Cardiac autonomic dysfunction is associated with white matter lesions in patients with mild cognitive impairment.

BACKGROUND: Cardiac autonomic dysfunction has been associated with cognitive impairment, but the underlying pathogenesis is complex and cerebral white matter lesions (WMLs) might be implicated. METHODS: Time and frequency heart rate variability (HRV) and visual rating of WMLs were carried out in 42 patients with mild cognitive impairment. RESULTS: After adjustment for relevant demographic and clinical characteristics, including left ventricular mass, reduced HRV indices of parasympathetic (root mean square of successive difference of RR intervals, RMSSD) and sympathetic modulation (low-frequency [LF] power) were associated with increased WML score (RMSSD: B -0.30, 95% CI -0.52 to -0.08, p = .01; LF: B -0.24, 95% CI -0.46 to -0.02, p = .05). In a multiple-adjusted model, RMSSD was the major independent predictor of WMLs (B -0.35, 95% CI -0.57 to -0.13, p = .002). CONCLUSION: The evidence for an independent association of cardiac autonomic dysfunction with WMLs might suggest its role in the pathogenesis of WMLs.

Percutaneous transluminal angioplasty is feasible and effective in patients on chronic dialysis with severe peripheral artery disease.

BACKGROUND: Peripheral arterial disease (PAD) is common among patients on chronic dialysis. Despite severe clinical manifestations, the indication for bypass surgery is controversial, because of the high morbidity and mortality rate of these patients. The less invasive percutaneous transluminal angioplasty (PTA) is a possible alternative, but data about PTA in dialysis patients are scarce. METHODS: We followed 107 dialysis patients (mean age 67+/-10, 75 males) with 132 ischaemic limbs (97% with critical limb ischaemia and ischaemic foot lesions or rest pain) consecutively treated by PTA. RESULTS: PTA was successful in 97% of cases. Median follow-up was 22 months. Cumulative limb salvage rates at 12, 24, 36 and 48 months were 86, 84, 84 and 62%, respectively. Log-rank test showed an association between major amputation and baseline presence of foot lesions (P=0.04). This association was confirmed by a Cox survival multivariate analysis [hazard ratio (HR)=7.03, 95% confidence interval (CI)=1.1-43.0, P=0.035]. Limb salvage without any new intervention on the same leg was achieved in 70% of the cases, and was associated with the absence of diabetes mellitus (P=0.01), lower number of treated lesions (P=0.04) and proximal level (iliac and/or femoro-popliteal) of PTA (P<0.001). Independent predictors were diabetes mellitus (HR=3.47, 95% CI=1.31-9.17, P=0.01) and proximal PTA (HR=0.28, 95% CI=0.08-0.94, P=0.04). Fifty-three (49%) patients died during follow-up. Patients older than 67 years (the median value in our sample) had a 2.4-fold increase in mortality risk (95% CI=1.4-4.1, P<0.001). CONCLUSIONS: PTA is feasible and effective in dialysis patients with PAD, and should be preferred to other more invasive interventions.