Značenje ultrazvučnih pokazatelja krutosti i debljine arterijske stijenke u perifernoj arterijskoj bolesti [The importance of arterial stiffness and intima-media thickness measured by ultrasound in peripheral arterial disease]

Vrkić Kirhmajer, Majda (2016) Značenje ultrazvučnih pokazatelja krutosti i debljine arterijske stijenke u perifernoj arterijskoj bolesti [The importance of arterial stiffness and intima-media thickness measured by ultrasound in peripheral arterial disease]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Peripheral artery disease (PAD) is a marker of advanced atherosclerosis, with high cardiovascular burden and mortality. The majority of PAD patients also have coronary and cerebrovascular disease, which is the main reason of poor prognosis. PAD detection and treatment are lower than other forms of atherosclerotic disease. The aim of this study is to investigate the predictive value of vascular biomarkers for poly-vascular disease in population with lower extremity arterial disease. A total of 160 subjects were enrolled in the study, 40 controls without significant atherosclerotic disease, and 120 patients with PAD (40 with isolated lower extremity artery disease and 80 with poly-vascular disease). PAD was defined as ankle - brachial index of ≤ 0,9. Intima - media thickness (IMT) and arterial stiffness of the common carotid artery were determined by high-resolution ultrasonography and Echo-tracking technology. We found that value of carotid IMT > 0,91 mm is strong predictor of poly-vascular disease in patients with lower extremity arterial disease (OR=10,38; 95%CI: 3,68 -29,3; p < 0,001). The stiffness parameter ß index, PWV-ß and Ep, were significantly higher in poly-vascular disease than in isolated lower extremity arterial disease, but when adjusted for cIMT, the significance was lost. Augmentation index (AI) and arterial compliance (AC) did not significantly differ between groups. There were no significant association between symptoms of PAB and all investigated vascular biomarker. Investigated vascular biomarkers, particularly cIMT, could provide more accurate individual risk stratification and treatment of patient with peripheral artery disease. Key words: peripheral artery disease, poly-vascular disease, intima media thickness, arterial stiffness

Abstract in Croatian

Periferna arterijska bolest donjih ekstremiteta je pokazatelj generalizirane ateroskleroze, povećanog kardiovaskularnog i ukupnog mortaliteta. Veći dio bolesnika koji se prezentiraju simptomima PAB-a ima pridruženu koronarnu ili karotidnu bolest što je glavni razlog loše prognoze. Cilj ovog istraživanja je ispitati vrijednost vaskularnih biomarkera u predikciji polivaskularne bolesti u oboljelih od PAB. Ispitivanje je uključivalo 160 ispitanika, 40 ispitanika bez signifikantne aterosklerotske bolesti i 120 ispitanika s perifernom arterijskom bolesti, od kojih je 80 imalo polivaskularnu bolest. Dijagnoza periferne arterijske bolest je postavljena pomoću pedobrahijalnog indeksa. Svim bolesnicima je na zajedničkoj karotidnoj arteriji napravljeno ultrazvučno mjerenje debljine intima-medija, te određeno pet parametra arterijske krutosti (ß indeks, PWV-ß, Ep, AC i AI) pomoću aparata Aloka alpha -10. Glavni rezultat ovog istraživanja izdvaja cIMT > 0,91 mm kao najznačajnijeg prediktora polivaskularne bolesti u populaciji bolesnika s PAB-om (OR=10,38; 95%CI: 3,68 -29,3; p < 0,001). Od pet parametara arterijske krutosti signifikantne razlike između izolirane PAB i polivaskularne bolesti pokazuju ß indeks, PWV-ß i Ep, no u kombinaciji s cIMT gube značajnost u predikciji polivaskularne bolesti. Augmentacijski indeks (AI) i arterijska popustljivost (AC) u ovom se istraživanju nisu značajno razlikovale među ispitivanim skupinama. Također, vrijednosti karotidnog IMT i parametara krutosti ne razlikuju se značajno između simptomatske i asimptomatske PAB. Vaskularni biomarkeri mogli bi doprinijeti boljoj spoznaji individualnog kardiovaskularnog rizika i liječenju oboljelih od periferne arterijske bolesti.

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