Passive leg movement: A tool to assess vascular health and guide rehabilitation

被动腿部运动：评估血管健康和指导康复的工具

• 批准号: 10379166
• 负责人: Russell S. Richardson
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10379166
• 关键词: Address; Aging; Ankle; Antiatherogenic; Award; Biological Availability; Blood Glucose; Blood Pressure; Blood Vessels; Blood flow; Body mass index; C-reactive protein; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular Physiology; Cardiovascular system; Cessation of life; Clinical; Clinical assessments; Common Femoral Artery; Coupled; Development; Dilator; Disease; Doppler Ultrasound; Elderly; Endothelium; Fasting; Fluconazole; Functional disorder; Health; Hyperemia; Ketorolac; Leg; Measurement; Measures; Mediating; Methods; Movement; Nitric Oxide; Nitric Oxide Synthase; Pathway interactions; Patients; Physicians; Prevalence; Prostaglandins; Rehabilitation therapy; Research; Risk; Risk Factors; Risk Marker; Role; Thick; Vascular Diseases; Vascular Endothelium; Vasodilation; Vasodilator Agents; Veterans; Work; aging population; blood lipid; cardioprotection; cardiovascular disorder risk; clinical practice; clinically relevant; coronary calcium scoring; demographics; diagnostic accuracy; diagnostic tool; diagnostic value; endothelial dysfunction; event cycle; femoral artery; implementation evaluation; improved; in vivo Bioassay; indexing; interest; novel; omega-N-Methylarginine; personalized medicine; programs; response; restoration; tool; tool development

Current U.S. Veteran demographics reveal an aging population with significant cardiovascular dysfunction. This ultimately manifests as mobility limitation, inactivity, and a subsequent worsening of cardiovascular disease (CVD) that often leads to death. However, despite this clear negative cycle of events, there is not a single clinically accepted, and therefore routinely utilized, method of assessing vascular health. As nitric oxide (NO) is anti-atherogenic and cardioprotective, identifying an in vivo bioassay of NO bioavailability has significant worth in this arena. Fueled predominantly by the VA Merit Award prior to this renewal application, single passive leg movement (sPLM) and the subsequent blood flow increase, measured non-invasively by ultrasound Doppler in the common femoral artery, is emerging as a method by which vascular endothelial function and therefore NO bioavailability can be determined. However, although this work has yielded an initial characterization of sPLM and established this method to be a novel, valid, and a clinically relevant approach to determine vascular health, further understanding of the sPLM response with advancing age and, ultimately, its implementation and assessment in both rehabilitation and clinical arenas is still necessary. With the growing interest in personalized medicine, the development of tools, such as sPLM, that allow individualized assessments to guide the physician, the patient, and the rehabilitative team, are essential. Therefore, two specific aims are proposed that will address the Central Hypothesis that the sPLM paradigm provides a clinically meaningful assessment of endothelial function. First, cardiac rehabilitation will be assessed by sPLM in the elderly, and, coupled with studies in the young, will elucidate the predominant pathways responsible for the change in endothelial function with aging and rehabilitation. Second, the CVD diagnostic value of the sPLM assessment of endothelial function will be evaluated relative to classic measures and markers of subclinical disease in order accelerate the inclusion of endothelial dysfunction as a CVD risk factor. The proposed studies aim to catalyze the transition of the assessment of endothelial function by sPLM from research to clinical practice.

目前的美国退伍军人人口统计数据显示，人口老龄化，心血管功能障碍严重。 这最终表现为活动受限、缺乏活动以及随后的心血管恶化 经常导致死亡的疾病（CVD）。然而，尽管事件出现了这种明显的负面循环，但并没有一个解决办法。 单一的临床接受并因此常规使用的评估血管健康的方法。作为一氧化氮 (NO) 具有抗动脉粥样硬化和心脏保护作用，通过体内生物测定来确定 NO 的生物利用度 在这个领域具有重要的价值。在此续签申请之前，主要由 VA 优异奖推动， 单次被动腿部运动 (sPLM) 和随后的血流量增加，通过非侵入性测量 股总动脉超声多普勒是一种新兴的方法，通过该方法可以使血管内皮细胞 功能，因此可以确定 NO 的生物利用度。然而，尽管这项工作已经取得了初步成果 sPLM 的表征，并将该方法确立为一种新颖、有效且具有临床相关性的方法 确定血管健康状况，进一步了解 sPLM 随着年龄增长的反应，并最终确定其 在康复和临床领域的实施和评估仍然是必要的。随着日益增长的 对个性化医疗的兴趣，开发诸如 sPLM 之类的工具，可以实现个性化 指导医生、患者和康复团队的评估至关重要。因此，两个 提出的具体目标将解决 SPLM 范式提供了一个中心假设 对内皮功能有临床意义的评估。首先，心脏康复将通过 sPLM 进行评估 在老年人中，并结合年轻人的研究，将阐明负责的主要途径 内皮功能随衰老和康复的变化。二、sPLM的CVD诊断价值 内皮功能的评估将根据经典测量方法和亚临床标志物进行评估 疾病，以加速将内皮功能障碍纳入 CVD 危险因素。拟议的研究 旨在促进 sPLM 内皮功能评估从研究到临床的转变 实践。