Diastolic versus systolic ankle-brachial pressure index using ultrasound imaging & automated oscillometric measurement in diabetic patients with calcified and non-calcified lower limb arteries.

Akram M. Asbeutah,Sami K. Asfar,Abdullah A. AlMajran

doi:10.1186/s12872-016-0377-1

Akram M. Asbeutah, Sami K. Asfar + Show 1 more

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https://doi.org/10.1186/s12872-016-0377-1

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Abstract

BackgroundAnkle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and therefore loses its value in this cohort of patients. We aim at investigating the feasibility of using the diastolic (ABI-d) instead of ABI-s to calculate the ABI in diabetic patients with calcified limb arteries.MethodsA total of 51 patients were chosen from the diabetic foot clinic. Twenty six of these patients had calcified leg arteries by Duplex scan (Group A) and 25 patients did not have calcifications in their leg arteries (Group B). Twenty five healthy volunteers were enrolled in the study for group C and they were matched with other participants from group B and A in age and sex. ABI measurement was performed using “boso ABI-system 100 machine”. Systolic ABI (ABI-s) and diastolic ABI (ABI-d) were calculated based on bilateral brachial and ankle oscillometric pressures. ABI is considered normal when it is ≥0.9. Repeated measures ANOVA test was used to test for comparing mean scores for ABI-s and ABI-d across the three groups. Statistical significance is considered when P < .05.ResultsThe mean age of all participants (±SD) was 64.30 ± 7.1 years (range, 50–82 years). ABI-s mean ± SD was 1.3 ± 0.10 (range, 1.18–1.58) in group A patients, 1.07 ± 0.05 (range, 1–1.16) in group B patients, and 1.06 ± 0.05 (range, 1–1.16) in group C volunteers. While ABI-d mean ± SD was 1.07 ± 0.05 (range, 1.1–1.17) in group A patients, 1.06 ± 0.05 (1–1.14) in group B patients, and 1.05 ± 0.04 (range, 1.01–1.14) in group C volunteers. In group A, repeated measures ANOVA test showed statistical significant difference between ABI-s and ABI-d (P < 0.001) whereas in group B & C was not (P > 0.05).ConclusionsABI-d may be helpful and can be used as a complementary measure instead of ABI-s in falsely elevated ABI caused by partial incompressible vessel.

Highlights

Ankle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and loses its value in this cohort of patients
A total of 51 diabetic patients and 25 healthy control participated in this ABI study
In the present study we have shown that the boso ABI machine measurement is repeatable, oscillometric machines have been previously shown to be inaccurate in nearly 20 % of the time [17]

Summary

Introduction

Ankle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and loses its value in this cohort of patients. Many studies showed that by measuring the ABI, many patients with unrecognized PAD can be diagnosed. This early detection of PAD by this test is crucial as it has been found that the presence of PAD is an independent predictor of future cardiovascular disease [6, 7]. Since the very beginning of modern noninvasive vascular laboratory studies, the ankle-brachial systolic pressure index (ABI-s) has been a fundamental tool used to detect, screen, and follow up of patients suffering from PAD [8].

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