Vascular Medicine最新文献

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.

This systematic review aimed to describe the association between peripheral artery disease (PAD) and cognitive impairment or dementia. We included studies reporting on the association between PAD (defined by ankle-brachial index ⩽ 0.9) and cognitive function in adult populations. MEDLINE, Embase, CINAHL, PsycINFO, and CENTRAL were systematically searched from inception to January 2025. Study quality was assessed using the Risk of Bias In Nonrandomized Studies of Exposure effects (ROBINS-E) tool. A narrative synthesis was undertaken structured by cognitive outcome and study design. Thirty-eight studies were included in the review (58,586 participants). The results provide evidence that PAD is associated with cognitive impairment. Seventeen (81%) cross-sectional studies and four (67%) longitudinal studies reported associations of PAD with poorer cognitive performance or increased risk of cognitive impairment. Impaired memory and processing speed were most frequently associated with PAD. PAD was also associated with increased dementia risk in cross-sectional (odds ratios = 1.50-2.41) and longitudinal studies (hazard ratios = 1.03-2.40), although proportionally fewer longitudinal studies reported significant association of PAD with dementia. Results suggest increased prevalence of cognitive impairment, independent of cardiovascular risk factors and cerebrovascular disease. Awareness of the prevalence of cognitive impairment and its potential impact on treatment adherence and engagement in a healthy lifestyle is important for clinicians treating patients with PAD. Screening for cognitive impairment in those with PAD may aid early diagnosis and management of cognitive impairment in this high-risk population. Further research is required to determine whether screening for and optimal management of PAD has cognitive benefits. (PROSPERO Registration No.: CRD42023399608).

Introduction: Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO₂) that has been validated with a constant-load treadmill protocol, is useful to assess patients with suspected lower-extremity peripheral artery disease (PAD). To date, nothing is known about its use with a graded protocol. The aim of this study is to compare the Exercise-TcPO₂ results obtained in patients with suspected PAD using a graded Gardner-Skinner (3.2 km/h, 2% grade increase every 2 min) versus a constant modified Strandness (3.2 km/h, 10% grade) treadmill test.

Methods: Patients with suspected PAD were assessed twice on the same day on a treadmill using the modified Strandness (Strand) followed by the Gardner-Skinner (Gard) tests. In both tests, the decrease from resting oxygen pressure (DROP) indexes were measured at the buttock and calf levels as previously validated. A DROP_Strand index ⩽ -15 mmHg was considered positive for the diagnosis of PAD. The relationship between DROP_Gard and DROP_Strand as well as DROP value differences between the two tests and concordances were studied.

Results: This prospective study included 40 patients. Using a linear mixed model, the relationship between DROP_Gard and DROP_Strand was defined as DROP_Gard = 0.647 × DROP_Strand - 1.858. The mean difference between DROP_Gard and DROP_Strand was -4.3 ± 7.3 mmHg. Positive and negative agreements were 78.0% and 86.3%, respectively. The kappa coefficient between DROP_Gard and DROP_Strand was 0.65 [0.54; 0.77].

Conclusion: Exercise-TcPO₂ results using the Gardner-Skinner and modified Strandness treadmill tests were highly correlated. This study suggests the use of a DROP_Gard value ⩽ -12 mmHg to diagnose PAD when performing Exercise-TcPO₂ with a Gardner-Skinner test. However, this cut-off value should be confirmed against an imaging gold standard. ClinicalTrials.gov identifier: NCT03186391.