Document Detail

Limb stress-rest perfusion imaging with contrast ultrasound for the assessment of peripheral arterial disease severity.
MedLine Citation:
PMID:  19356447     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We hypothesized that stress-rest perfusion imaging of skeletal muscle in the lower extremity with contrast-enhanced ultrasound (CEU) could evaluate the severity of peripheral arterial disease (PAD).
BACKGROUND: Perfusion imaging may provide valuable quantitative information on PAD, particularly in patients with diabetes in whom microvascular functional abnormalities are common.
METHODS: Study subjects included 26 control subjects and 39 patients with symptomatic PAD, 19 of whom had type 2 diabetes mellitus. A modified treadmill exercise test was performed to determine exercise time to development of claudication. Multilevel pulse-volume recordings and ankle-brachial index (ABI) at rest and post-exercise ABI were measured in both extremities. Microvascular blood flow in the gastrocnemius and soleus muscles was measured at rest and after 2 min of calibrated plantar-flexion exercise.
RESULTS: During exercise, claudication did not occur in normal subjects and occurred earlier in PAD patients with diabetes than without (median time 1.2 min [95% confidence interval (CI) 0.6 to 2.5] vs. 3.0 min [95% CI 2.1 to 6.0], p < 0.01). Compared to control subjects, patients with PAD had lower skeletal muscle blood flow during plantar-flexion exercise and lower flow reserve on CEU. After adjusting for diabetes, the only diagnostic tests that predicted severity of disease by claudication threshold were CEU exercise blood flow and flow reserve (odds ratios 0.67 [95% CI 0.51 to 0.88; p = 0.003] and 0.64 [95% CI 0.46 to 0.89, p = 0.008], respectively). A quasi-likelihood information analysis incorporating all non-invasive diagnostic tests indicated that the best models for predicting severity of disease were the combination of diabetes and either exercise blood flow or flow-reserve on CEU.
CONCLUSIONS: Perfusion imaging of limb skeletal during exercise and measurement of absolute flow reserve can provide valuable information on the severity PAD. This strategy may be useful for evaluating the total impact of disease in patients with complex disease or those with coexisting functional abnormalities of flow regulation.
Jonathan R Lindner; Lisa Womack; Eugene J Barrett; Judy Weltman; Wendy Price; Nancy L Harthun; Sanjiv Kaul; James T Patrie
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  1     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2008 May 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-04-23     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  343-50     Citation Subset:  IM    
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MeSH Terms
Ankle / blood supply
Blood Pressure
Brachial Artery / physiopathology
Case-Control Studies
Contrast Media / diagnostic use*
Diabetes Mellitus, Type 2 / complications,  physiopathology,  ultrasonography*
Exercise Test*
Intermittent Claudication / etiology*,  physiopathology,  ultrasonography
Lower Extremity
Middle Aged
Muscle, Skeletal / blood supply*
Perfusion Imaging / methods*
Peripheral Vascular Diseases / complications,  physiopathology,  ultrasonography*
Predictive Value of Tests
Regional Blood Flow
Risk Assessment
Risk Factors
Severity of Illness Index
Ultrasonography, Doppler*
Grant Support
R01 DK 063508/DK/NIDDK NIH HHS; R01 DK 57878/DK/NIDDK NIH HHS; R01 DK063508/DK/NIDDK NIH HHS; R01 DK063508-05/DK/NIDDK NIH HHS; R01 DK063508-09/DK/NIDDK NIH HHS; R01 DK073759/DK/NIDDK NIH HHS; R01 DK073759-02/DK/NIDDK NIH HHS; R01 HL 074443/HL/NHLBI NIH HHS; R01 HL 078610/HL/NHLBI NIH HHS; R01 HL074443/HL/NHLBI NIH HHS; R01 HL074443-04/HL/NHLBI NIH HHS; R01 HL078610/HL/NHLBI NIH HHS; R01 HL078610-03/HL/NHLBI NIH HHS; R01 HL078610-09/HL/NHLBI NIH HHS; RR 00847/RR/NCRR NIH HHS
Reg. No./Substance:
0/Contrast Media
Comment In:
JACC Cardiovasc Imaging. 2008 May;1(3):351-3   [PMID:  19356448 ]

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