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• W2790692177 abstract "We read with interest the paper of Kovacs et al. published in Atherosclerosis [ [1] Kovacs D. Siszar B. Biro K. Koltai K. Endrei D. et al. Toe-brachial index and exercise test can improve the exploration of peripheral artery disease. Atherosclerosis. 2018; 269: 151-158 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. The authors used discontinuous transcutaneous oxygen pressure measurement (TcPO2) in patients with claudication and suggested that the performance of exercise-TcPO2 was lower than post-exercise toe pressure. One issue when using TcPO2 relates to the local heating of the skin that takes at least 15 min to attain stable values. Once stable values are reached, the simultaneous and continuous measurements of limb and chest TcPO2 before, during, and following exercise can accurately detect exercise-induced lower limb ischemia with calculation of the “DROP” (limb changes minus chest changes) and analysis of minimal-DROP [ [2] Abraham P. Picquet J. Vielle B. Sigaudo-Roussel D. Paisant-Thouveny F. et al. Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: comparison with arteriography. Circulation. 2003; 107: 1896-1900 Crossref PubMed Scopus (115) Google Scholar , [3] Abraham P. Picquet J. Bouye P. L'Hoste P. Enon B. et al. Transcutaneous oxygen pressure measurements (tcpO2) at ankle during exercise in arterial claudication. Int. Angiol. 2005; 24: 80-88 PubMed Google Scholar ], as well as exercise induced systemic hypoxemia by analysis of chest changes during exercise [ [4] Bruneau A. Feuilloy M. Dussaussoy C. Gagnadoux F. Leftheriotis G. et al. The walking-induced transient hack concept is valid & relies on a transient early-exercise hypoxemia. PLoS One. 2013; 8 (e62651) Crossref Scopus (15) Google Scholar ]. Kovacs's report [ [1] Kovacs D. Siszar B. Biro K. Koltai K. Endrei D. et al. Toe-brachial index and exercise test can improve the exploration of peripheral artery disease. Atherosclerosis. 2018; 269: 151-158 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ], although interesting, raises multiple concerns: 1) chest TcPO2 values are unchanged from resting values at 5, 10 & 15 min following exercise, which seems inconsistent with our experience and previous results [ [5] Ouedraogo N. Feuilloy M. Mahe G. Leftheriotis G. Saumet J.L. et al. Chest tcpO2 changes during constant-load treadmill walking tests in patients with claudication. Physiol. Meas. 2011; 32: 181-194 Crossref PubMed Scopus (25) Google Scholar ]. 2) Limb TcPO2 results are still impaired 10 min after exercise, which seems inconsistent with the fact that most patients normalize their DROP within 10 min of recovery [ [6] Fouasson-Chailloux A. Abraham P. Colas-Ribas C. Feuilloy M. Vielle B. et al. Simultaneous pain intensity rating and quantification of ischemia throughout exercise and recovery in proximal versus distal arterial claudication. Vasc. Med. 2017 Dec; 22: 490-497 Crossref PubMed Scopus (6) Google Scholar ]. 3) Attachment after exercise and measurement at 5 and 10 min seem inconsistent with the time required to reach stable skin blood flow during local heating [ [7] Bruning R.S. Santhanam L. Stanhewicz A.E. Smith C.J. Berkowitz D.E. et al. Endothelial nitric oxide synthase mediates cutaneous vasodilation during local heating and is attenuated in middle-aged human skin. J. Appl. Physiol. 2012; 112 (1985): 2019-2026 Crossref PubMed Scopus (90) Google Scholar ]. Toe-brachial index and exercise test can improve the exploration of peripheral artery diseaseAtherosclerosisVol. 269PreviewWe assumed that hand-held Doppler ultrasound (DUS) at rest was insufficient to assess the severity of peripheral artery disease (PAD). Toe pressure and transcutaneous tissue oxygen pressure were studied to prove whether these could identify more patients with severe lower limb ischemia; exercise was applied to provoke ischemia. Full-Text PDF Reply to: “Exercise oximetry in patients with arterial claudication”AtherosclerosisVol. 272PreviewWe read with great interest the letter to the Editor “Exercise oximetry in patients with arterial claudication” of Pierre Abraham et al. [1]. It is highly appreciated to receive the opinion of experts who have large experience in this field. Below, we respond to their concerns. Full-Text PDF" @default.
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• W2790692177 date "2018-05-01" @default.
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• W2790692177 title "Exercise oximetry in patients with arterial claudication" @default.
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• W2790692177 doi "https://doi.org/10.1016/j.atherosclerosis.2018.02.032" @default.
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