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Clinical Trial
. 2013:2013:837130.
doi: 10.1155/2013/837130. Epub 2013 Apr 10.

A novel technique for the assessment of preoperative cardiovascular risk: reactive hyperemic response to short-term exercise

Robert Schier  1 , Jochen Hinkelbein, Hanke Marcus, Ashley Smallwood, Arlene M Correa, Reza Mehran, Randa El-Zein, Bernhard Riedel
Affiliations
Clinical Trial

A novel technique for the assessment of preoperative cardiovascular risk: reactive hyperemic response to short-term exercise

Robert Schier et al. Biomed Res Int. 2013.

Abstract

Background: Perioperative vascular function has been widely studied using noninvasive techniques that measure reactive hyperemia as a surrogate marker of vascular function. However, studies are limited to a static setting with patients tested at rest. We hypothesized that exercise would increase reactive hyperemia as measured by digital thermal monitoring (DTM) in association to patients' cardiometabolic risk.

Methods: Thirty patients (58 ± 9 years) scheduled for noncardiac surgery were studied prospectively. Preoperatively, temperature rebound (TR) following upper arm cuff occlusion was measured before and 10 minutes after exercise. Data are presented as means ± SD. Statistical analysis utilized ANOVA and Fisher's exact test, with P values <0.05 regarded as significant.

Results: Following exercise, TR-derived parameters increased significantly (absolute: 0.53 ± 0.95 versus 0.04 ± 0.42°C, P=0.04, and % change: 1.78 ± 3.29 versus 0.14 ± 1.27 %, P=0.03). All patients with preoperative cardiac risk factors had a change in TR (after/before exercise, ΔTR) with values falling in the lower two tertiles of the study population (ΔTR <1.1%).

Conclusion: Exercise increased the reactive hyperemic response to ischemia. This dynamic response was blunted in patients with cardiac risk factors. The usability of this short-term effect for the preoperative assessment of endothelial function warrants further study.

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Figures

Figure 1
Figure 1
Representative example of a temperature-time trace in response to occlusion-hyperemia.
Figure 2
Figure 2
Increase of reactive hyperemia (temperature rebound, TR%) 10 minutes after peak exercise.
See this image and copyright information in PMC

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