| Publicación: |
[Barcelona] : Universitat Autònoma de Barcelona, 2016 |
| Descripción: |
1 recurs electrònic (271 p.) |
| Resumen: |
1-Introduction: Intima-media thickness of the carotid artery, measured with doppler ultrasound is considered an early marker for cardiovascular diseases121. Peripheral arterial disease (PAD) is a highly prevalent and costly health condition1-3. The ankle-brachial index (ABI) is currently defined as the "gold-standard" for the diagnosis of PAD, as it is closely related with cardiovascular events and their prognosis132. Doppler ultrasound exploration of the superficial femoral artery is fast, painless, cost-effective and reproducible and provides additional information to ABI. 2-Hypothesis: Pre-Hunter intima-media thickness of the superficial femoral artery (SFA IMT) may be a marker for peripheral arterial disease. 3-Objetive: Assess the usefulness of pre-Hunter SFA IMT in the diagnosis and/or prognosis of PAD, comparing the relation of IMT with: - ABI. - Fontaine stages of intermittent claudication (IC). - Number of cardiovascular risk factors (CRF). 4-Material and Methods The study was assessed and approved by the Ethics Committee and written informed consent of all patients was obtained. Design: a transversal study performed in 2011, with follow-up in 2015. 167 patients were included between January-September 2011. Inclusion criteria: age ≥ 50 years, ≥1 CRF (diabetes mellitus, hypertension, dyslipaemia, smoking). Exclusion criteria: PAD Fontaine stage III or IV. Collected data: - First visit 2011: blood test (leukocytes, monocytes, total cholesterol, LDL-C , HDL-C, triglycerides, glycaemia, glycosylated haemoglobin), ABI, SFA IMT by doppler ultrasound in millimetres, CRF and cardiovascular events, body mass index and waist circumference. - Second visit 2015: SFA IMT by doppler ultrasound in millimetres, ABI, new cardiovascular events, body mass index and waist circumference. Statistical Analysis: - Descriptive: quantitative variables (median; standard deviation); qualitative variables (absolute and relative frequencies). - Analytical: multilevel models. Data analysis: R Core Team (2015) statistical package. Graphs: quantitative variables (Scatter plots); qualitative variables (Box plots) Statistical level: 0. 05. 5-Results: - 2011 visit: 167 patients, 52% women and 48% men, mean age 69 years. - 2015 control visit: 145 patients, 3 died and 19 were lost to follow-up. - Descriptive analysis: 31. 7% of patients had IC of the right leg and 28% of the left; 35% had 2 CRF; arterial hypertension was the most common CRF (73%); 10% had a history of acute myocardial infarction and 8. 39% cerebral ischemic events. - Comparative analysis: a 1mm increase of IMT SFA correlated with a 0. 35 decrease of ABI (p 0. 001). Patients with IC had SFA IMT 0. 28mm greater than those without IC (p 0. 001); patients with IC Fontaine stage IIB had an SFA IMT 0. 27mm greater than those without IC (p 0. 001). The greater the number of CRF, the thicker the SFA IMT; patients with 4 CRF had an SFA IMT 0. 2mm higher than those with 1 CRF (p=0. 002). 6-Conclusions: Pre-Hunter intima-media thickness of the superficial femoral artery is a reliable marker for peripheral arterial disease. 1- Intima-media thickness correlates inversely with ankle-brachial index 2- Patients with intermittent claudication have a greater intima-media thickness than patients without intermittent claudication. 3- The greater the intima-media thickness, the more advanced the grade of intermittent claudication (Fontaine classification). 4- The greater the number of cardiovascular risk factors, the higher the intima-media thickness. |
| Nota: |
Tesi doctoral - Universitat Autònoma de Barcelona. Departament de Cirurgia, 2016 o = 50ª, 1 o más factores de riesgo cardiovascular ( diabetes mellitus, hipertensión, dislipemia, tabaco). Criterios de exclusión: enfermedad arterial periférica grado Fontaine-III o IV. Se registraron: -Visita 1_2011: analítica sangre(leucocitos_monocitos, colesterol total,LDL_col, HDL_col, triglicéridos, glicemia, hemoglobina glicosilada), índice tobillo-brazo, grosor íntima-media arteria femoral superficial medida por eco-doppler en milímetros, factores de riesgo y eventos cardiovasculares, índice de masa corporal y perímetro cintura. -Visita 2_2015: grosor íntima-media arteria femoral superficial medida por eco-doppler en milímetros, índice tobillo-brazo, nuevos eventos cardiovasculares, índice de masa corporal y perímetro cintura. Análisis Estadístico: -Descriptivo: variables cuantitativas (media;desviación estándar); variables cualitativas(frecuencias absolutas y relativas). -Analítico: modelos multinivel. Análisis de los datos: paquete estadístico R Core Team (2015). Gráficos: variables cuantitativas ( Scatter plots ); variables cualitativas (Box pots). Nivel de significación: 0.05. 5-Resultados: -Visita 2011: 167paciente, 52% mujeres y 48% hombres. Edad media de 69años. -Control 2015 :145 pacientes, 3 fueron éxitos y 19 fueron pérdidas. -Análisis descriptivo: 31,7% con claudicación intermitente (CI) de la extremidad inferior derecha y un 28% de la izquierda. El número de factores de riesgo(NºFRCV) más predominante fueron 2(35,3%);la hipertensión arterial fue el factor de riesgo más común(73%).Un 10% presentaban antecedentes de infarto agudo de miocardio y 8,39% de accidente isquémico cerebral. -Análisis analítico: Por cada 1milímetro que el GIM AFS aumentaba, el ITB disminuïa 0,35(p 0,001).Pacientes con una CI presentaban un GIM AFS 0,28mm mayor que los que no presentaban CI (p 0,001); pacientes con CI grado Fontaine IIB presentaban un GIM AFS 0,27mm mayor que pacientes sin CI(p 0,001). A mayor NºFRCV, mayor GIM AFS, pacientes con NºFRCV=4 presentaban un GIM AFS 0,2mm mayor que los pacientes con NºFRCV=1(p=0,002). 6-Conclusiones: El grosor íntima-media de la arteria femoral superficial pre-Hunter puede considerarse un marcador de la enfermedad arterial periférica porque: 1-A mayor grosor íntima-media, menor índice tobillo-brazo. 2-Existe un mayor grosor íntima-media en pacientes con claudicación intermitente respecto a los pacientes sin claudicación intermitente. 3-A mayor grosor íntima-media, se observa un grado más avanzado de la claudicación intermitente ( clasificación Fontaine). 4-A mayor número de factores de riesgo cardiovascular, mayor grosor íntima-media |
| Derechos: |
L'accés als continguts d'aquesta tesi queda condicionat a l'acceptació de les condicions d'ús establertes per la següent llicència Creative Commons  |
| Lengua: |
Castellà |
| Documento: |
Tesi doctoral ; Versió publicada |
| Materia: |
Arteriosclerosi ;
Sistema cardiovascular ;
Malalties |
| ISBN: |
9788449061875 |
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