Abnormal Ankle-brachial Pressure Index Research Articles

Peripheral artery disease in patients with stable coronary artery disease in general practice: results from an Italian nationwide study-PAD & CAD study.

Peripheral artery disease (PAD) remains underdiagnosed in patients with coronary artery disease (CAD) and barriers persist to measure screening PADin routine clinical practice. We assessed the prevalence of PAD in patients with CAD in Italian primary care setting using an easy automatic instrument to measure ankle brachial pressure index (ABI). A multicenter, observational study was conducted with 32 General Practitioners (GPs). Prevalence of PAD was calculated dividing the number of patients with abnormal ABI value, or with symptoms associated with PAD or history of lower limb revascularization procedures, over the total number of patients included in the study. Incidence of major CV clinical events and all-cause death was also evaluated at 12months in both CAD and CAD + PAD groups. In total, 713 CAD patients were included in the study, 148 (20.8%) patients had also PAD, asymptomatic in nearly 15% of them (106). The 35.4% of patients had ABI value ≤ 0.9 and 46.0% > 1.3 ABI. A significantly higher incidence of major CV events and all-cause death was seen in patients with PAD than in those without. Over 80% of patients received the therapy for secondary CV prevention and difference was seen between groups. Our findings showed that the use of an easy automatic instrument to measure ABI, easily managed by nurses, allowed to detect PAD in a relevant proportion of CAD patients who otherwise would not have been recognized. This encourages performing PAD screening in primary care setting to optimize the management of major CV risk factors associated with PAD. NCTumber: NCT03921905.

English

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

Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality

BackgroundAn abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse prognosis in patients with previous CV events or with cancer mortality. Materials and MethodsConsecutive subjects undergoing ABI assessment for suspected peripheral artery disease or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy), between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3, and abnormal <0.9 or >1.3. All-cause mortality and CV or cancer mortality and hospitalizations for CV disease were collected from administrative databases up to December 2018. ResultsThe study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was 61.6 months (53.4–70.1). All-cause, CV and cancer mortality were higher in patients with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48–2.69), 1.98 (95% CI 1.24–3.17) and 1.85 (95% CI 1.09–3.15). Among subjects with abnormal ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17–2.12), and CV mortality, HR 2.39 (95% CI 1.43–3.99), was higher in those with previous CV events. These latter also had a higher risk of hospitalization for myocardial infarction and stroke: HR 1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10–4.28). ConclusionsThe co-existence of abnormal ABI and a history of CV events identifies subjects at higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor of cancer mortality.

The prevalence of and risk factors for peripheral arterial occlusive disease in human immunodeficiency virus-infected omani patients: The first study in GCC

Aim: To assess the prevalence of peripheral arterial occlusive disease (PAOD) in human immunodeficiency virus (HIV)-infected Omani patients and to assess the potential risk factors in this group. Methodology: This was a single-center, cross-sectional study. All patients attending the infectious disease clinic between July 2017 and March 2018 were included in the study; their peripheral pulses were examined and pre- and postexercise ankle–brachial pressure index (ABPI) was measured. Normal ABPI was considered as being in the range of 1.0 ± 0.1, and a reduction of >15% postexercise ABPI was considered as a cutoff limit to define PAOD. The Edinburgh Claudication Questionnaire was answered by all patients, and CD4 count, viral load, albumin and Vitamin D (25-OH) levels, and glycated hemoglobin (HbA1c) were measured. The data were analyzed using IBM SPSS Statistics version 22. Results: Eighty-eight patients who were retroviral positive were enrolled in the study. Fifty-three (60.2%) patients were male and 35 (39.8%) were female, with a mean age of 43 years (24–71). The dorsalis pedis artery pulsation was absent bilaterally in 3 (3.4%) patients. None of the patients had a history of claudication; 1 (1.1%) had an abnormal ABPI; 17 (19.2%) had a reduction of >15% postexercise ABPI; 7 (8%) had CD4 count

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

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.

Does Severity of Coronary Artery Disease Predict an Abnormal Ankle Brachial Pressure Index (ABPI)?

