Abstract
The aim of this study was to compare the ankle-brachial index between patients with atrial fibrillation (AF) and those without atrial fibrillation. A total of 286 patients admitted to the Departments of Neurology or Cardiology, Kaunas Clinical Hospital, during 2008-2010 and referred for a consultation with an internist and/or a cardiologist were included in this study. All patients had at least one prevalent cardiovascular disorder and were screened for diagnosis of permanent AF based on medical records and electrocardiogram and evaluated for the ankle-brachial index (ABI). Peripheral artery disease (PAD) was defined as an ABI of <0.9 assessed by using a 5-MHz Doppler ultrasound device. The patients with permanent AF had a significantly lower ABI compared with the patients without AF (P<0.001). Binary regression analysis revealed that permanent AF was associated with PAD (OR, 2.5; 95% 1.5-4.2). The likelihood of having an ABI of <0.9 increased with each additional risk factor: AF (OR, 2.2; 95% CI, 1.3-3.8), stroke (OR, 2.3; 95% CI, 1.3-4.2), age of >69 years (OR, 2.4; 95% CI, 1.3-4.7), and myocardial infarction (OR, 2.4; 95% CI, 1.1-5.5). Nearly one-fourth (24.5%) of all patients with an ABI of <0.9 did not report any PAD-specific symptoms. The patients with cardiovascular disorders and permanent atrial fibrillation were found to have a significantly lower mean ankle-brachial index and higher prevalence of peripheral artery disease compared with cardiovascular patients without atrial fibrillation. The patients who were found to have a lower ankle-brachial index and permanent atrial fibrillation were older and often had several cardiovascular diseases (angina pectoris, stroke, myocardial infarction, or hypertension).
Highlights
Diagnosis of peripheral artery disease (PAD) is important in preventing further cardiovascular complications
The patients with permanent Atrial fibrillation (AF) had a significantly lower ankle-brachial index (ABI) compared with the patients without AF (P
The patients with cardiovascular disorders and permanent atrial fibrillation were found to have a significantly lower mean ankle-brachial index and higher prevalence of peripheral artery disease compared with cardiovascular patients without atrial fibrillation
Summary
Diagnosis of peripheral artery disease (PAD) is important in preventing further cardiovascular complications. The ankle-brachial index (ABI) is a simple and reliable tool for diagnosing PAD. It is simple enough to be performed in any physician’s office, especially if a patient reports limb symptoms. Normal ABI values generally range from 0.91 to 1.3, and the value of 0.9 or less is considered as an evidence of PAD [1]. Many studies have underscored the importance of using ABI values as independent predictors of cardiovascular events, such as stroke, myocardial infarction, heart failure, lower extremity amputation, and mortality [2, 3]. Atrial fibrillation (AF) in patients with symptomatic PAD is associated with worse cardiovascular outcomes.
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