A Toe Flexion NIRS assisted Test for Rapid Assessment of Foot Perfusion in Peripheral Arterial Disease: Feasibility, Validity, and Diagnostic Accuracy

Autor: T Rossi, Francesco Mascoli, Fabio Manfredini, Paolo Zamboni, Nino Basaglia, Nicola Lamberti
Rok vydání: 2017
Předmět:
Male
Flexion Test
030204 cardiovascular system & hematology
Hemoglobins
0302 clinical medicine
Prospective Studies
030212 general & internal medicine
Ultrasonography
Doppler
Color
Aged
80 and over
Spectroscopy
Near-Infrared
Near-Infrared Spectroscopy
Area under the curve
Middle Aged
Exercise Test
Peripheral Arterial Disease
Near-Infrared Spectroscopy
Diabetic Foot
Sensitivity and Specificity
Diabetic Foot
Peripheral
medicine.anatomical_structure
Area Under Curve
Ambulatory
Cardiology
Female
Cardiology and Cardiovascular Medicine
Perfusion
Blood Flow Velocity
Adult
medicine.medical_specialty
Adolescent
Sensitivity and Specificity
NO
Young Adult
Peripheral Arterial Disease
03 medical and health sciences
Predictive Value of Tests
Internal medicine
medicine
Humans
Ankle Brachial Index
Aged
business.industry
Microcirculation
Hemodynamics
Reproducibility of Results
Toes
medicine.disease
Diabetic foot
Surgery
body regions
Blood pressure
ROC Curve
Regional Blood Flow
Case-Control Studies
Oxyhemoglobins
Exercise Test
Feasibility Studies
Ankle
business
Biomarkers
Zdroj: European Journal of Vascular and Endovascular Surgery. 54:187-194
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2017.04.013
Popis: Feasibility, validity, and diagnostic accuracy of a non-invasive dynamic ambulatory test were assessed with near infrared spectroscopy (NIRS) evaluating foot perfusion in peripheral arterial disease (PAD).This was a prospective observational study. Eighty PAD patients (63 males, 71 ± 9 years), including 41 patients with coexisting diabetes, participated. Thirteen healthy subjects (8 males, 26 ± 8 years) were also studied by echo colour Doppler providing 160 diseased and 26 non-diseased limbs. Under identical clinostatic conditions, participants performed a 10-repetition toe flexion tests with NIRS probes on the dorsum of each foot; the area under the curve of the oxygenated haemoglobin trace ("toflex area") was calculated and the ankle-brachial index (ABI) was measured. Time of execution, rate of wrong tests, and adverse reactions were recorded. Within session reliability was assessed by administering the test twice, with a 5 minute interval between tests. The validity was assessed determining whether the toflex area was (a) dependent on the oxygen delivery from the lower limb arteries simulating PAD conditions by a progressive blood flow restriction (40-120% of systolic pressure) in healthy subjects; (b) consistent with the degree of PAD ranked by ABI and correlated with ABI and ankle pressure values in PAD patients. The diagnostic accuracy in detecting PAD was compared with examination using echo colour Doppler ultrasound.All tests were rapidly, satisfactorily (1% mistakes), and safely performed. Toflex area values, superimposable in the two sessions (intra-class correlation coefficient 0.92), were comparable to PAD values following blood flow restriction, consistent with PAD severity, correlated with dorsal pedis artery pressure (r = .21; p = .007) and ABI (r = .65; p .001) in PAD, but not in the presence of diabetes. Toflex area was similar to echo colour Doppler for detecting PAD following receiver operating characteristic curve analysis (area = 0.987, p .001; toflex area values ≤ -28 arbitrary units, sensitivity/specificity 95.6/100).The toe flexion test enables ambulatory assessment of foot perfusion and PAD detection, even in the presence of non-measurable ABI or diseases affecting the microcirculation.
Databáze: OpenAIRE
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