Introduction: Coronary artery disease (CAD) and peripheral arterial disease (PAD) share the same pathophysiology, but whether the angiographic extent of CAD predicts an abnormal ABPI in a Coronary Care Unit (CCU) setting has not been evaluated. Objectives: We examined for associations between angiographic CAD severity and abnormal ABPI, suggesting the presence of PAD. Methods: We performed a prospective consecutive observational series involving patients admitted to CCU and undergoing coronary angiography. Patients with unmeasurable ABPI or pre-existing PAD were excluded. The ABPI was performed by trained clinical staff and an ABPI ≤ 0.90 was taken as abnormal, which was analysed against the severity of CAD. Angiographic severity >70% stenosis in any major vessel, or previous coronary revascularisation was taken as significant CAD. Results: 82 patients were recruited between August and December 2018. The prevalence of an abnormal ABPI was similar in those with normal coronary arteries and those with any degree of coronary disease: 1 of 8 (12.50%) with normal coronaries had abnormal ABPI versus 12 of 74 (16.21%) of those with coronary disease (p = 0.785). When assessing for a relationship between significant CAD and abnormal ABPI there was none seen; out of 21 patients with no significant CAD (none or mild disease), 3 had abnormal ABPI (14.28%), compared with 10 of 61 patients with significant CAD (16.39%) (p = 0.820). Similarly, there was no association between double and triple vessel CAD and abnormal ABPI. Conclusion: Despite the shared pathophysiology, severity of CAD does not predict an abnormal ABPI in this clinical setting.

Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus: Correlating Ankle Brachial Pressure Index with Coronary Angiography

Diabetes mellitus (DM) affects over 366 million people worldwide ; this figure is expected to rise to 522 million by the year 2030. The macrovascular complications of diabetes cause morbidity and mortality. Ankle brachial pressure index (ABPI) is a simple non-invasive tool which may indicate atherosclerotic changes in the blood vessels. It is useful in diagnosis of peripheral artery disease (PAD), and is also an indicator of increased cardiovascular morbidity and mortality. Previous studies have reported a correlation between ABPI and coronary artery disease (CAD). Despite the well-established association between diabetes and coronary artery disease, the role of ABPI in predicting the presence and severity of CAD in diabetics has not been proven. The study was done to find whether there was an association between ABPI and coronary angiogram in diabetics. Materials and Methods: This was a cross sectional study that included 100 patients of Diabetes Mellitus who had undergone a coronary angiogram during the current admission. All coronary angiograms were evaluated by a cardiologist. The ABPI was measured according to the standardized protocol before the patients underwent the coronary angiogram procedure. Results: Out of the patients, 4 patients (4.3%) had ABPI < 0.9 out of which 2 (50%) had double vessel disease and 2 (50%) had triple vessel disease. Conclusion: Though all patients with abnormal ABPI had CAD as assessed by CAG, not all patients with abnormal CAG had abnormal ABPI. Thus the utility of ABPI as a surrogate marker in screening of CAD is limited.

Concomitant Occlusive Vascular Lesions of Legs in Patients with Degenerative Lumbar Diseases: Do These Lesions Influence Treatment?

Vascular narrowing or obstruction reduces blood flow to the lower limbs during exercise or at rest. Symptoms may range from intermittent claudication to pain at rest. Narrowing of these arteries may produce pain in the buttocks, thighs, or legs. These symptoms may resemble those of lumbar radicular pain. Spine surgeons may overlook obstructive vascular lesions of the lower limbs in patients with lumbar degenerative diseases such as spinal stenosis and spondylolisthesis. We investigated the clinical and radiologic risk factors of concomitant vascular pathologic lesions in patients with degenerative lumbar diseases. If patients presented with a weak or absent dorsalis pedis artery pulse, edema of both legs, and a past history related to vascular lesions of the lower limbs, we evaluated the veins and arteries of the lower extremities using Doppler sonography. If abnormal vascular findings were detected, computed tomography angiography (CTA) of the lower extremities was performed. Radiologic and clinical risk factors of concomitant occlusive arterial lesions of the lower limb were analyzed by logistic regression analysis. In 2013, 335 patients suspected of having vascular lesions underwent Doppler sonography. Among them, CTA of the lower extremities was performed in 58 patients. The mean age was 69.4 years (35 men and 23 women). Severe narrowing or total occlusion of the leg arteries was detected in 23 patients. Partial obstructive arterial disease of the legs was detected in 14 patients. Occlusion but with good collateral circulation of the leg was found in three patients. Surgical treatment plans were cancelled or changed in 28 patients. The risk factors for occlusive arterial lesions of the legs were an abnormal ankle-brachial pressure index (ABPI), absent dorsalis pedis artery pulse, and lack of response after a pain-blocking procedure. If patients present with a weak or absent dorsalis pedis artery pulse, abnormal ABPI ratio, and no response after a pain-blocking procedure, the clinician should consider the possibility of severe arterial occlusion of the legs. We suggest that the differential diagnosis of obstructive arterial lesions of the legs from lumbar degenerative diseases is important to prevent unnecessary invasive surgical treatment of the lumbar spine.

