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Echocardiographic assessment at rest and during stress in patients with intermittent claudication

Journal article
Authors Joakim Nordanstig
Odd Bech-Hanssen
Per Skoog
Lennart Jivegård
Published in Scandinavian Cardiovascular Journal
Volume 53
Issue 3
Pages 153-161
ISSN 1401-7431
Publication year 2019
Published at Institute of Medicine
Pages 153-161
Language en
Keywords Peripheral arterial disease, intermittent claudication, stress echocardiography, cardiac function, ventricular ejection fraction, ankle-brachial index, quality-of-life, noninvasive treatment, exercise, disease, risk, revascularization, mortality, perfusion, Cardiovascular System & Cardiology
Subject categories Cardiac and Cardiovascular Systems


Objective. Skeletal muscle perfusion during walking relies on complex interactions between cardiac activity and vascular control mechanisms, why cardiac dysfunction may contribute to intermittent claudication (IC) symptoms. The study aims were to describe cardiac function at rest and during stress in consecutive IC patients, to explore the relations between cardiac function parameters and treadmill performance, and to test the hypothesis that clinically silent myocardial ischemia during stress may contribute to IC limb symptomatology. Design. Patients with mild to severe IC (n=111, mean age 67 y, 52% females, mean treadmill distance 195 m) underwent standard echocardiography, dobutamine stress echocardiography (SE) and treadmill testing. The patient cohort was separated in two groups based on treadmill performance (HIGH and LOW performance). Results. Ten patients (9%) had regional wall motion abnormalities of which three had left ventricular ejection fraction <50% at standard echocardiography. A majority had lower than expected systolic- and diastolic ventricular volumes. LOW performers had smaller diastolic left ventricular volumes and lower global peak systolic velocity during dobutamine stress. No patient demonstrated significant cardiac dysfunction during dobutamine provocation that was not also evident at standard echocardiography. Conclusions. Most IC patients were without signs of ischemic heart disease or cardiac failure. The majority had small left ventricular volumes. The hypothesis that clinically silent myocardial ischemia impairing left ventricular function during stress may contribute to IC limb symptomatology was not supported.

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