RESUMEN
BACKGROUND: VascuQoL-6 (VQ-6) is a disease-specific quality of life (QoL) instrument validated for use in clinical practice and vascular registries before and after treatment for peripheral arterial disease (PAD). To improve future interpretation of self-reported outcome, an unselected cohort was followed through one year to provide observational data after both conservative and invasive treatment. METHODS: Consecutive patients with intermittent claudication (IC) or critical limb ischemia (CLI) were included. All patients completed VQ-6 and Short Form-36 (SF-36), and were evaluated with ankle-brachial index (ABI) measurement pre- and post-exercise, a constant load treadmill test and clinical consultation at baseline and after one year. Change statistics and correlation analysis were used to describe self-reported outcome after conservative and invasive treatment for PAD. RESULTS: One hundred seventy-one patients with peripheral arterial disease (PAD) were included, 70 (41%) female. 147 (86%) of the patients suffered from IC. 136 (80%) patients had one-year follow up, death, amputation and withdrawal were the major causes of loss to follow-up. Forty-eight patients (35%) evaluated their health to be unchanged compared to one year ago. There was a strong correlation between self-reported general health status based on SF-36 item 2 and VQ-6 summary score (Spearmans rho = - 0.536). Patients admitted to invasive intervention (endovascular or surgery) improved in all domains of SF-36, and in the physical component summary score (SF-36 PCS). Patients admitted to best medical treatment, smoking cessation and walking exercise (conservative group) improved only in the physical domains. There was significant improvement in VQ-6 summary score for both groups, mean 2.20 (95%CI 1.14-3.27) in the conservative group, 4.68 (95%CI 3.67-5.70) in the invasive group. VQ-6 sum score improved more than four points for 56% in the invasive group, 36% in the conservative group. CONCLUSIONS: Treatment for symptomatic PAD, both invasive and conservative, improves self-reported health status and disease specific QoL after one year. Interpretation of patient-reported outcome measured with VQ-6 after surgery or endovascular treatment must be seen in light of the improvement from conservative treatment alone. TRIAL REGISTRATION: ISRCTN14846962 (retrospectively registered).
Asunto(s)
Estado de Salud , Medición de Resultados Informados por el Paciente , Enfermedad Arterial Periférica/terapia , Calidad de Vida , Anciano , Anciano de 80 o más Años , Índice Tobillo Braquial , Tratamiento Conservador , Terapia por Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/psicologíaRESUMEN
Tolerance to +G(z) gravitational stress is reduced when +G(z) stress is preceded by exposure to hypogravity (fractional, 0, or negative G(z)). For example, there is an exaggerated fall in eye-level arterial pressure (ELAP) early on during +G(z) stress (head-up tilt; HUT) when this stress is immediately preceded by -G(z) stress (head-down tilt; HDT), termed the "push-pull effect." The aim of the present study was to test the hypothesis that sympathetic responses contribute to the push-pull effect. Young, healthy subjects (n = 7 males and 3 females) were subjected to 30 s of 30 degrees HUT from a horizontal position and to 30 s of 30 degrees HUT when HUT was immediately preceded by 20 s of -15 degrees HDT. Four bouts of HDT-HUT were alternated between five bouts of HUT in a counterbalanced design, and 1 min was allowed for recovery between tilts. This protocol was repeated during clonidine administration (2.5 microg/kg bolus over 30 min and then continuously at 0.36 microg x kg(-1) x h(-1)). Clonidine blunted the vasomotor responses to tilting, and this led to exaggerated changes in arterial pressure. Clonidine exerted little specific influence on the push-pull effect. Thus sympathetic responses appear neither to contribute to, nor protect against, the push-pull effect for the rate and duration of tilting imposed in the present study.
Asunto(s)
Sistema Cardiovascular/inervación , Hemodinámica , Hipotensión Ortostática/fisiopatología , Extremidad Inferior/irrigación sanguínea , Intolerancia Ortostática/fisiopatología , Postura , Sistema Nervioso Simpático/fisiopatología , Adaptación Fisiológica , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Adulto , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Gasto Cardíaco , Sistema Cardiovascular/diagnóstico por imagen , Sistema Cardiovascular/efectos de los fármacos , Clonidina/administración & dosificación , Electrocardiografía , Femenino , Gravedad Alterada , Inclinación de Cabeza , Frecuencia Cardíaca , Hemodinámica/efectos de los fármacos , Humanos , Hipotensión Ortostática/diagnóstico por imagen , Infusiones Intravenosas , Flujometría por Láser-Doppler , Masculino , Intolerancia Ortostática/diagnóstico por imagen , Flujo Sanguíneo Regional , Sistema Nervioso Simpático/efectos de los fármacos , Pruebas de Mesa Inclinada , Factores de Tiempo , Ultrasonografía Doppler de Pulso , Adulto JovenRESUMEN
The windkessel function of the arterial system converts the intermittent action of the heart into more continuous microcirculatory blood flow during diastole via the return of elastic energy stored in the walls of the arteries during systole. Might the same phenomenon occur regionally within the arterial system during tilting owing to regional differences in local arterial pressure imposed by gravity? We sought to test the hypothesis that during tilt-back from a head-up posture, the return of stored elastic energy in leg arteries would work to slow, or perhaps transiently reverse, the flow of blood in the femoral artery. Femoral artery blood flow and arterial pressure were recorded during tilt back from a 30 degrees head-up posture to supine (approximately 0.5 G) in young, healthy subjects (n = 7 males and 3 females) before and during clonidine infusion. During control (no drug) conditions femoral artery blood flow ceased for an entire heart beat during tilt-back. During clonidine infusion femoral artery blood flow reversed for at least one entire heart beat during tilt-back, i.e., blood flow in the retrograde direction in the femoral artery from the leg into the abdomen. Thus substantial capacitive effects of tilting on leg blood flow occur in humans during mild changes in posture.