Diagnosis of peripheral vascular disease for diabetic foot risk assessment

BackgroundWithin Australia, peripheral arterial disease (PAD) affects 10–25% of people over the age of 55, which can lead to foot ulceration and gangrene. PAD is more common in people with type 2 diabetes, who if ulcers appear, have a lower recovery rate. Therefore it is important to find diagnostic tools, which are accurate and identify PAD early in disease development. The ankle-brachial-pressure index (ABPI) is most often used in primary health care. However these lack sensitivity. MethodsUsing convenience sampling 60 participants were recruited at Charles Sturt University and divided into two age groups of <30 and >30 years as well as into females and males. The ABPI and pulse wave analysis, using peak blood flow velocity (PBFV) were compared. Both parametric and nonparametric statistics were used depending on the data source. Significance was set at p<0.05. ResultsTwenty-nine participants were under 30 years of age and the remainder above 30 years of age with no known pathology. ABPI results ranged between 0.91 and 1.17 and PBFV between 7.6 and 51.8cm/s. No participants had abnormal ABPI. Only PBFV showed significant differences for age and gender (p<0.05). Post hoc analysis indicated that both ABPI and PBFV were significantly different between the younger males compared to the older females; older males to older females and younger females to older females. DiscussionNormative data in a healthy younger population is an important adjunct to clinical reviews and the method used to determine abnormal blood flow. Of interest is that the ABPI results fall between 0.91 and 1.17 suggesting that the currently used lower cut-off of 0.9 is appropriate but that that the higher cut-off could be moved down from 1.3 for clinical decision making.

Association of Ankle Brachial Pressure Index (ABPI) in Patients with Ischemic Stroke : A Case Control Study

Background: Several epidemiological studies have identified the association of abnormal ABPI with ischemic stroke. So the goal of this study was to determine the actual relationship of ABPI with ischemic stroke in the context of our country. Methods: This case control study was carried out in the Department of Neurology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. ABPI was measured by Doppler ultrasound machine of 100 patients who were admitted to the Mitford Hospital during the study period. Among them 50 patients with Ischemic stroke, confirmed by CT/MRI scan of brain were considered as ‘case’ and 50 age-sex matched individuals with one or more vascular risk factors (VRF) but without stroke were considered as ‘control’. Then the results of ABPI were compared between the two groups. Results: Among the 50 patients with ischemic stroke (case group), 74% had normal ABPI and 26% had ABPI&lt; 0.9; on the other hand among 50 age and sex matched individuals (control group) 90% had normal ABPI and 10% had ABPI &lt;0.9. The difference was statistically significant between two groups. (p=&lt;0.05).This association remained significant even after adjustment for potential confounders (age, gender, high BMI, hypertension, diabetes mellitus, hyperlipidemia, smoking, ischemic heart disease and family history) in a multiple logistic regression model. Conclusion: The incidence of low ABPI is significantly higher in ischemic stroke patients than the age- sex matched control. Chattagram Maa-O-Shishu Hospital Medical College Journal Volume 12, Issue 3, September 2013: 27-33

The prevalence of abnormal pulse wave velocity, pulse contour analysis and ankle-brachial index in patients with livedo reticularis: a controlled study

To evaluate the prevalence of abnormal pulse wave velocity (PWV), pulse contour analysis (PCA) and abnormal ankle-brachial pressure index (ABPI) in patients with livedo reticularis (livedo) and without livedo. We recruited 74 patients, of whom 41 had livedo: 16 APS, 9 APS with SLE and 16 with livedo (negative for aPL or lupus). The other group of 33 patients without livedo consisted of 10 APS, 8 APS with SLE and 15 with SLE only. Livedo was diagnosed and confirmed by a dermatologist. PWV was assessed in fasting patients by the Micro Medical PulseTrace analyser using a 4 MHz continuous-wave directional Doppler probe and digital PCA was analysed by Micro Medical PulseTrace by the same operator. Chi-square with Yates's correction was used for comparing results. The median age of the livedo patients was 46 (29-71) years and of the non-livedo patients was 45 (25-68) years. Abnormal values of PWV in 10/41 (24.40%), ABPI in 4/41 (9.8%) and PCA in 10/41 (24.40%) patients were observed in the livedo group and in the non-livedo group abnormal values of PWV in 1/33 (P ≤ 0.025), ABPI in 0/33 (P = NS) and PCA in 5/33 (P = NS) were observed. Patients with livedo reticularis are more likely to have abnormal PWV, indicating arterial stiffness.

