Determination Of Ankle-brachial Index Research Articles

Peculiarities of polyvascular disease and the diagnostic significance of the ankle-brachial index in patients with coronary artery disease: results from the real-world registry KAMMA (Clinical registry on patient population with polyvascular disease in the Russian Federation and Eurasian countries)

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

Ankle-Brachial Index: Diagnostic Tool of Peripheral Arterial Disease and Predictor of Cardiovascular Risk-An Update of Current Knowledge.

The ankle-brachial index (ABI) was introduced as a screening method for the diagnosis of lower extremity peripheral arterial disease (PAD). Later findings recognized ABI as a prognostic marker of adverse cardiovascular events due to its relation to atherosclerosis in other vascular territories. This narrative review aims to appraise the validity, reliability, and utility of ABI in the detection of PAD and the determination of global atherosclerotic cardiovascular risk. While the ABI value can be influenced by different physiological characteristics including age, sex, body position, and techniques used for ABI determination, it has high specificity and reproducibility in the assessment of vascular patients. In conclusion, when used correctly, the ABI remains a reliable and invaluable indicator of lower-limb perfusion and a useful tool for predicting the risk of future cardiovascular events. However, its underutilization in clinical settings is noteworthy.

Iliac endofibrosis in high-performance sports: an interdisciplinary diagnostic challenge

Iliac endofibrosis (IE) is a rare arterial disease in endurance athletes, especially cyclists and triathletes. The diagnosis is considered challenging and the latency from the onset of initial symptoms to diagnosis is often several years. Diagnostic options include determination of the ankle brachial index (ABI) after maximal exercise as a non-invasive procedure, as well as duplex sonography, CT or MRI angiography, and invasive angiography. The aim of this paper is to analyse in more detail this time lag to correct diagnosis from the first description in 1985 to the year 2021, as well as to identify the most important diagnostic tools for practice. Literature research according to PRISMA criteria in PubMed, Web of Science, Cochrane databases, supplemented by a search in Google Scholar up to 10/18/2021. We identified a total of 133 publications that dealt thematically with IE in endurance athletes. In 42 publications (40 case reports and 2 clinical trials), the diagnosis was confirmed intraoperatively, and in 32 (32/42; 74.4%), statements were made about the duration from the onset of the first symptoms to the final diagnosis (mean 45, median 36 months). This latency was constant over the entire observation period from 1985 to 2021, with no trend toward shortening. Twenty-four papers (24/42; 56%) reported detailed results of ABI determination as well as further diagnostic testing. In all cases, the ABI value decreased to less than 0.66 (in 5 case reports, this decrease was measured at rest; in 19 case reports, it occurred after stress), whereas further diagnostic testing by duplex sonography, DSA, MRA, or CTA revealed no abnormal findings in 3 cases (3/24; 12.5%) and showed no more than minor stenosis in 14 cases (14/24; 58.3%). A drop in ABI after exercise is the most reliable method to diagnose iliac endofibrosis. This non-invasive and easy-to-perform examination should be integrated into the performance diagnostics of highly ambitious endurance athletes at risk. This may ideally prevent irreversible vessel wall damage by early diagnosis as well as a reduction of the presumed high number of undetected cases.

TO STUDY OCCURRENCE OF PERIPHERAL ARTERIAL DISEASE IN YOUNG PATIENTS WITH CORONARY ARTERY DISEASE USING ANKLE BRACHIAL INDEX -A SMS HOSPITAL BASED OBSERVATIONAL STUDY

Background: Coronary artery disease (CAD) and peripheral arterial disease (PAD) both are manifestations of systemic atherosclerosis. Many patients with CAD have associated PAD however, many patients are asymptomatic and thus remain underdiagnosed. Currently, little is known about the actual incidence and clinical implications of asymptomatic PAD in young patients less than 50-year-old undergoing coronary angiography in Indian population, so we will conduct this study to assess the prevalence of previously unrecognized PAD among patients with suspected ischemic heart disease undergoing coronary angiography, and to determine the relationship among PAD, severity of coronary angiographic stenosis, and major cardiovascular risk factors, in western Indian population. Method: This is an observational study conducted at a tertiary referral hospital. A total of 395 patients referred for coronary angiography without a prior diagnosis of PAD, between January 2023 to June 23 who fulfilling eligibility criteria of study, were included. Patients were evaluated through detailed medical history taking, a questionnaire survey to assess symptoms and functional status, ankle-brachial index (ABI) measurement, and coronary angiography. PAD was considered present if the ABI was< 0.90 in either leg. Result: In all patients, the prevalence of previously unrecognized PAD was 5.8%. There was significant difference between men and women (7.2% vs 1.1%, P=0.027). Abnormal angiographic results were seen in 63% (249 of 395). The prevalence of PAD was 7.2% in patients with abnormal coronary angiographic result, higher than that in patients with normal results but not statistically significant (3.2%, P=0.119). Patients with PAD were significantly older, and had higher rates of hypertension, dyslipidaemia, diabetes mellitus, current smoking, history of CAD than patients without PAD demonstrating high occurrence of PAD strongly associated with conventional risk factor for CAD. The occurrence of asymptomatic PAD was more among stable ischemic heart disease group(p=0.04). In our analysis, patients with PAD had a more severe form of CAD manifested by a higher frequency of multivessel coronary disease(p=0.002). Conclusion: The high occurrence of asymptomatic PAD in young patients with CAD confirms the importance of active screening for PAD by using ABI even in young patients. Routine determination of ABI in the clinical evaluation of all patients with CAD may helpful inidentifyhigh-risk patients.

