Andrade-Lima, Aluísio, Chehuen, Marcel, Silva Junior, Natan, Fecchio, Rafael, Peçanha, Tiago, Brito, Leandro, Miyasato, Roberto, Leicht, Anthony S., and Forjaz, Cláudia L.M. (2019) Reproducibility of hemodynamic, cardiac autonomic modulation and blood flow assessments in patients with intermittent claudication. Annals of Vascular Surgery, 57. pp. 144-151.

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Abstract

Objective: To identify, in patients with peripheral artery disease and intermittent claudication (IC), the reproducibility of heart rate (HR), blood pressure (BP), rate pressure product (RPP), heart rate variability (HRV), and forearm and calf blood flow (BF) and vasodilatory assessments.

Methods: Twenty-nine patients with IC underwent test and retest sessions, 8-12 days apart. During each session, HR, BP, HRV, BF and vasodilatory responses were measured by electrocardiogram, auscultation, spectral analysis of HRV (low frequency, LFR-R; high frequency, HFR-R) and strain gauge plethysmography (baseline BF, post-occlusion BF, post-occlusion area under the curve, AUC). Reproducibility was determined by intraclass coefficient correlation (ICC), typical error, coefficient of variation (CV) and limits of agreement.

Results: The ICC for HR and BP were > 0.8 with CV < 9%. For most HRV measures, ICC were > 0.9 while CV were < 7%, except for LF/HF (ICC = 0.737; CV = 93.8%). The ICC for forearm and calf baseline BF assessments were > 0.9 while CV were < 19%; variable ICC and CV for vasodilatory responses were exhibited for calf (0.653 – 0.770; 35.2 – 37.7%) and forearm (0.169 – 0.265; 46.2 – 55.5%).

Conclusions: In male patients with IC, systemic hemodynamic (HR and BP), cardiac autonomic modulation (LFR-R and HFR-R) and forearm and calf baseline BF assessments exhibited excellent reproducibility, whereas the level of reproducibility for vasodilatory responses were moderate to poor. Assessment reproducibility has highlighted appropriate clinical tools for the regular monitoring of disease/intervention progression in patients with IC.

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