Alex Sullivan

We look forward to building on this work with colleagues across the vascular community.
@heatherlgornik.bsky.social @2scottish.bsky.social @vmj-svm.bsky.social @herbaronowmd.bsky.social @drmarkcreager.bsky.social @katemcginiglemd.bsky.social @erictopol.bsky.social

Thrilled to collaborate and work alongside outstanding cardiovascular and vascular surgery colleagues at VUMC, UTSW, and Scripps!

👉Check out the full article here: ahajournals.org/doi/10.1161/...

#PAD #Claudication #PADAwareness #LegPain #VascularHealth

Study lead by @joshuabeckmanmd.bsky.social with support from @americanheart.bsky.social @ahascience.bsky.social (#AHASFRN)

Exercise-induced skeletal muscle angiogenesis: impact of age, sex, angiocrines and cellular mediators - European Journal of Applied Physiology Exercise-induced skeletal muscle angiogenesis is a well-known physiological adaptation that occurs in humans in response to exercise training and can lead to endurance performance benefits, as well as...

💪Our findings also make clear that microvascular function is an important determinant of function in people without PAD as well.

Exercise increases skeletal muscle capillary density, endothelial function, and capillary-to-fiber ratio. link.springer.com/article/10.1...

Association of Physiological Stenosis Severity and Angina-Limited Exercise Time in Stable Coronary Artery Disease This cohort study assesses the association between all commonly-used indices of physiological stenosis severity and angina-limited exercise time in patients with stable angina.

🤔For those wondering how can this be true, ask yourself: what is the functional limitation caused by an 80% RCA stenosis? There is no answer!

Why⁉️Because function seems more driven by the microvasculature, while events are driven by the larger vessels.
jamanetwork.com/journals/jam...

💡Takeaways:
✅PAD walking impairment is largely driven by microvascular dysfunction.

✅Improvements in microvascular function, not conduit artery revascularization, predict walking improvement.

✅New therapies should target the microvasculature as a key mechanism of recovery.

After exercise or revascularization:

Change in ABI ❌ not associated with walking gains

Change in macrovascular (popliteal artery) post-ischemic inflow ❌ not associated

Change in post-ischemic MICROVASCULAR reactivity ✅ correlated with walking improvement (R=0.46; P=0.014)

✅ ABI, macrovascular inflow, AND microvascular reactivity all correlated with walking distance (6MWT).

In multivariable models, post-ischemic MICROVASCULAR reactivity was strongest (β=825.3, P=0.023).

👩‍🔬 68 participants (50 PAD, 18 controls)

🧪 MRI measures (at rest & after ischemic stimulus):
- Macrovascular (popliteal artery) inflow
- Calf skeletal muscle microvascular reactivity

🚶 6-minute walk test (6MWT)

Subset reassessed after exercise therapy or revascularization

🔎 In PAD, claudication and walking limitation are not fully explained by large artery occlusive disease, as captured by reductions in ABI.

We asked:
Could SKELETAL MUSCLE MICROVASCULAR FUNCTION be the missing link🔗?

Microvascular Function and Ambulatory Capacity in Peripheral Artery Disease | Circulation: Cardiovascular Interventions BACKGROUND: Patients with peripheral artery disease experience walking impairment that is incompletely explained by large-artery atherosclerotic occlusive disease and abnormal ankle-brachial index (AB...

Ever wonder why walking capacity varies across ABIs in those with PAD?

Calf skeletal muscle microvascular dysfunction, not conduit artery occlusive disease, is the strongest driver of walking impairment in PAD.

Happy to share our work in Circ CV Interventions!
www.ahajournals.org/doi/10.1161/...