El Grosor íntima-media de la arteria femoral superficial como marcador de la aterosclerosis y de la enfermedad arterial periférica
1-Introduction: Intima-media thickness of the carotid artery, measured with doppler ultrasound is considered an early marker for cardiovascular diseases121. Peripheral arterial disease (PAD) is a highly prevalent and costly health condition1-3. The ankle-brachial index (ABI) is currently defined as...
| Autor: | |
|---|---|
| Tipo de recurso: | tesis doctoral |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | español |
| OAI Identifier: | oai:ddd.uab.cat:166226 |
| Acceso en línea: | https://ddd.uab.cat/record/166226 |
| Access Level: | acceso abierto |
| Palabra clave: | Arteriosclerosi Sistema cardiovascular |
| Sumario: | 1-Introduction: Intima-media thickness of the carotid artery, measured with doppler ultrasound is considered an early marker for cardiovascular diseases121. Peripheral arterial disease (PAD) is a highly prevalent and costly health condition1-3. The ankle-brachial index (ABI) is currently defined as the "gold-standard" for the diagnosis of PAD, as it is closely related with cardiovascular events and their prognosis132. Doppler ultrasound exploration of the superficial femoral artery is fast, painless, cost-effective and reproducible and provides additional information to ABI. 2-Hypothesis: Pre-Hunter intima-media thickness of the superficial femoral artery (SFA IMT) may be a marker for peripheral arterial disease. 3-Objetive: Assess the usefulness of pre-Hunter SFA IMT in the diagnosis and/or prognosis of PAD, comparing the relation of IMT with: - ABI. - Fontaine stages of intermittent claudication (IC). - Number of cardiovascular risk factors (CRF). 4-Material and Methods The study was assessed and approved by the Ethics Committee and written informed consent of all patients was obtained. Design: a transversal study performed in 2011, with follow-up in 2015. 167 patients were included between January-September 2011. Inclusion criteria: age ≥ 50 years, ≥1 CRF (diabetes mellitus, hypertension, dyslipaemia, smoking). Exclusion criteria: PAD Fontaine stage III or IV. Collected data: - First visit 2011: blood test (leukocytes, monocytes, total cholesterol, LDL-C , HDL-C, triglycerides, glycaemia, glycosylated haemoglobin), ABI, SFA IMT by doppler ultrasound in millimetres, CRF and cardiovascular events, body mass index and waist circumference. - Second visit 2015: SFA IMT by doppler ultrasound in millimetres, ABI, new cardiovascular events, body mass index and waist circumference. Statistical Analysis: - Descriptive: quantitative variables (median; standard deviation); qualitative variables (absolute and relative frequencies). - Analytical: multilevel models. Data analysis: R Core Team (2015) statistical package. Graphs: quantitative variables (Scatter plots); qualitative variables (Box plots) Statistical level: 0.05. 5-Results: - 2011 visit: 167 patients, 52% women and 48% men, mean age 69 years. - 2015 control visit: 145 patients, 3 died and 19 were lost to follow-up. - Descriptive analysis: 31.7% of patients had IC of the right leg and 28% of the left; 35% had 2 CRF; arterial hypertension was the most common CRF (73%); 10% had a history of acute myocardial infarction and 8.39% cerebral ischemic events. - Comparative analysis: a 1mm increase of IMT SFA correlated with a 0.35 decrease of ABI (p 0.001). Patients with IC had SFA IMT 0.28mm greater than those without IC (p 0.001); patients with IC Fontaine stage IIB had an SFA IMT 0.27mm greater than those without IC (p 0.001). The greater the number of CRF, the thicker the SFA IMT; patients with 4 CRF had an SFA IMT 0.2mm higher than those with 1 CRF (p=0.002). 6-Conclusions: Pre-Hunter intima-media thickness of the superficial femoral artery is a reliable marker for peripheral arterial disease. 1- Intima-media thickness correlates inversely with ankle-brachial index 2- Patients with intermittent claudication have a greater intima-media thickness than patients without intermittent claudication. 3- The greater the intima-media thickness, the more advanced the grade of intermittent claudication (Fontaine classification). 4- The greater the number of cardiovascular risk factors, the higher the intima-media thickness. |
|---|