量化了与运动功能降低相关的微血管灌注缺陷，可用于评估PAD患者的治疗效果。
Zotero 插件