Peripheral Arterial Disease in Patients with Atrial Fibrillation
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 14, Issue 1
Abstract
Peripheral Arterial Disease (PAD) is defined as a systemic atherosclerotic disease, which occurs due to narrowing and obstruction of major systemic arteries other than coronary arteries and aorta. It affects 200 million individuals worldwide and is independent risk factor for total mortality and incident cardiovascular or cerebrovascular events [1]. Da-ta of Rotterdam study present that only 10% of 55-59 years old participants had PAD and 60% subjects in age group >85 years was diagnosed with this condition. According to the National Health and Nutrition Examination Survey 1999-2000 major risk factors for PAD include arterial hypertension, diabetes, hypercholesterolemia, smoking, obesity. Over 95% of patients with peripheral arterial disease has one of these risk factors and over 70% has two major risk factors. Some studies suggest that chronic renal failure may influence manifestation of PAD. Collaborative meta-analysis of international cohorts made by Matsushita et al. showed that even mild-tomoderate chronic kidney disease increases risk of incident peripheral artery disease [2]. Increased inflammatory markers such as C-Reactive Protein (CRP) have an impact on PAD. CRP demonstrated a statistically significant correlation of risk for PAD compared with patients without PAD [3-5]. Classical clinical manifestation of low extremities PAD include aching pain especially in the calves which occurs during activity and reliefs by rest (intermittent claudication), poikilothermic (cold sensation), pallor of the limb and ulceration. Most of the cases patients are associating these signs with other earlier diagnosed disease such as diabetes, arthritis, etc. In the PIPETTE study 33% of participants with severe symptoms of intermittent claudication that warranted subsequent endovascular intervention had not previously presented to their general practice [3]. Up to 50% of patients with PAD has no symptoms and this group is most under-recognised and under-treated. This is one of the reasons why PAD is diagnosed in severe stages with high mortality risk. Early diagnosis of PAD is important to prevent cardiovascular complications. Ac-cording to NHANES mortality from cardiovascular events among patients diagnosed with PAD was 29.2% [4]. Simple, non-invasive, fast and cheap tool to diagnose this condition is the Ankle-Brachial Index (ABI). The measurement of blood pressure at the ankle was proposed as a test for PAD as early as 1950 and led to the development of the Ankle-Brachial Index (ABI) [1]. ABI is defined as the ratio between systolic blood pressure at the ankle and in the arm. Measurements may be obtained using Doppler ultrasound or oscillometric sphygmomanometry. An ABI of < 0.9 is considered as abnormal and is associated with symptomatic and asymptomatic forms of PAD and higher risk of cardiovascular events. According to 2017 ECS guidelines on the diagnosis and treatment of peripheral arterial disease an ABI < 0.90 is associated with 2- to 3-fold increased risk of total and cardiovascular death. American Heart Association recommends determining anklebrachial index in the following cases: adults ≥65 years old, adults ≥50 years old with a history of smoking or diabetes, and adults of any age with exertional leg symptoms or non-healing wounds. European Society of Cardiology suggests considering screening with ABI in patients with Coronary Artery Disease (CAD). ARTPER cohort study showed that at 9 years 20% of patients with low ABI had ma-jor cardiovascular events such as myocardial infarction, ischaemic stroke and vascular mortality. Patients with borderline ABI (0.90-0.99) should be considered also as a high-risk group and further diagnostic tests should be made [6]. The Multi- Ethnic Study of Atherosclerosis (6570 participants) identified that patient with PAD and low ABI (< 0.90) had twice risk for the development of atrial fibrillation or stroke [7]. Peripheral arterial disease is common in patients with Atrial Fibrillation (AF), but the association between these two conditions are not completely understood. Both diseases share risk factors such as diabetes, arterial hypertension, hypercholesterolemia and are associated with increased levels of inflammation and platelet-mediated thrombosis [7].
Authors and Affiliations
Zinkienė D, Mašanauskienė E, Naudžiūnas A, Sadauskas S
Keywords
Related Articles
- EP ID EP594303
- DOI 10.26717/BJSTR.2019.14.002491
- Views 177
- Downloads 0
Expressions of Growth Factors in Autologous Derived Platelet-Rich Plasma and Platelet-Poor Plasma; Implication for Tissue Reparation and Wound Healing
Objectives: The growth factors (GFs) released from platelet-rich plasma (PRP) is proposed to modulate vascular reactivity and the inflammatory process. other GFs implicated in the wound healing cascade includes Platelet...
Isolated Pancreatic Islets: Features of Technology of Fixation and Embedding of Islets and of Insulin Staining in B-Cells
For investigations of effects of various chemicals or drugs on pancreatic β-cells it is preferably to use the tissue culture method of isolated pancreatic islets (PI) which possess two important advantages in compared wi...
Numerical Simulation in Electrocardiology Using an Explicit Generalized Finite Difference Method
In this paper we present a fast, accurate and conditionally stable algorithm to solve a monodomain model in 2D, which describes the electrical activity in the heart. The model consists of a parabolic anisotropic Partial...
Evodiamine Induces Extrinsic Apoptosis Through P38 Mapk Pathway and Inhibits Autophagy in Gallbladder Cancer
The gallbladder cancer is the most common malignant tumor of the biliary tract and the third most common gastrointestinal malignant tumor in the world for public health with extremely poor prognosis. The primary purpose...
Meridian on Medical Duality of Particle and Wave
What is Life? Erwin Schrodinger Whispered.Nine years later, the DNA had been discovered from the concept of aperiodic crystal. What is light?: Let there be light, the first day, God said. (Genesis in the Bible). Let the...