Limb Stress-Rest Perfusion Imaging With Contrast Ultrasound for the Assessment of Peripheral Arterial Disease Severity
Jonathan R. Lindner, MD, FACC*,*,
Lisa Womack, MS ,
Eugene J. Barrett, MD, PhD ,
Judy Weltman, MS,
Wendy Price, RN,
Nancy L. Harthun, MD ,
Sanjiv Kaul, MD, FACC*,
James T. Patrie, MS
* Cardiovascular Division, Oregon Health & Science University, Portland, Oregon
General Clinical Research Center, University of Virginia, Charlottesville, Virginia
Endocrinology Division, University of Virginia, Charlottesville, Virginia
Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Figure 1 CEU Data From a Normal Subject and a Patient With PAD
Images were obtained at incremental pulsing intervals in seconds (s) and corresponding time versus intensity data from the calf plantar flexor muscles at rest and during exercise in a limb from a control subject (A) and a patient with peripheral arterial disease and claudication (B). For each panel, rest images are above and exercise images are below. Despite an identical workload for the 2 patients (38 W), exercise blood flow and flow reserve were markedly impaired in the patient with peripheral arterial disease (PAD). Color scale is shown at bottom of the first image. BG = background image obtained immediately after microbubble destruction; CEU = contrast-enhanced ultrasound.
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Figure 2 Predictors of Disease Severity
Predictors of disease severity were defined as exercise treadmill time until the onset of claudication before (A) and after (B) stratification according to the presence of diabetes mellitus. ABI = ankle-brachial index; CI = confidence interval; DM = diabetes mellitus; Ex = exercise; PVR = pulse volume recording.
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Figure 3 Multivariate Model for Best Predictors of Disease Severity
A reduction in quasi-likelihood information coefficient (QICu) scores indicates improved predictive value for exercise time until claudication. Models are shown before (A) and after (B) stratification according to the presence of diabetes mellitus. Ex Flow = blood flow at peak exercise; MFR = muscle flow reserve; other abbreviations as in Figure 2.
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