Reliability of the vascular claudication reporting in diabetic patients with peripheral arterial disease: a study with near-infrared spectroscopy.
We evaluated whether altered reporting of ischemic symptoms occurs in diabetic patients with peripheral arterial disease (PAD) and stable claudication. Patients (n = 152) with claudication were enrolled (120 males; mean age: 71.0 ± 8.6 years): 74 with diabetes (DM-PAD) and 78 without (DMfree-PAD). The degree of muscle oxygenation at symptom onset and maximal speed (Smax) during an incremental treadmill test was recorded at the gastrocnemius by near-infrared spectroscopy (NIRS) and quantified by area under the curve of oxygenated hemoglobin (AUC-Hbo 2) and area under the curve of differential hemoglobin (AUC-dHb). The DM-PAD and DMfree-PAD showed similar exercise capacities inversely correlated with the degree of muscle oxygenation but significantly lower values of AUC-Hbo 2 and AUC-dHb for DM-PAD at symptom onset and Smax (-356 vs -122 and -1200 vs -359, P < .0001). During a NIRS-assisted test, the report of claudication in the presence of diabetes was delayed, occurring at a lower degree of oxygenation than in patients with PAD only, with potential implications for testing, functional staging, and balance disorders.
Vascular Diseases Center, University of Ferrara, Italy Department of Rehabilitation Medicine, S. Anna Hospital University, Ferrara, Italy.
Fabio
F
Manfredini
Vascular Diseases Center, University of Ferrara, Italy.
Nicola
N
Lamberti
Vascular Diseases Center, University of Ferrara, Italy Program Pathophysiology of Vascular Peripheral System and Day Surgery, S. Anna Hospital University, Ferrara, Italy mlgnmr@unife.it.
Anna Maria
AM
Malagoni
Vascular Diseases Center, University of Ferrara, Italy.
Christel
C
Zambon
Department of Rehabilitation Medicine, S. Anna Hospital University, Ferrara, Italy.
Nino
N
Basaglia
Vascular Diseases Center, University of Ferrara, Italy.
Francesco
F
Mascoli
Vascular Diseases Center, University of Ferrara, Italy Department of Medical Sciences, Clinica Medica, University of Ferrara, Italy.
Roberto
R
Manfredini
Vascular Diseases Center, University of Ferrara, Italy Program Pathophysiology of Vascular Peripheral System and Day Surgery, S. Anna Hospital University, Ferrara, Italy.
Paolo
P
Zamboni
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005080:Exercise Test; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000378:metabolism; D010101:Oxygen Consumption; D010108:Oxyhemoglobins / Q000378:metabolism; D058748:Pain Perception; D058729:Peripheral Arterial Disease / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D057566:Self Report; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors
D015415:Biomarkers; D010108:Oxyhemoglobins
diabetes; exercise tests; near-infrared spectroscopy; pain perception; peripheral arterial disease