SAT0296 Brachial-ankle index for assessing cardiovascular risk in patients with psoriatic arthritis, psoriasis alone and controls

BackgroundPatients with psoriatic arthritis (PsA) and with moderate to severe chronic plaque psoriasis (PS) have a higher prevalence of cardiovascular (CV) risk factors and atherosclerosis. The Ankle-Brachial pressure Index (ABPI)...

Association of Ankle Brachial Pressure Index (ABPI) in Patients with Ischemic Stroke: A Case-Control Study

Background: Several epidemiological studies have identified the association of abnormal ABPI with ischemic stroke. So the goal of this study was to determine the actual relationship of ABPI with ischemic stroke in the context of our country.&#x0D; Materials and Methods: This case control study was carried out in the Department of Neurology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. ABPI was measured by Doppler ultrasound machine of 100 patients who were admitted to the Mitford Hospital during the study period. Among them 50 patients with Ischemic stroke, confirmed by CT/MRI scan of brain were considered as ‘case’ and 50 age- sex matched individuals with one or more vascular risk factors (VRF) but without stroke were considered as ‘control’. Then the results of ABPI were compared between the two groups.&#x0D; Results: Among the 50 patients with ischemic stroke (case group) , 74% had normal ABPI and 26% had ABPI&lt; 0.9; on the other hand among 50 age and sex matched individuals (control group) 90% had normal ABPI and 10% had ABPI &lt;0.9. The difference was statistically significant between two groups (p=&lt;0.05).This association remained significant even after adjustment for potential confounders (age, gender, high BMI, hypertension, diabetes mellitus, hyperlipidemia, smoking, ischemic heart disease and family history) in a multiple logistic regression model.&#x0D; Conclusion: The incidence of low ABPI is significantly higher in ischemic stroke patients than the age- sex matched control.&#x0D; Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 31-42

Brachial‐Ankle Pulse Wave Velocity and the Cardio‐Ankle Vascular Index as a Predictor of Cardiovascular Outcomes in Patients on Regular Hemodialysis

Brachial-ankle pulse wave velocity (baPWV) and the cardio-ankle vascular index (CAVI) are both used to evaluate arterial stiffness. The aim of the present study is to determine whether baPWV or CAVI is superior as a marker of arterial stiffness in hemodialysis (HD) patients. Of 194 patients, 59 patients had been excluded from the study due to advanced age over 76 years old (n = 29), or abnormal ankle-brachial pressure index (ABI) (<0.90 or ≥1.30) (n = 30). We then followed the 135 patients (age: 60 ± 11 years, time on HD: 110 ± 93 months) for the 63 ± 4 (55-70) months. Thirty-two (23.7%) patients had expired, 22 of them of cardiovascular (CV) causes. There were 37 fatal and non-fatal CV events. Kaplan-Meier analysis revealed that the patients with the highest tertile of baPWV (≥16.6 m/s) had a significantly lower survival rate (P < 0.01) when compared with the second (13.4 ≤ baPWV < 16.6 m/s) and the lowest tertiles (<13.4 m/s). Cox hazards analysis after adjustment for comorbid risk factors revealed that the top tertile of baPWV was a determinant of CV death (hazards ratio [HR]: 16.9 [1.1-251.8], P < 0.05) In contrast, CAVI did not associate with CV mortality or events. These findings suggest that baPWV is superior to CAVI as a predictor of CV outcomes in patients on regular HD.

Nurse-led rapid access vascular examination clinic triage reduces inappropriate referrals for peripheral arterial disease

