Diagnostic accuracy of automated oscillometric determination of the ankle-brachial index in peripheral artery disease

IntroductionIt is common for patients with PAD to have concomitant CAD because both are caused by atherosclerosis, a systemic process. This has been well established in international studies. The incidence of PAD in patients with known CAD in our population is unknown. The ankle brachial index (ABI) can be calculated by taking the ratio of ankle systolic pressure and brachial systolic pressure. It is a simple, easy and cost effective bedside tool to diagnose peripheral arterial disease (PAD).Objective:The objective of the study was to:Determine the incidence of PAD in patients with known coronary artery disease (CAD) in our population.Determine the diagnostic accuracy of ABI in diagnosing PAD in patients with CAD taking dup-lex ultrasound as gold standard in local population.Study Design: Cross sectional study.Setting:Department of Cardiology (CCU), Jinnah Hospital, Lahore.Study Duration:Six months from 01 June 2014 to 31 December 2014.Subjects and Methods:310 patients who met the inclusion / exclusion criteria were entered in the study. Mercury sphygmomanometer was used to take the systolic blood pressure of all the four limbs, and the ratio of ankle systolic pressure (higher of systolic pressure taken in both left and right limb was taken) to brachial systolic pressure (higher of systolic pressure taken in both left and right limb was taken) was used to calculate the ABI. An abnormal ABI was conside-red if the ratio was < 0.9. All subjects underwent duplex ultrasound as a gold standard to detect the presence or absence of PAD.Results:Out of 310 cases, common age was calcula-ted as 59.21 8.93 years, 53.23% (n = 165) were male while 46.77% (n = 145) were female, frequency of peripheral artery disease (PAD) on gold standard was recorded as 28.71% (n = 89), diagnostic accuracy of Ankle-Brachial Index (ABI) in diagnosing peripheral artery disease (PAD) in patients with coronary artery disease (CAD) was calculated as 93.25%, 94.21%, 86.46%, 97.20% and 93.87% as specificity, sensitivity, negative predictive value, positive predictive value and accuracy rate respectively.Conclusion:There is a 28.7% incidence of PAD in patients with known CAD in our study population. The ABI is a simple, easy low cost and yet underutilized tool that can detect PAD with high diagnostic accuracy in this population.Keywords:Coronary artery disease (CAD), peripheral artery disease (PAD), diagnosis, ankle bra-chial index (ABI), accuracy

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Diagnostic accuracy of the postexercise ankle–brachial index for detecting peripheral artery disease in suspected claudicants with and without diabetes

Vascular Medicine ◽

10.1177/1358863x17751259 ◽

2018 ◽

Vol 23 (2) ◽

pp. 116-125 ◽

Cited By ~ 13

Author(s):

Peta Ellen Tehan ◽

Alex Louise Barwick ◽

Mathew Sebastian ◽

Vivienne Helaine Chuter

Keyword(s):

Diagnostic Accuracy ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Area Under The Curve ◽

Duplex Ultrasound ◽

Peripheral Artery ◽

Diabetes Group ◽

Artery Disease ◽

Similar Accuracy ◽

Vascular Status

The postexercise ankle–brachial index (ABI) is recommended in patients with normal resting ABI when peripheral artery disease (PAD) is suspected. The aims of this study were to determine the comparative diagnostic accuracy of the resting and postexercise ABI for detecting PAD, and, the effect of the presence of diabetes on these. Three methods of interpretation currently in use were also investigated: a reduction in postexercise ABI by >20% compared to resting ABI, an ABI value of ≤0.90 postexercise, or a reduction in systolic ankle pressure of >30 mmHg postexercise. This retrospective study used colour duplex ultrasound (CDU) as the reference standard. In 278 limbs (whole group), the resting ABI had an overall area under the curve (AUC) of 0.71, with the postexercise ABI yielding a similar diagnostic accuracy of AUC 0.72. In the non-diabetes group ( n=171), the resting ABI had an overall AUC of 0.74 and the postexercise ABI had a similar AUC of 0.76. In the diabetes group ( n=107), overall accuracy was reduced compared to the non-diabetes group, with the resting ABI having an overall AUC of 0.65 and the postexercise ABI yielding a similar accuracy with an AUC of 0.64. The overall diagnostic accuracy of the postexercise ABI for diagnosing PAD was not greatly improved compared to resting ABI. Given the lower overall diagnostic accuracy in the diabetes group, both the resting and the postexercise ABI results in diabetes populations should be interpreted with caution. There is a risk of undiagnosed disease if relying on these results alone to determine lower limb vascular status.

