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This is a pilot study with the purpose of measuring vascular function, assessed by evaluating arterial stiffness (pulse wave velocity and augmentation index) and endothelial function (flow mediated dilatation), in elite/amateur symptomatic male cyclists with unilateral Endofibrosis (EF), compared to asymptomatic males cyclists and to a group of age matched healthy males (non-athletes).
Endofibrosis (EF) of the iliac arteries is a non-atheromatous flow-limiting condition specific to highly trained athletes. Although the pathophysiology is not well understood, haemodynamic injury and mechanical stress are considered to play a key role in developing EF. Recurrent exposure to these factors could trigger an arterial remodelling process that results in an intravascular lesion such as EF that more resembles an "adaptive intimal thickening". Although the natural history of this condition is not known, it is believed to be progressive with increasing numbers of reports of limb threatening ischaemia due to dissection and/or thrombosis of the arterial lumen. Therefore, it is imperative to understand the pathophysiological mechanism behind this condition in order to develop accurate diagnostic and screening criteria/tools for an early identification and characterization of EF. As there are no data in the literature supporting this hypothesis, the investigators have designed this pilot study to evaluate this hypothesis as to whether athletes with EF have evidence of vascular dysfunction in their arteries. There are currently no data on whether athletes who develop EF have underlying arterial disease or abnormalities. It is quite possible that people who develop EF have an underlying systemic endothelial dysfunction and that this may represent a risk factor for the development of the disease. Therefore the investigators will study non-invasively endothelial function (measured as flow mediated dilatation) as well as arterial stiffness (measured as pulse wave velocity and augmentation index) to improve the understanding about the structural and mechanical characteristics of the vascular tree in this cohort of patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 1-Elite Cyclist | 10 symptomatic cyclists with unilateral diagnosis of iliac EF, FLOW MEDIATED DILATION Ankle brachial pressure index (ABPI) PULSE WAVE VELOCITY AND AUGMENTATION INDEX Blood pressure RAMP Test |
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| 2-Amateur Cyclist | 10 asymptomatic cyclists with no evidence of EF FLOW MEDIATED DILATION ABPI PULSE WAVE VELOCITY AND AUGMENTATION Blood pressure RAMP Test |
| |
| 3-Control | 10 age-matched healthy male group FLOW MEDIATED DILATION ABPI PULSE WAVE VELOCITY AND AUGMENTATION Blood pressure RAMP Test |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| flow mediated dilation (endothelial function) | Other |
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| Measure | Description | Time Frame |
|---|---|---|
| Flow Mediated Dilatation | is the gold standard to measure endothelial function with a High Definition Imaging 3000 ultrasound system (ATL, Bothell, WA, USA) equipped with a 12.5 MHz linear array transducer | 6 months |
| pulse wave velocity | is the gold standard o assess arterial stiffness using the non invasive system of Complior (Arthec Medical) | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| augmentation index | measurement to assess arterial stiffness using the non invasive system of Complior (Arthec Medical) | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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Elite Cyclists with diagnosis of unilateral iliac EF - symptomatic Amateur racing cyclists with at least 3 years training asymptomatic Healthy males (age matched)
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Cristiana Vitale, Md, PhD | Contact | 07702288177 | cristinan.vitale@gmail.com | |
| Fabrizio D'Abate, MSc | Contact | 07730441382 | fabrizio.d'abate@nhs.net |
| Name | Affiliation | Role |
|---|---|---|
| Rob Hinchliffe | St George's, University of London | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St George's University Hospitals NHS Foundation Trust | Recruiting | Tooting | London | SW17 0QT | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22186674 | Background | Peach G, Schep G, Palfreeman R, Beard JD, Thompson MM, Hinchliffe RJ. Endofibrosis and kinking of the iliac arteries in athletes: a systematic review. Eur J Vasc Endovasc Surg. 2012 Feb;43(2):208-17. doi: 10.1016/j.ejvs.2011.11.019. Epub 2011 Dec 19. |
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| ID | Term |
|---|---|
| D059289 | Vascular Stiffness |
| D001794 | Blood Pressure |
| ID | Term |
|---|---|
| D002320 | Cardiovascular Physiological Phenomena |
| D002943 | Circulatory and Respiratory Physiological Phenomena |
| D055986 | Vital Signs |
| D010808 | Physical Examination |
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| ABPI | Other |
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| Pulse wave velocity and augmentation index | Other |
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| blood pressure | Other |
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| ramp test | Other |
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| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D006439 | Hemodynamics |