The impact of exercise capacity in the atherosclerotic patient: Keep on walking!

__Abstract__ Peripheral arterial disease (PAD) is a manifestation of systemic arteriosclerosis. It is a common disease affecting millions of people. Depending on the age of the investigated population prevalences between 4% to 29% has been reported. It is alarming that the prevalence is expected to rise in the following decades due to the aging of the western population and the increase of risk factors such as diabetes mellitus, obesity and lack of exercise. Patients with PAD are of an increased risk of cardiovascular events and mortality. In addition, they may also experience signifi cant limitations in their physical functioning and impairment in their quality of life. It is important to diagnose patients with PAD early in the course of the disease to provide them optimal treatment as soon as possible in attempting to lower the complication rates, improve morbidity, mortality and subsequent their quality of life. However, symptoms of PAD are diverse. The classical symptoms are intermittent claudication consisted of calf pain provoked by walking and declining at rest. Earlier investigations, on the other hand, have demonstrated a large range of symptoms ranging from no pain at all till pain at rest . A major problem is that between 20% till 50% of the patients are asymptomatic . Commonly, to identify patients with PAD the resting ankle brachial index (ABI) is used. This is the ratio between the ankle’s systolic blood pressure, measured at the dorsalis pedis or posterial tibial arterie using a Doppler ultrasonic instrument, and the systolic blood pressure at the arm. An ABI below 0.90 is associated with angiographic stenosis of more than 50% . According to the guidelines a resting ABI of < 0.90 is defi ned as PAD. Several studies have found that an ABI of < 0.90 is associated with an increased risk of cardiovascular diseases and mortality. Moreover it can also be used for prognostic risk stratifi cation

Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p &lt; 0.001), lower perfusion quality (p &lt; 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration. Graphical abstract: [Figure not available: see fulltext.].</p

Microcirculatory Monitoring in Children with Congenital Heart Disease Before and After Cardiac Surgery

In this prospective observational study, we investigated whether congenital heart disease (CHD) affects the microcirculation and whether the microcirculation is altered following cardiac surgery with cardiopulmonary bypass (CPB). Thirty-eight children with CHD undergoing cardiac surgery with CPB and 35 children undergoing elective, non-cardiac surgery were included. Repeated non-invasive sublingual microcirculatory measurements were performed with handheld vital microscopy. Before surgery, children with CHD showed similar perfused vessel densities and red blood cell velocities (RBCv) but less perfused vessels (p < 0.001), lower perfusion quality (p < 0.001), and higher small vessel densities (p = 0.039) than children without CHD. After cardiac surgery, perfused vessel densities and perfusion quality of small vessels declined (p = 0.025 and p = 0.032), while RBCv increased (p = 0.032). We demonstrated that CHD was associated with decreased microcirculatory perfusion and increased capillary recruitment. The microcirculation was further impaired after cardiac surgery. Decreased microcirculatory perfusion could be a warning sign for altered tissue oxygenation and requires further exploration

Young Women With Type 1 Diabetes Have Lower Bone Mineral Density That Persists Over Time

OBJECTIVE—Individuals with type 1 diabetes have decreased bone mineral density (BMD), yet the natural history and pathogenesis of osteopenia are unclear. We have previously shown that women with type 1 diabetes (aged 13–35 years) have lower BMD than community age-matched nondiabetic control subjects. We here report 2-year follow-up BMD data in this cohort to determine the natural history of BMD in young women with and without diabetes