ß-Blockers and Vascular Hemodynamics in Patients With Peripheral Arterial Disease.

Aortic augmentation index (AIx) is a marker of central aortic pressure burden and is modulated by antihypertensive drugs. In patients with peripheral arterial disease (PAD) undergoing antihypertensive treatment, aortic pressures parameters, heart rate-adjusted augmentation index (AIx75), and unadjusted AIx were determined. The (aortic) systolic and diastolic blood pressure did not differ between PAD patients who were taking ß-blockers (n=61) and those who were not taking ß-blockers (n=80). In patients taking ß-blockers, augmentation pressure and pulse pressure were higher than in patients who did not take ß-blockers (augmentation pressure, P=.02; pulse pressure, P=.005). AIx75 was lower in PAD patients taking ß-blockers than in patients not taking ß-blockers (P=.04), while the AIx did not differ between PAD patients taking and not taking ß-blockers. The present study demonstrates that ß-blockers potentially affect markers of vascular hemodynamics in patients with PAD. Because these markers are surrogates of cardiovascular risk, further studies are warranted to clarify the impact of selective ß-blocker treatment on clinical outcome in patients with PAD.

Increased permeability of cutaneous lymphatic capillaries and enhanced blood flow in psoriatic plaques.

INTRODUCTION: Morphological abnormalities of microvessels are described in psoriasis. However, there are conflicting data as to whether their function is also altered. OBJECTIVE: Our aim was to study the morphology and function of the lymphatic capillaries of psoriatic skin. METHODS: Morphology and permeability of initial lymphatics were studied by microlymphography and densitometry in 20 patients. Perfusion was studied by laser Doppler fluxmetry. RESULTS: Permeability of lymphatics in plaques was increased by 7.6% compared to unafflicted skin (p < 0.001). Lymphatic vessel density and the extension of dye in lymphatic networks were not significantly different between involved and uninvolved areas. Both sites showed a wide range of diameters of lymphatics. The median laser Doppler flux in plaques was increased by 144% (91-380%) compared to unaffected skin (p < 0.001). CONCLUSIONS: Increased permeability of lymphatics and increased blood flow was demonstrated in vivo in psoriatic skin lesions. These findings may reflect the local inflammatory process and may be used as markers when studying new therapeutic approaches for psoriasis.

Predictive value of auscultation of femoropopliteal arteries.

BACKGROUND: Femoropopliteal bruits indicate flow turbulences and increased blood flow velocity, usually caused by an atherosclerotic plaque or stenosis. No data exist on the quality of bruits as a means for quantifying the degree of stenosis. We therefore conducted a prospective observational study to investigate the sensitivity and specificity of femoropopliteal auscultation, differentiated on the basis of bruit quality, to detect and quantify clinically relevant stenoses in patients with symptomatic and asymptomatic peripheral arterial disease (PAD). METHODS: Patients with known chronic and stable PAD were recruited in the outpatient clinic. We included patients with known PAD and an ankle-brachial index (ABI) <0.90 and/or an ABI ≥0.90 with a history of lower limb revascularisation. Auscultation was performed independently by three investigators with varied clinical experience after a 10-minute period of rest. Femoropopliteal lesions were classified as follows: normal vessel wall or slight wall thickening (<20%), atherosclerotic plaque with below 50% reduction of the vessel lumen, prestenotic/intrastenotic ratio over 2.5 (<70%), over 3.5 (<99%) and complete occlusion (100%). RESULTS: Weighted Cohen's κ coefficients for differentiated auscultation were low in all vascular regions and did not differ between investigators. Sensitivity was low in most areas with an increase after exercise. The highest sensitivity in detecting relevant (>50%) stenosis was found in the common femoral artery (86%). CONCLUSION: Vascular auscultation is known to be of great use in routine clinical practice in recognising arterial abnormalities. Diagnosis of PAD is based on various diagnostic tools (pulse palpation, ABI measurement) and auscultation can localise relevant stenosis. However, auscultation alone is of limited sensitivity and specificity in grading stenosis in femoropopliteal arteries. Where PAD is clinically suspected further diagnostic tools, especially colour-coded duplex ultrasound, should be employed to quantify the underlying lesion.