scholarly journals Utility of Alternative Ankle Brachial Pressure Index for Screening Asymptomatic Peripheral Arterial Diseases in Patients with Acute Myocardial Infarction and Cerebrovascular Accident

2021 ◽  
Vol 10 (10) ◽  
pp. 684-688
Author(s):  
Amulya Cherukumudi ◽  
Kalale Radhakrishna Iyengar Bhagavan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Peripheral Arterial Disease ◽  
Cerebrovascular Accident ◽  
Arterial Disease ◽  
Ankle Brachial Pressure Index ◽  
Pressure Index ◽  
Peripheral Arterial Diseases ◽  
Acute Mi ◽  
Peripheral Arterial

BACKGROUND Peripheral arterial disease (PAD) is one of the macrovascular manifestations of systemic, diffuse atherosclerosis. Patients with acute myocardial infarction are at 3 - 5 times higher risk of developing associated PAD. Ankle Brachial Pressure Index (ABPI) is a simple, non-invasive test to diagnose peripheral arterial diseases in symptomatic cases. We wanted to assess the utility of an alternative formula for Ankle Brachial Pressure Index as a sensitive screening tool for asymptomatic peripheral arterial diseases in patients with acute myocardial infarction and cerebrovascular accident. METHODS This is a prospective observational study, recruiting eligible patients from medicine and cardiology outpatient department (OPD). Patients included were those with acute myocardial infarction (MI) or cerebrovascular accident (CVA). Sample size was calculated to be 257. ABPI was measured using a hand-held Doppler of 8 MHz and a standard sphygmomanometer. Statistical analysis was performed using SPSS software. RESULTS Alternate ABPI showed a mean value of 0.9 + / - 0.072. In the study population, 61.1 % were found to have abnormal ABPI i.e., less than 0.9, which is nearly two thirds of the population. Receiver operating characteristic curve (ROC) was plotted against ABPI for sensitivity and specificity for the co-morbidities considered in the study. It was found that the AUC (Area Under the Curve) was statistically significant for acute MI and acute CVA, with a fair positive correlation. CONCLUSIONS The alternative, ABPI is a good screening test for detecting asymptomatic PAD in patients with acute MI and CVA. However, further comparative studies are required to confirm the utility of the same in such patients, especially in a larger, varied population. KEY WORDS Ankle Brachial Pressure Index, Atherosclerosis, Peripheral Arterial Disease, Cardiovascular Diseases

Ankle Brachial Pressure Index: An update for the vascular specialist and general practitioner

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 560-570 ◽  
Author(s):  
Benjamin Thurston ◽  
Joseph Dawson
Keyword(s):  
Blood Pressure ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Cardiac Risk Factor ◽  
Diabetic Patients ◽  
Ankle Brachial Pressure Index ◽  
Pressure Index ◽  
Clinical Scenarios ◽  
Invaluable Tool ◽  
Peripheral Arterial

Objectives Ankle brachial pressure index (ABPI) is an invaluable tool for assessing the severity of peripheral arterial disease. In addition, it can be used as an independent marker of cardiovascular risk, with a predictive ability similar to the Framingham criteria. Identification of an abnormal ABPI should therefore trigger aggressive cardiac risk factor modulation for a patient. Unfortunately, the significance of abnormal ABPIs is poorly understood within the general medical community. This is compounded by the influence of various comorbidities on accurate measurement of ABPI, potentially leading to a wide variability in readings that need to be considered before interpretation in these patient populations. We aim to address these issues by revealing several common misunderstandings and pitfalls in ABPI measurement, describing accurate methodology, and highlighting patient cohorts in whom additional or alternative approaches may be required. Methods We present a narrative review of the role of ABPI in both the community and hospital setting. We have performed a literature review, exploring the validity and reproducibility of methodology for obtaining ABPI, alongside the utility of ABPI in different clinical scenarios. Results The measurement of ABPI is often performed incorrectly. Common pitfalls include inadequate patient preparation, failure to obtain the blood pressure from the correct lower limb artery in patients with tibial disease, failure to account for differences in brachial blood pressure between the arms, inappropriately chosen equipment and patient factors such as highly calcified arteries. Standardisation of methodology greatly improves reliability of the test. Exercise ABPI can identify significant peripheral arterial disease in patients with normal resting ABPI. In addition to its role in peripheral arterial disease, ABPI measurement has a role in assessing venous ulcers, entrapment syndromes and injured extremities; conversely, it has a more limited utility in the diabetic population. Conclusions A thorough understanding of the correct technique and associated limitations of ABPI measurement is essential in accurately generating and interpreting the data it provides. With this knowledge, the ABPI is an invaluable tool to help manage patients with peripheral arterial disease. Perhaps more importantly, ABPI can be used to identify and risk stratify patients with asymptomatic peripheral arterial disease, itself a major indicator of significant underlying cardiovascular disease. With the emergence of best medical therapy, targeted pharmacotherapy and lifestyle changes can reduce the risk of major cardiovascular events in high-risk patients by approximately 30%, particularly in diabetic patients. Therefore, the utility of ABPI transgresses vascular surgery, with an essential role in general practice and public health.

Sign in / Sign up

Export Citation Format

Share Document