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: 10064168
• 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/10064168
• 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; Diagnostic; 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; endothelial dysfunction; event cycle; femoral artery; 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.

当前的美国退伍军人人口统计数据显示，人口衰老，心血管功能障碍严重。 这最终表现为移动性限制，无活动性和随后的心血管恶化 经常导致死亡的疾病（CVD）。但是，尽管事件的明显负面循环，但没有 单临床接受，因此经常使用评估血管健康的方法。作为一氧化氮 （否）抗动脉粥样硬化和心脏保护性，识别无生物利用度的体内生物测定 在这个舞台上值得一提。在此续签申请之前，主要是由VA优异奖授予的， 单一被动腿运动（SPLM）和随后的血流增加，无创测量 普通股动脉中的超声多普勒正在作为一种血管内皮的方法出现 功能，因此无法确定生物利用度。但是，尽管这项工作已经产生了最初的 SPLM的表征并确定了这种方法是一种新颖，有效和临床相关的方法 确定血管健康，进一步了解SPLM的反应，并随着年龄的增长而最终 在康复和临床领域的实施和评估仍然是必要的。随着增长 对个性化医学的兴趣，工具的开发，例如SPLM，允许个性化的 指导医师，患者和康复团队的评估至关重要。因此，两个 提出了具体目的，该目标将解决中心假设，即SPLM范式提供了 临床上有意义的内皮功能评估。首先，心脏康复将由SPLM评估 在老年人中，再加上对年轻人的研究，将阐明负责的途径 内皮功能随老化和康复的变化。第二，SPLM的CVD诊断值 将对内皮功能的评估相对于经典措施和亚临床标记进行评估 疾病为了加速将内皮功能障碍作为CVD危险因素。提出的研究 旨在催化SPLM从研究到临床的内皮功能评估的过渡 实践。