16
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Exercise transcutaneous oxygen pressure measurement has good sensitivity and specificity to detect lower extremity arterial stenosis assessed by computed tomography angiography

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Peripheral artery disease (PAD) is a highly prevalent disease diagnosed by the use of ankle-brachial index (ABI) at rest. In some clinical conditions (diabetes, renal insufficiency, advanced age), ABI can be falsely normal and other tests are required for the PAD diagnosis (American Heart Association statement). This study was conducted to determine the accuracy of exercise transcutaneous oxygen pressure measurement (exercise-TcPo2) in detection of arterial stenosis ≥50% using computed tomography angiography (CTA) as the gold standard.

          We retrospectively analyzed consecutive patients referred to our vascular unit (University Hospital, Rennes, France) for exercise-TcPo2 testing from 2014 to 2015. All included patients had a CTA performed within 3 months of the exercise-TcPo2 test. Exercise-TcPo2 was performed on treadmill (10% slope; 2 mph speed). We calculated the Delta from Resting Oxygen Pressure (DROP) index (expressed in mm Hg) at the proximal and distal levels. Two blinded physicians performed stenosis quantification on CTA. The receiver operating characteristic (ROC) curve was used to define a cutoff point to detect arterial stenosis ≥50%, stenosis ≥60%, and stenosis ≥70%.

          A total of 34 patients (mean age 64 ± 2 years old; 74% men) were analyzed. The highest areas under the curve (AUC) were found for 60% stenosis at both proximal and distal levels. For stenosis ≥50%, sensitivity and specificity of proximal minimal DROP were 80.9% [67.1–89.7], 81.0% [59.3–92.7] respectively. For stenosis ≥50%, sensitivity and specificity of distal minimal DROP were 73.2% [60.3–83.1], 83.3% [53.8–96.2], respectively. For stenosis ≥60%, sensitivity and specificity of proximal minimal DROP were 82.5% [67.6–91.5] and 85.7% [67.7–94.8] respectively. For stenosis ≥60%, sensitivity and specificity of distal minimal DROP were 80.4% [67.3–89.1] and 88.2% [64.2–97.7], respectively. For stenosis ≥70%, sensitivity and specificity of proximal minimal DROP were 85.7% [67.7–94.8] and 75.0% [59.6–85.9] respectively. For stenosis ≥70%, sensitivity and specificity of distal minimal DROP were 86.0% [72.2–93.7] and 76.0% [56.1–88.7], respectively.

          Exercise-TcPo2 using a proximal minimal DROP value ≤−15 mm Hg or a distal minimal DROP value ≤−16 mm Hg is accurate to diagnose arterial stenosis especially stenosis ≥60% on the lower limbs. Exercise-TcPo2 is safe and noninvasive test that might be used in second line for PAD diagnosis.

          Related collections

          Most cited references17

          • Record: found
          • Abstract: found
          • Article: not found

          The meaning and use of the area under a receiver operating characteristic (ROC) curve.

          A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic. These two relationships are exploited to (a) provide rapid closed-form expressions for the approximate magnitude of the sampling variability, i.e., standard error that one uses to accompany the area under a smoothed ROC curve, (b) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area, and (c) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: comparison with arteriography.

              We sought to identify whether transcutaneous oxygen tension (tcPo2) measurements could be used to noninvasively detect lesions in the arterial network supplying blood flow to the hypogastric circulation. A study was undertaken in vascular patients with suspected (PC, n=43) and not with suspected (NPC, n=34) proximal ischemia. TcPo2 was measured on both buttocks and with a chest reference electrode. Arteriography on the right or left side was positive for stenoses (> or =75%) or occlusion of one or more of the following arteries: the aorta, the common iliac arteries, or the internal iliac arteries. The arteriography was compared with the resting tcPo2 values (REST) and with the minimal value (MIN) and maximal change from rest normalized to eventual chest changes (DROP) recorded during or after a treadmill test. REST, MIN, and DROP were, respectively, as follows in positive versus negative arteriograms (mean+/-SD; in mm Hg): 80.2+/-10.9 versus 78.6+/-11.5 (P>0.05), 55.2+/-20.0 versus 69.9+/-15.8 (P 0.05), 64.4+/-21.0 versus 75.1+/-14.6 (P<0.02), and -24.1+/-13.5 versus -8.7+/-4.8 (P<0.0001) in NPC. In PC and NPC respectively, with a cutoff point of -16 and -15 mm Hg, DROP showed, respectively, 83%/82% and 79%/86% sensitivity/specificity in the diagnosis of positive arteriograms. Proximal ischemia is a frequent finding in vascular patients. TcPo2 measurement on the buttocks during exercise is a sensitive and specific indicator for lesions in the arterial tree toward the hypogastric circulation. Potentially it could objectively assess the response to endovascular or surgical approaches to iliac lesions.
                Bookmark

                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                September 2016
                09 September 2016
                : 95
                : 36
                : e4522
                Affiliations
                [a ]CHU Rennes, Imagerie Cœur-Vaisseaux
                [b ]INSERM, Centre d’investigation clinique 1414
                [c ]Movement, Sport and Health Laboratory, EA 1274, UFR APS, University of Rennes, Rennes
                [d ]Department of Sport Sciences and Physical Education, ENS Rennes, Bruz
                [e ]Université de Rennes 1, Rennes, France.
                Author notes
                []Correspondence: Guillaume Mahe, Pôle Imagerie Médicale et Explorations Fonctionnelles, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes, F-35033, France (e-mail: maheguillaume@ 123456yahoo.fr ).
                Article
                04522
                10.1097/MD.0000000000004522
                5023864
                27603342
                a94d71b8-35b4-4f0b-acf3-1e43d03cbd5f
                Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 2 March 2016
                : 14 July 2016
                : 14 July 2016
                Categories
                3400
                Research Article
                Diagnostic Accuracy Study
                Custom metadata
                TRUE

                exercise,methods,oxymeter,pad,peripheral artery disease,vascular medicine

                Comments

                Comment on this article