Vascular Medicine最新文献

Introduction: Vascular contributions to cognitive impairment and dementia are potentially modifiable. Early detection of reversible arterial injury may improve risk stratification and provide treatment monitoring. We hypothesized that carotid ultrasound grayscale median (GSM), a novel imaging biomarker of early arterial injury, would predict incident all-cause dementia in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: The MESA enrolled adults free of atherosclerotic cardiovascular disease. Common carotid GSM was measured at baseline. Incident all-cause dementia events were identified by hospital and death records. Cox proportional hazards models with natural cubic splines investigated the association of baseline GSM and all-cause dementia.

Results: The 1788 participants were a mean (SD) 63.1 (10.3) years old and 53% were women. Over a median 13.7 years, 157 all-cause dementia events occurred. In fully adjusted models, with additional adjustment for carotid intima-media thickness, lower (worse) GSM independently predicted incident all-cause dementia (hazard ratio, 1st to 3rd tertile, 1.45 [95% CI, 1.11-1.90], p = 0.021).

Conclusions: Lower GSM independently predicts all-cause dementia, beyond traditional arterial injury measures, suggesting it may serve as an early marker of dementia risk.

Background: In patients with chronic limb-threatening ischemia (CLTI), a subset of patients are beneficiaries of welfare assistance. We sought to investigate the clinical features and prognosis of patients with CLTI receiving welfare compared to those not receiving welfare in the Japanese population.

Methods: This is a subanalysis of the multicenter, prospective Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchemia (WARRIORS) registry. We evaluated 440 patients with CLTI accompanied by tissue loss undergoing infrapopliteal revascularization. The outcome measures included a 24-month wound-healing rate, and overall survival and follow-up continuity. We compared the outcomes between the welfare and nonwelfare groups (n = 48 and 392, respectively) using the Kaplan-Meier method and log-rank tests.

Results: Frequencies of nonambulatory status, diabetes mellitus, hemodialysis, and wound severity stratified by Wound, Ischemia, and foot Infection classification showed no significant inter-group differences. The number of patients treated with bypass surgery was lower in the welfare group than in the nonwelfare group. The 24-month wound healing and follow-up continuity rates were significantly lower in the welfare group compared to the nonwelfare group (37.3% vs 59.6%, p = 0.005 and 47.9% vs 58.0%, p = 0.048, respectively). In contrast, the 24-month overall survival rate did not differ significantly between the groups (63.1% vs 71.7%, p = 0.27).

Conclusions: Patients receiving welfare had significantly worse wound-healing rates and a higher loss to follow up even within the framework of the Japanese universal health insurance system.

Introduction: Chronic venous disease (CVD) is highly prevalent, imposing a significant burden on patients. Treatment options include surgical and nonsurgical modalities. Neuromuscular electrical stimulation (NMES) is an alternative that artificially activates the calf muscle pump, improving blood flow parameters. This systematic review evaluates its effectiveness in relieving CVD symptoms.

Methods: PubMed, Web of Science, and Scopus were sought for experimental and observational studies published between 2000 and March 2025. Included studies assessed NMES for CVD symptoms. Exclusion criteria were electrode application directly to or around ulcers and sample sizes under 10 patients. The primary objective included peripheral edema, quality of life, venous leg ulcer healing, and leg pain. Adverse effects were the secondary outcome. Risk of bias was evaluated using appropriate tools.

Results: Out of 269 records gathered, eight were included (three randomized controlled trials, one nonrandomized controlled trial, and four case series), totaling 311 patients, 214 of whom used NMES. The mean age was 56.7 years (95% CI: 48.0-65.4 years) and 49.9% (95% CI 40.5-59.2%) were women. Devices used were Geko and Veinoplus (three studies each) and Revitive IX (two studies). Six studies evaluated edema, with a decrease in NMES groups in four. Quality of life was evaluated in five studies; pain and ulcer healing were appraised in three each, all showing improvement. Reported adverse effects included mild skin irritation and rash.

Conclusion: NMES shows promising results across all outcomes studied. However, studies may suffer from publication or selection bias, imperfect designs, and other individual factors. (PROSPERO registration No.: CRD42023401762).

Background: Pseudoxanthoma elasticum (PXE) is a rare disease caused by pathogenic ABCC6 variants, leading to arterial calcifications and increased cardiovascular risk. Validated intermediate endpoints are needed to evaluate cardiovascular risk-reducing therapies in PXE. This prospective cohort study investigates the relationship between arterial stiffness and cardiovascular events in patients with PXE. Methods: This prospective cohort study obtained patients from the Dutch University Medical Center Utrecht Expertise Center for PXE. Arterial stiffness was measured with carotid-femoral pulse wave velocity (cfPWV) and the augmentation index (AIx). Cardiovascular endpoints were cardiovascular death, cerebrovascular and coronary events, and peripheral artery interventions. Cox proportional hazard models analyzed associations between arterial stiffness and cardiovascular events, adjusting for confounders. Results: Among 390 patients (mean age 51 ± 15 years, 60% women), 45 cardiovascular events occurred during a median follow up of 6.1 years (IQR 3.2; 9.2). A 1-m/s higher cfPWV was related to an increased risk of cardiovascular events (hazard ratio [HR]: 1.28; 95% CI 1.06-1.53). The effect of cfPWV depends on age (p-value = 0.03), with a lower cardiovascular risk HR at older age (HR age at 40 years: 1.51; 95% CI 1.11-1.97 to HR age at 60 years: 1.12; 95% CI 1.00-1.26). A 10% higher AIx at baseline was related to future cardiovascular events (HR 1.46; 95% CI 1.10-1.95). No significant interaction between the AIx and age was found. Conclusion: This prospective cohort study shows that arterial stiffness, measured by cfPWV and AIx, is independently associated with increased cardiovascular risk in PXE. Measures of arterial stiffness could be explored as intermediate endpoints in trials evaluating cardiovascular risk-reducing therapies in PXE.

Background: Peripheral artery disease (PAD) is a global health challenge. Advances in artificial intelligence (AI), such as large language models (LLMs) and chain-of-thought (CoT) reasoning, offer novel approaches for clinical recommendations. This study compared the readability and guideline adherence of responses from physicians and AI for a standardized PAD case.

Methods: This cross-sectional study gathered responses from 30 specialized physicians (11 cardiologists, 19 vascular surgeons) across seven Latin American countries and 13 LLM systems (10 standard, three CoT). Both groups addressed diagnosis, treatment, risks, and prognosis; LLMs responded as vascular specialists. Responses were blindly evaluated with five validated Spanish readability indices and compared to the 2024 ACC/AHA multisocietal PAD guideline. Three experts scored guideline adherence; nonparametric tests were applied.

Results: Guideline adherence did not differ significantly between physicians (median 5.8 [3.4-7.6]) and LLMs (7.3 [4.7-9.7], p = 0.169), though CoT-LLMs achieved the highest scores (9.7 [8.5-11.0]). LLMs more often recommended supervised exercise (84.6% vs 30.0%, p = 0.002) and revascularization for quality of life (69.2% vs 20.0%, p = 0.004), whereas physicians favored cilostazol (60.0% vs 30.8%, p = 0.104). LLM responses had lower Readability μ values (46.9 vs 51.4, p = 0.012). Inter-rater reliability was highest for CoT-LLMs (intraclass correlation coefficient [ICC] = 0.98) versus physicians (ICC = 0.76).

Conclusion: LLM showed comparable guideline adherence to physicians although CoT models achieved the highest scores. The difference in physician and AI treatment preferences suggest the potential of AI as adjunct clinical tools and warrants further study.