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12.15 ACCURACY OF OSCILLOMETRIC DETERMINATION OF THE ANKLE-BRACHIAL INDEX AS SCREENING METHOD FOR PERIPHERAL ARTERY DISEASE

Artery Research ◽

10.1016/j.artres.2011.10.198 ◽

2011 ◽

Vol 5 (4) ◽

pp. 204 ◽

Cited By ~ 1

Author(s):

L. Campens ◽

T. De Backer ◽

S. Simoens ◽

F. Vermassen ◽

M. Coeman ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Screening Method ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Artery Disease

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Validation of a New Method of Detecting Peripheral Artery Disease by Determination of Ankle-Brachial Index Using an Automatic Blood Pressure Device

Angiology ◽

10.1177/000331970405500203 ◽

2004 ◽

Vol 55 (2) ◽

pp. 127-134 ◽

Cited By ~ 31

Author(s):

Alain Benchimol ◽

Virginie Bernard ◽

Xavier Pillois ◽

Nghi Tran Hong ◽

Daniel Benchimol ◽

...

Keyword(s):

Blood Pressure ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

New Method ◽

Peripheral Artery ◽

Automatic Blood Pressure ◽

Artery Disease ◽

Blood Pressure Device

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Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽

10.1177/00033197211004393 ◽

2021 ◽

pp. 000331972110043

Author(s):

Clemens Höbaus ◽

Gerfried Pesau ◽

Bernhard Zierfuss ◽

Renate Koppensteiner ◽

Gerit-Holger Schernthaner

Keyword(s):

Peripheral Artery Disease ◽

Cox Regression ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Cross Sectional ◽

Term Survival ◽

Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

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Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2352 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Yu ◽

J Teliewubai ◽

X Fan ◽

C Chi ◽

H Ji ◽

...

Keyword(s):

Myocardial Perfusion ◽

Peripheral Artery Disease ◽

Wave Reflection ◽

Pulse Wave ◽

Ankle Brachial Index ◽

Community Dwelling ◽

Peripheral Artery ◽

Cardiac Damage ◽

Pulse Wave Reflection ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P<0.001) but higher AP (19 vs. 17 mmHg, P<0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

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Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease

Diagnostics ◽

10.3390/diagnostics11081407 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1407

Author(s):

Robert K. Clemens ◽

Monika Hunjadi ◽

Andreas Ritsch ◽

Lucia Rohrer ◽

Thomas O. Meier ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cholesterol Efflux ◽

Ankle Brachial Index ◽

Mortality Rates ◽

High Density Lipoproteins ◽

Peripheral Artery ◽

Cholesterol Efflux Capacity ◽

Hdl Function ◽

All Cause Mortality ◽

Artery Disease

Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.

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A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease

Angiology ◽

10.1177/0003319719896477 ◽

2019 ◽

Vol 71 (4) ◽

pp. 303-314

Author(s):

Rupert Bauersachs ◽

Sebastian Debus ◽

Mark Nehler ◽

Maria Huelsebeck ◽

Janita Balradj ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Disease Burden ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Economic Burden Of Disease ◽

Surgical Interventions ◽

Treatment Practice ◽

Patient Profile ◽

Increased Risk ◽

Artery Disease

Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.

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