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Inflammation and loss of skeletal muscle mass in chronic limb threatening ischemia

  • Joana Ferreira
    Correspondence
    Correspondence to: Joana Ferreira, Vascular Surgery Department- Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega 5000-508 Vila Real Portugal.
    Affiliations
    Vascular Surgery Department – Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real Portugal

    Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal
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  • Alexandre Carneiro
    Affiliations
    Radiology Department - ULSAM, Viana do Castelo, Portugal
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  • Isabel Vila
    Affiliations
    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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  • Cristina Silva
    Affiliations
    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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  • Cristina Cunha
    Affiliations
    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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  • Adhemar Longatto-Filho
    Affiliations
    Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal

    Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil

    Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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  • Amílcar Mesquita
    Affiliations
    Vascular Surgery Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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  • Jorge Cotter
    Affiliations
    Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal

    Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
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  • Armando Mansilha
    Affiliations
    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Department of Pathology (LIM-14), University of São Paulo School of Medicine, São Paulo, Brazil
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  • Margarida Correia-Neves
    Affiliations
    Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal
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  • Pedro Cunha
    Affiliations
    Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal

    Centro Académico Hospital da Senhora da Oliveira, Guimarães, Portugal

    ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal

    Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal

    Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk, Internal Medicine Department - Hospital da Senhora da Oliveira, Guimarães, Portugal
    Search for articles by this author
Published:August 01, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.009

      Abstract

      Background

      Lower extremity peripheral arterial disease (PAD) is an atherosclerotic disease of the lower extremities. Atherosclerosis, inflammation and sarcopenia are independently associated and potentiate each other. Inflammation is deeply involved in the formation and progression of atherosclerosis and is also involved in the pathophysiology of sarcopenia. Sarcopenia is defined as low muscle mass, with low muscle strength. This study aims to determine the differences in skeletal muscle characteristics and in inflammatory parameters between patients with claudication and with chronic limb threatening ischemia (CLTI).

      Methods

      An observational, prospective study in patients with PAD was conducted from January 2018 to December 2020. The clinical characteristics and the cardiovascular risk factors were prospectively registered. The inflammatory parameters determined were: positive acute phase proteins (C-reactive Protein- CRP- and fibrinogen) and negative acute phase proteins (albumin, total cholesterol and high-density lipoprotein- HDL. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer.

      Results

      116 patients (mean age: 67.65±9.53 years-old) 64% with claudication and 46% with CLTI were enrolled in the study. No differences were registered between patients with claudication and CLTI on age, cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, smoking habits) and medication. There was a higher prevalence of men in the claudication group (88.89% versus 71.70%, p=0.019). Analysing the inflammatory parameters, we noted that patients with CLTI had an increased serum levels of positive acute phase proteins: CRP (37.53±46.61mg/L versus 9.18±26.12mg/L, p=0.000), and fibrinogen (466.18±208.07mg/dL versus 317.37±79.42mg/dL, p=0.000). CLTI patients had decreased negative acute phase proteins: albumin (3.53±0.85g/dL versus 3.91±0.72g/dL, p=0.001), total cholesterol (145.41±38.59mg/dL versus 161.84±34.94mg/dL, p=0.013) and HDL (38.70±12.19mg/dL versus 51.31±15.85mg/dL, p=0.000). We noted that patients with CLTI had lower skeletal muscle area and mass (14349.77±3036.60 mm2 versus 15690.56±3183.97 mm2 p=0.013; 10.11±17.03HU versus 18.02±13.63HU p=0.013). After adjusting for the variable sex, the association between skeletal muscle density and CLTI persisted (r(97)=-0.232, p=0.021). The groups did not differ in strength (patients with claudication: 25.39±8.23 Kgf versus CLTI: 25.17±11.95 Kgf p=0.910).

      Conclusions

      CLTI patients have decreased skeletal muscle mass and a systemic inflammation status. Recognizing the deleterious triad of atherosclerosis, inflammation and loss of skeletal mass patients with CLTI is an opportunity to improve medical therapy and to perform a timely intervention to stop this vicious cycle.

      Keywords

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