Sinusoidal changes in transcutaneous oxygen pressure, suggesting Cheyne-Stokes respiration, are frequent and of poor prognosis among patients with suspected critical limb ischemia

• Published in: Atherosclerosis 2021-01, Vol.316, p.15-24
• Main Authors: Hersant, Jeanne, Ramondou, Pierre, Trzepizur, Wojciech, Gagnadoux, Frederic, Picquet, Jean, Abraham, Pierre, Henni, Samir
• Format: Article
• Language: English
• Subjects: Cheyne-Stokes respiration; Critical limb ischemia; Life Sciences; Lower extremity artery disease; Mortality; Transcutaneous oxygen pressure
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2020.11.017

Transcutaneous oxygen pressure (TcpO2) is used in patients with suspected critical limb ischemia (CLI). Sinusoidal changes (SC~) in TcpO2 are found in patients with Cheyne-Stokes respiration (CSR). We aimed to determine the characteristics of TcpO2 changes at rest in patients with suspected CLI, define the objective criteria for SC ~ TcpO2 patterns (SC+), and estimate the prevalence of SC+ in our population and its impact on the outcome. We retrospectively analyzed 300 chest TcpO2 recordings performed in a 16-month period. We determined the presence/absence of SC ~ TcpO2 by visual analysis. We determined the acceptable error in the regularity of peaks of the cross-correlation with ROC curve analysis, among patients with typical SC ~ TcpO2 and non-sinusoidal patterns. Then, we defined SC + as a minimum of five peaks, a standard deviation of TcpO2 >1.25 mmHg, an error in regularity of peaks of the cross-correlation < 10%, and a cycle length between 30 and 100 s. In patients included until October 2019, we compared the outcome as a function of SC + or SC- with Cox models. Mathematical detection of SC + found that 43 patients (14.3%) fulfilled all four defined criteria at the chest level, but only 23 did so at the limb level. In the follow-up of 207 patients, the presence of Sc ~ TcpO2 at the chest significantly increased the risk of mortality: hazard ratio: 2.69 [95%CI: 1.37–5.30]; p