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)

💪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...

🤔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🔗?