Peripheral arterial disease causing intermittent claudication (IC) causes decreased quality of life and significant morbidity. We hypothesized that triage of patients referred with suspected IC at a nurse-led rapid access vascular examination (RAVE) clinic would identify those patients requiring vascular surgery assessment. A prospective cohort study was performed. Patients referred with suspected IC were assessed using the Edinburgh claudication questionnaire (ECQ) and arterial Doppler assessment with segmental waveform analysis and calculation of ankle brachial pressure index (ABPI). Data were collected regarding cardiovascular risk and its modification. Of 451 consecutive patients, mean age was 65 years (range 30-89). Cardiovascular risk factors included: 173/451 (38%) current smokers (162/451 (36%) were ex-smokers); diabetes, 22%; hypertension, 46%; ischaemic heart disease (angina), 29%; dyslipidaemia, 27%. Therapeutic risk modifications included: antiplatelet therapy, 64.4%; lipid-lowering therapy, 57.8%. abnormal ABPI readings were present in 264/451 (59%), with ratio <0.9 in 209/451 (46.3%), >1.3 in 48/451 (10.6%), and incompressible vessels 7/451 (1.5%). Normal ABPI (ratio >0.9 and <1.3, triphasic Doppler waveforms) were found in 187/451 (41%), these patient were considered inappropriate referrals. Considering those patient with PAD diagnosed on abnormal ABPI (<0.9 or >1.3), Doppler waveform analysis was more sensitive and specific than ECQ. Diagnosis of IC with clinical history alone is inaccurate in 41 percent of cases, leading to inappropriate referral to vascular surgery. Doppler waveform analysis had excellent sensitivity and specificity for prediction of ABPI <0.9. ABPI measurement in primary care could result in a more efficient use of clinical resources.

Recurrence Risk after Noncardioembolic Mild Ischemic Stroke in a Japanese Population

Background and Purpose: This study aimed to identify the recurrence rate and risk factors or clinical variables predictive of vascular events after mild ischemic stroke (IS). Methods: From December 2006 to September 2007, patients with acute IS with a modified Rankin Scale of 0∼1 were consecutively enrolled in this study. Variables including sex, family history of vascular disease, age, height, weight, stroke subtype, blood pressure, lipid profile, fasting glucose, HbA1c, smoking, alcohol consumption, exercise habits, waist circumference, ankle-brachial pressure index, salt intake and physical activity were assessed. The primary outcome was stroke recurrence or other vascular events such as myocardial infarction, angina pectoris, and peripheral artery disease. Survival curves were calculated by Kaplan-Meier survival analysis, and hazard ratios for recurrence were determined by univariate and multivariate Cox proportional hazards regression models. Results: A total of 102 mild IS patients (78 men and 24 women, mean age 64 years) were successfully followed for 3 years. Of those 102 patients, 25 (24.5%) had stroke recurrence, and 4 (3.9%) had a coronary event. Among the variables studied, abnormal ankle-brachial pressure index, metabolic syndrome, stroke subtypes, salt intake and poor lifestyle management were significant independent predictors of stroke recurrence or cardiovascular events. Conclusions: In mild IS patients within 3 years after onset, not only pathophysiological factors but also lifestyle factors can aid in the identification of patients at high risk for recurrence.

No early signs of atherosclerotic alterations in carriers of inherited thrombophilia

Background Congenital thrombophilia is a risk factor for venous thromboembolism (VTE). Whether it is associated with increased risk of arterial disease is today a matter of debate. We aimed to look for early signs of atherosclerotic alterations in carriers of inherited thrombophilic alterations (ITA). Methods Between January 2006 and September 2008 ultrasonography assessment of the carotid arteries with measurement of intima-media thickness (IMT), and determination of the ankle/brachial pressure index (ABI), was performed in: a) 161 carriers of ITA (deficiency of antithrombin, protein C or S, factor V Leiden or prothrombin G20210A mutations), 84 of whom with previous VTE, and b) 180 subjects without ITA, matched for age, sex and previous VTE. All subjects were < 66 year old. Results Carotid plaques were found in 8 subjects [3 (1.9%) with ITA]. Increased IMT values (> 1 mm) were detected in 6 subjects with and 1 without thrombophilia (p = 0.055). The prevalence of IMT values > 90 th percentile was not different in subjects with/without thrombophilia (15.2% vs 11.6%, p = 0.416). At multivariate analysis only age was significantly associated with increased odds ratios for IMT values > 90 th percentile. No subjects had abnormal (< 0.9) ABI values. Conclusions The present study, the first to investigate the presence of atherosclerotic markers in relatively young subjects with inherited thrombophilia, did not find a particular prevalence of signs of early atherosclerotic markers in these subjects.

