DIAGNOSING PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH KNOWN CORONARY ARTERY DISEASE IN A TERTIARY CARE CENTER IN LAHORE AND ASSESSING DIAGNOSTIC ACCURACY OF ANKLE � BRACHIAL INDEX TAKING DUPLEX ULTRASOUND AS GOLD STANDARD

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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The role of novel cytokines in inflammation: Defining peripheral artery disease among patients with coronary artery disease

Vascular Medicine ◽

10.1177/1358863x18763096 ◽

2018 ◽

Vol 23 (5) ◽

pp. 428-436 ◽

Cited By ~ 12

Author(s):

Demet Ozkaramanli Gur ◽

Savas Guzel ◽

Aydin Akyuz ◽

Seref Alpsoy ◽

Niyazi Guler

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Vascular Involvement ◽

Future Research ◽

Syntax Score ◽

Peripheral Artery ◽

Artery Disease ◽

Distinct Features

Coronary artery disease (CAD) patients with concomitant peripheral artery disease (PAD) experience more extensive and calcified atherosclerosis, greater lesion progression and more common coronary events compared to patients with CAD only. To characterize the distinct features of this aggressive atherosclerotic disease, we studied novel cytokines that code different stages of atherogenesis. One hundred and eighty consecutive subjects (60 patients into each group of CAD+PAD, CAD and controls) were recruited among patients with stable angina pectoris scheduled for coronary angiography. An ankle–brachial index (ABI) ≤0.9 was determined as occlusive PAD. Fasting serum tumor necrosis factor (TNF)-like antigen 1A (TL1A) and its receptor death receptor 3 (DR3), NOGO-B (reticulon 4B) and its receptor NUS1, high-sensitivity C-reactive protein (hsCRP), A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 1, 4, 5 and interleukin (IL) 6 levels were determined. Serum hsCRP and DR3/TL1A concentrations were similar and higher than controls in the CAD and CAD+PAD groups. Levels of NOGO-B and its receptor NUS1 were increased and ADAMTS-5 was decreased in patients with CAD+PAD. Independent predictors of ABI in multivariate analysis were smoking (B = −0.13, p = 0.04), NUS1 (B = −0.88, p < 0.001), ADAMTS-5 (B = 0.63, p < 0.001) and SYNTAX score (B = −0.26, p < 0.001). Similarly, smoking (OR = 5.5, p = 0.019), SYNTAX score (OR = 1.2, p < 0.001), NUS1 (OR = 14.4, p < 0.001), ADAMTS-5 (OR = 1.1, p < 0.001) and age (OR = 1.1, p = 0.042) independently predicted the involvement of peripheral vasculature in logistic regression. The diagnostic performance of these cytokines to discriminate CAD+PAD were AUC 0.79 ( p < 0.001) for NUS1 and 0.37 ( p = 0.013) for ADAMTS-5. We report herein that circulating cytokines can give clues to the ongoing atherosclerotic process and the extent of vascular involvement in which distinct features of ADAMTS-5 and NUS1 make them promising cytokines for future research.

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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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Soluble RAGE Plasma Levels in Patients with Coronary Artery Disease and Peripheral Artery Disease

The Scientific World JOURNAL ◽

10.1155/2013/584504 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 22

Author(s):

Colomba Falcone ◽

Sara Bozzini ◽

Luigina Guasti ◽

Angela D’Angelo ◽

Anna Clizia Capettini ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Control Subjects ◽

Soluble Rage ◽

Large Patient ◽

Artery Disease

The objective of the present study was define in a relatively large patient population with coronary artery disease (CAD) whether the concomitant presence of peripheral artery disease (PAD), which is known to convey additional cardiovascular risk, was associated with different circulating levels of sRAGE with respect to CAD alone and control subjects. Clinical and laboratory parameters including the ankle brachial index (ABI) and sRAGE (enzyme-linked immunosorbent assay kit) were investigated in 544 patients with angiographically documented CAD and 328 control subjects. 213/554 CAD patients (39%) showed an ABI <0.9 associated with typical symptoms (group CAD + PAD), whereas 331 patients were free from PAD. The concentration of plasma sRAGE was significantly lower (P<0.0001) in CAD population, with and without PAD, than in control subjects. Among CAD patients, those with PAD showed lower levels of sRAGE. The distribution of the three groups (CAD, CAD + PAD, and controls) according to sRAGE tertiles showed that lower levels were more frequent in patients with CAD and CAD + PAD, whereas higher levels were more frequently found in controls. CAD patients presenting with PAD have lower sRAGE levels than CAD patients without peripheral atherosclerosis showing that stable atherosclerotic lesions in different vascular districts are inversely related to soluble decoy receptor sRAGE.

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Fréquence de l’association artériopathie oblitérante des membres inférieurs et coronaropathie : résultats d’une étude transversale monocentrique à l’est algérien

Batna Journal of Medical Sciences (BJMS) ◽

10.48087/bjmsoa.2020.7202 ◽

2020 ◽

Vol 7 (2) ◽

pp. 74-78

Author(s):

Rachid Merghit ◽

◽

Mouloud Ait Athmane ◽

Abdelhak Lakehal

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Systolic Pressure ◽

Lower Limbs ◽

University Hospital ◽

Peripheral Artery ◽

Cross Sectional ◽

Artery Disease ◽

Brachial Systolic Pressure

Introduction. Patients with both Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD) have a worse cardiovascular prognosis. It therefore seems interesting to detect this association, in particular by measuring the ankle-brachial systolic pressure index (ABI) which is a simple, inexpensive, and non-invasive way with a significant diagnostic input that can detect silent but threatening lesions. It can also identify a subgroup of patients with coronary artery disease at a higher cardiovascular risk requiring a more specific management. Aims. Estimate the frequency of peripheral artery disease (PAD) in patients with Coronary Artery Disease CAD who were recruited at the department of cardiology at the university hospital of Constantine. This the study also aims to detect the risk factors of this association. Patients and methods. Our study is descriptive, cross-sectional, single-centered in cardiovascular exploration units of the regional military university hospital of Constantine. The included subjects had at least one significant coronary lesion in a major coronary artery using radial Coronary angiography. Guided medical history and a cardiovascular clinical examination preceded the measurement of the ABI for each patient. PAD was defined by an ABI of less than 0.90 in one of the four distal arteries of the two lower limbs. Data were analyzed and processed by Epi-Info Statistics V7. Results. 300 coronary patients, the average age of 61 years, mostly males, took part in the study. The frequency of the combination of PAD and coronary artery disease was 34.7% using the ABI, asymptomatic in 18% of cases. independent factors of the association were : Age≥ 65 [aOR 3,67, P <0,0001], tobacco [aOR 4,10, P<0,002], diabetes [aOR 3,48, P<0,0001] , AHT [aOR 3,30, P<0,0001], dyslipidemia [aOR 2.32, P<0,009], inactivity [aOR 2,14, P<0,015] , stroke [aOR 6,4, P<0,015] and severe coronary impairment [aOR 2,36, P<0,015]. Conclusion. ABI, in addition to being an early detection tool for PAD, its dissemination in medical practice would help in the approach and refinement of vascular risk in coronary heart patients.

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