title: Asymmetric dimethylarginine correlates with measures of disease severity, major adverse cardiovascular events and all-cause mortality in patients with peripheral arterial disease The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Leg strength predicts mortality in men but not in women with peripheral arterial disease. Prognostic value of functional performance for mortality in patients with peripheral artery disease.
abstract: Peripheral arterial disease ( PAD ) is associated with major cardiovascular morbidity and mortality . Abnormalities in nitric oxide metabolism due to excess of the NO synthase inhibitor asymmetric dimethylarginine ( ADMA ) may be pathogenic in PAD . We explored the association between ADMA levels and markers of atherosclerosis , function , and prognosis .  A total of 133 patients with symptomatic PAD were enrolled .  Ankle — brachial index ( ABI ) , walking time , vascular function measures ( arterial compliance and flow-mediated vasodilatation ) and plasma ADMA level  were assessed for each patient at baseline . ADMA correlated inversely with ABI ( r = —0.238 , p = 0.003 ) and walking time ( r = —0.255 , p = 0.001 ) , independent of other vascular risk factors . We followed up 125 ( 94 % ) of our 133 initial subjects with baseline measurements ( mean 35 months ) . Subjects with ADMA levels in the highest quartile ( > 0.84 μmol/l ) showed a significantly greater occurrence of a major adverse cardiovascular event ( MACE ) compared to those with ADMA levels in the lower three quartiles ( p = 0.001 ) . Cox proportional-hazards regression analysis revealed that ADMA was a significant predictor of MACE , independent of other risk factors including age , sex , blood pressure , smoking history , diabetes and ABI ( hazard ratio = 5.1 , p < 0.001 ) . Measures of vascular function , such as compliance , flow-mediated vasodilatation ( FMVD ) and blood pressure , as well as markers of PAD severity , including ABI and walking time , were not predictive . In conclusion , circulating levels of ADMA correlate independently with measures of disease severity and major adverse cardiovascular events . Agents that target this pathway may be useful for this patient population . Clinical Trial Registration — URL : http:// www . clinical trials.gov . Unique identifier : Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND The objective of this study was to assess the role of a symptom-limited stair climbing test in predicting postoperative cardiopulmonary complications in elderly c and i date s for lung resection . METHODS A consecutive series of 109 patients more than 70 years of age who underwent pulmonary lobectomy for lung carcinoma from January 2000 through May 2003 formed the prospect i ve data base of this study . All patients in the analysis performed a preoperative symptom-limited stair climbing test . Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications . RESULTS At univariate analysis , the patients with complications had a lower forced expiratory capacity percentage of predicted ( p = 0.048 ) , predicted postoperative forced expiratory volume in 1 second percentage of predicted ( p = 0.049 ) , climbed a lower height at preoperative stair climbing test ( p = 0.0004 ) , and presented a greater proportion of cardiac comorbiditiy with respect to the patients without complications ( p = 0.02 ) . After logistic regression analysis , significant predictors of postoperative complications result ed in the presence of a concomitant cardiac disease ( p = 0.04 ) and a low height climbed preoperatively ( p = 0.0015 ) . CONCLUSIONS A symptom-limited stair climbing test was a safe and simple instrument capable of predicting cardiopulmonary complications in the elderly after lung resection OBJECTIVE To establish associations between leg strength and mortality in men and women with lower extremity peripheral arterial disease ( PAD ) . METHODS This was an observational , prospect i ve study of 410 men and women with PAD aged 55 and older recruited from Chicago-area medical centers and followed for a mean of 60 months . The participants were followed for a mean of 60.0 months . Isometric knee extension , knee flexion , hip extension , and hip flexion were measured at baseline . Primary outcomes were all-cause and cardiovascular disease mortality . Cox proportional hazards models were used to assess relations between leg strength and all-cause and cardiovascular disease mortality among men and women , adjusting for age , race , comorbidities , physical activity , smoking , body mass index , and the ankle brachial index . RESULTS Among the 246 male participants , poorer baseline strength for knee flexion ( P trend = .029 ) , knee extension ( P trend = .010 ) , and hip extension ( P trend = .013 ) were each associated independently with higher all-cause mortality . Poorer strength for knee flexion ( P trend = .042 ) and hip extension ( P trend = .029 ) were associated with higher cardiovascular mortality . Compared with those in the fourth ( best ) baseline knee flexion quartile , hazard ratios for all-cause and cardiovascular disease mortality among men in the first ( poorest ) knee flexion quartile were 2.23 ( 95 % confidence interval [ CI ] , 1.02 - 4.87 ; P = .045 ) and 4.20 ( 95 % CI , 1.12 - 15.79 ; P = .044 ) , respectively . No significant associations of leg strength and all-cause mortality were identified among women . CONCLUSIONS Poorer leg strength is associated with increased mortality in men , but not women , with PAD . Future study is needed to determine whether interventions that increase leg strength improve survival in men with PAD OBJECTIVES Among persons with lower extremity peripheral artery disease ( PAD ) , we determined whether objective measures of walking performance predict mortality independently of the ankle brachial index ( ABI ) . BACKGROUND The ability of office-based functional performance measures to predict mortality in patients with PAD is unknown . METHODS Participants were 444 persons with PAD followed prospect ively for 4.8 years . The 6-min walk and 4-m walks at usual and fastest pace were measured at baseline . Cox proportional hazard models were used to assess relations between baseline measures of lower extremity performance with mortality , adjusting for confounders . RESULTS One hundred twenty-seven patients ( 28.6 % ) died during follow-up . Adjusting for age , gender , race , comorbidities , ABI , and other confounders , participants in the poorest baseline quartile of 6-min walk performance had significantly increased total mortality ( hazard ratio [ HR ] 2.36 [ 95 % confidence interval ( CI ) 1.33 to 4.18 ] ) and cardiovascular mortality ( HR 5.59 [ 95 % CI 1.97 to 15.9 ] ) compared with the best quartile of baseline performance . Participants in the poorest baseline quartile of normal-paced 4-m walking speed had significantly increased total mortality ( HR 1.86 [ 95 % CI 1.06 to 3.29 ] ) and cardiovascular mortality ( HR 2.55 [ 95 % CI 1.01 to 6.46 ] ) compared with the best quartile of baseline performance . CONCLUSIONS This study demonstrates for the first time that performance-based measures , which can be administered in an office setting , provide prognostic information regarding mortality in persons with PAD beyond that provided by the ABI
target: No significant associations were found for hip flexion strength , WIQ distance score , or WIQ speed score with mortality .
  CONCLUSIONS A number of lower extremity performance measures are prognostic markers for mortality in PAD and may be useful clinical tools for identifying patients at higher risk of death .
background: BACKGROUND Peripheral artery disease ( PAD ) is associated with impaired mobility and a high rate of mortality .
  The aim of this systematic review was to investigate whether reduced lower extremity performance was associated with an increased incidence of  cardiovascular and all-cause mortality in people with PAD .