The Pulse Volume Recorder as a Measure of Peripheral Vascular Status in People with Diabetes Mellitus

Peripheral vascular disease is common in persons with diabetes. There is growing evidence that the vascular contribution to foot disease in diabetes is greater than has previously been realized. A cross-sectional study of vascular status in 205 subjects with type 1 and type 2 diabetes mellitus was carried out as part of a larger diabetes assessment study. Palpation of pedal pulses, color spectral waveforms, pulse volume recording, and Doppler ankle-brachial pressure index (ABPI) were recorded bilaterally in all subjects. These modalities were evaluated descriptively, and kappa statistics were used to evaluate agreement between ABPI and pulse volume recording. In addition, visual comparisons between the color spectral waveforms (study gold standard) and pulse volume recordings were also undertaken, and clinical usefulness of pulse volume recording was evaluated. Results of this study identified 15.6% (n = 32) subjects having one or more pedal pulses absent on either foot, 47% (n = 98) an abnormal ABPI (<0.9/>1.30), 7.8% (n = 16) an abnormal monophasic waveform, and 7.3% (n = 15) with an abnormal pulse volume recording. The level of agreement between ABPI and pedal pulse palpation was low at 52.2%, between ABPI and spectral waveforms was low at 58%, and between ABPI and pulse volume recording was also low at 45.3%. When the pulse volume recordings were compared with the color spectral waveforms, however, the level of agreement was high at 91.7%. Pulse volume recording agrees well with the color spectral waveforms. It can be used with all subjects including those with edema. It is simple, quick, and valuable in a community setting to determine the need for further investigations.

Ankle-brachial pressure index: a simple tool for assessing cardiovascular risk in patients with systemic vasculitis

Cardiovascular disease may be increased in patients with systemic vasculitides (SV). The Ankle-Brachial Pressure Index (ABPI) is a non-invasive tool for the assessment of cardiovascular risk (CV). Our aim was to determine the prevalence of an abnormal ABPI in patients with SV and healthy controls and to correlate with clinical and serological parameters. We studied 54 consecutive vasculitis patients (20 males) attending the vasculitis clinic and 49 healthy subjects. Patients were classified according to the ACR 1990 criteria and the Chapel Hill Consensus definitions. There were 18 patients with Wegener's granulomatosis, eight with Behcet's disease, seven with Churg-Strauss Syndrome, three with Henoch-Schonlein purpura, three with polyarteritis nodosa, three with Takayasu's disease, three with p-ANCA associated vasculitis, three with urticarial vasculitis, two with cutaneous leucocytoclastic angiitis, one with microscopic polyangiitis, one with primary central nervous system angiitis, one giant cell arteritis and one with cutaneous vasculitis secondary to Sjogren's syndrome. Traditional risk factors as well as glucose, lipid profile, CRP, hsCRP, ANCA and aPL were assessed. ABPI was measured according to a consensus statement on the methodology. The ABPI was abnormal in 11/54 (20.4%) of SV patients and 2/49 (4%) of the control group (chi(2) with Yates correction = 4.8, P <or= 0.03). CV events were more prevalent in the SV patients with abnormal ABPI (45.5% vs 11.6%, P <or= 0.01). There is an increased prevalence of an abnormal ABPI in patients with systemic vasculitides implying an increased risk of cardiovascular disease. This simple tool may be clinically useful in identifying systemic vasculitis patients at risk of accelerated atherosclerosis.

Evaluation of the one‐minute exercise test to detect peripheral arterial disease

Asymptomatic peripheral arterial disease (PAD) is common amongst the elderly and is a risk factor for cardiovascular morbidity and mortality. PAD can be assessed by non-invasive tests such as the ankle/brachial pressure index (ABPI) at rest and Doppler flow velocity (DFV) scanning, but these tests may underestimate the prevalence of PAD. The aim of this study was to estimate the added value, for the detection of PAD, of the one-minute exercise test, defined as positive if the drop of the ankle systolic pressure was more than 30 mmHg. We also investigated whether the combination of the ABPI at rest and the one-minute exercise test could replace DFV scanning. We studied this in a random sample (n = 631) of a 50- to 75-year-old population. Of these subjects 11% (66/631) had an abnormal ABPI (< 0.9) and 16% (102/631) had an abnormal DFV curve. Of this sample 72% of the subjects performed a one-minute exercise test. Of all subjects 6% (27/451) had an abnormal ABPI (< 0.9) and 12% (54/451) had an abnormal DFV curve. The one-minute exercise test revealed seven cases of PAD (beyond the 67 already identified) which were not detected by an abnormal ABPI at rest and/or DFV scanning. As a result the prevalence of PAD increased by 2%. All patients with an aortoiliac or femoropopliteal obstruction had an ABPI at rest < 0.9. The sensitivity of the combination of the ABPI at rest and the one-minute exercise test to detect abnormal DFV curves was low for crural obstructions. The one-minute exercise test slightly improves the detection of peripheral arterial disease in the general population.