Asunto(s)
Presión Sanguínea , Arteria Femoral/fisiología , Extremidad Inferior/irrigación sanguínea , Postura , Adaptación Fisiológica , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Adulto , Sistema Nervioso Autónomo/fisiología , Velocidad del Flujo Sanguíneo , Presión Sanguínea/efectos de los fármacos , Clonidina/administración & dosificación , Adaptabilidad , Electrocardiografía , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/efectos de los fármacos , Arteria Femoral/inervación , Gravedad Alterada , Frecuencia Cardíaca , Humanos , Infusiones Intravenosas , Flujometría por Láser-Doppler , Masculino , Flujo Sanguíneo Regional , Posición Supina , Pruebas de Mesa Inclinada , Factores de Tiempo , Ultrasonografía , Adulto JovenRESUMEN
The transient and steady-state effects of the calf muscle pump on the rise in muscle perfusion during rhythmic plantarflexions were investigated in 20 volunteers. Because a large hydrostatic column would increase the effect of a muscle pump, exercise in the supine and head-up tilted positions was compared. Within approximately 15 s of the start of muscle work, femoral artery flow (ultrasound Doppler) rose 0.37 L/min above rest in the supine and 0.5 L/min above rest in the tilted position. The latter is a significantly larger rise (P < 0.05). After 80 s of muscle work, femoral flow was stable at 0.38 and 0.39 L/min above rest in the supine and tilted positions, respectively. We conclude that the muscle pump contributes to muscle perfusion during the initial phase of muscle work, but that metabolic vasodilation is a more important determinant of muscle perfusion during steady-state muscle work.
Asunto(s)
Ejercicio Físico/fisiología , Pierna , Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Postura/fisiología , Adolescente , Adulto , Presión Sanguínea/fisiología , Femenino , Arteria Femoral/fisiología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Flujo Sanguíneo Regional/fisiología , Posición Supina/fisiología , Pruebas de Mesa Inclinada , Vasodilatación/fisiología , Adulto JovenRESUMEN
Tolerance to +G(z) gravitational stress is reduced when +G(z) stress is preceded by exposure to hypogravity (fraction, 0, or negative G(z)). For example, there is an exaggerated fall in eye-level arterial pressure (ELAP) early on during +G(z) stress (head-up tilt; HUT) when this stress is immediately preceded by -G(z) stress (head-down tilt; HDT). The aims of the present study were to characterize the hemodynamic consequences of brief HDT on subsequent HUT and to test the hypothesis that an elevation in leg vascular conductance induced by -G(z) stress contributes to the exaggerated fall in ELAP. Young healthy subjects (n = 3 men and 4 women) were subjected to 30 s of 30 degrees HUT from a horizontal position and to 30 s of 30 degrees HUT when HUT was immediately preceded by 20 s of -15 degrees HDT. Four bouts of HDT-HUT were alternated between five bouts of HUT in a counterbalanced designed to minimize possible time effects of repeated exposure to gravitational stress. One minute was allowed for recovery between tilts. Brief exposure to HDT elicited an exaggerated fall in ELAP during the first seconds of the subsequent HUT (-17.9 +/- 1.4 mmHg) compared with HUT alone (-12.4 +/- 1.2 mmHg, P <0.05) despite a greater rise in stroke volume (Doppler ultrasound) and cardiac output over this brief time period in the HDT-HUT trials compared with the HUT trials (thereafter stroke volume fell under both conditions). The greater fall in ELAP was associated with an exaggerated increase in leg blood flow (femoral artery Doppler ultrasound) and was therefore largely (70%) attributable to an exaggerated rise in estimated leg vascular conductance, confirming our hypotheses. Thus brief exposure to -G(z) stress leads to an exaggerated fall in ELAP during subsequent HUT, owing to an exaggerated increase in estimated leg vascular conductance.