The effect of previous strokes on the relationship between ankle-brachial index determinations and incident strokes: A population-based, longitudinal prospective study in older adults.

Abnormal ankle-brachial index (ABI) determinations may be associated with an increased risk of incident strokes. However, the impact of previous strokes in this relationship is unknown. We estimated the role of previous strokes on the association between abnormal ABI determinations and incident stroke risk in community-dwelling older adults. Atahualpa residents aged ≥60 years received ABI determinations, cardiovascular risk factors assessment, and brain MRIs. ABIs were classified as abnormal if ≤0.9 or ≥1.4. Incident strokes were diagnosed by a certified neurologist with the aid of a post-event MRI. Poisson regression models were fitted to estimate stroke incidence rate ratio (IRR) according to categories of ABI. Analysis included 389 participants (mean age: 68.2 ± 8.1years). Eighty-six persons (22%) had abnormal ABI determinations. Incident strokes occurred in 38 (9.8%) individuals after a mean follow-up of 6.1 ± 1.9years. Abnormal ABIs were associated with incident strokes in unadjusted analyses (p = 0.002) as well as in a Poisson regression model adjusted for demographics and clinical covariates (IRR: 2.57; 95% C.I.: 1.29-5.13), but not when the model was adjusted for neuroimaging covariates (IRR: 1.46; 95% C.I.: 0.67-3.20). Interaction models showed that having both abnormal ABI and non-lacunar strokes at baseline made the individual 9.7 times more likely to have an incident stroke (95% C.I.: 3.87-24.4). The risk was reduced to 2.2 (95% C.I.: 0.96-5.13) for those who only had an abnormal ABI. An abnormal ABI is associated with a doubling the risk of incident strokes, but its importance is superseded by history of non-lacunar strokes.

Neutrophil-to-lymphocyte ratio but not monocyte-to-HDL cholesterol ratio nor platelet-to-lymphocyte ratio correlates with early stages of lower extremity arterial disease: an ultrasonographic study.

The role of inflammatory markers as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein-cholesterol ratio (MHR), and platelet-to-lymphocyte ratio (PLR) in cardiovascular diseases has been widely investigated in recent years. In the context of lower extremity arterial disease (LEAD), this association has been mainly studied in the advanced stages. The aim of our study was to investigate the role of these inflammatory markers in all stages of LEAD, including early ones, using ultrasonography as diagnostic tool, together with ankle-brachial index (ABI) determination. In this cross-sectional observational study, we enrolled 240 patients undergoing ultrasonographic evaluation of the lower limb arteries and ABI determination because of symptoms suggestive of LEAD or presence of known cardiovascular risk factors. In our study population, we found that ultrasonographic categories of LEAD were associated with NLR, but not with MHR and PLR. These results confirm that a specific pattern of inflammation can be found in all stages of LEAD, including early ones.

P.352 Improved cardiorespiratory fitness is associated with decreased symptom severity, less sleep complaints and reduced REM-latency in depression treatment.

A systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador).Participants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association.Out of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (n = 78) or frail (n = 77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (p = 0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate.This study found no independent relationship between cognitive frailty and LAA burden.

Mediation of age in the association between frailty and large artery atherosclerosis burden – A population study in community-dwelling older adults

BackgroundA systematic evaluation of the relationship between frailty and large artery atherosclerosis (LAA) burden has not been carried out. Here, we aimed to assess the association between these variables in community-dwelling older adults living in Atahualpa (rural Ecuador). MethodsParticipants underwent frailty assessment and determinations of LAA in several vascular beds. Frailty was estimated by the Edmonton Frailty Scale (EFS). LAA was investigated in the peripheral vascular bed by means of ankle-brachial index determinations, in the extracranial carotid bed by B-mode ultrasounds, and in the intracranial bed by high-resolution CT and time-of-flight MRA. Ordinal logistic regression with interaction models were fitted to assess the independent association between levels of cognitive frailty and the LAA burden. Casual mediation and sensitivity analysis, and the E value, evaluated the effect of age in this association. ResultsOut of 331 included individuals, 176 (53%) were robust and the remaining 47% were either pre-frail (n = 78) or frail (n = 77). Atherosclerosis affected only one (any) vascular bed in 111 (34%) individuals, two beds in 75 (23%), and three beds in 22 (7%); the remaining 123 (37%) had no evidence of atherosclerosis. Univariate analysis showed a significant inverse association between the robust status of cognitive frailty and LAA burden (p = 0.006). This association vanishes after considering the effect of covariates. Causal mediation analysis confirms that age captures 51.8% (95% C.I.: 34.6 to 97.2%) of the effect of the association. Sensitivity analysis and E-value computation find that the amount of bias provided by age is enough to explain away the effect estimate. ConclusionsThis study found no independent relationship between cognitive frailty and LAA burden.

The Association between Earlobe Crease (Frank's Sign) and Abnormal Ankle-Brachial Index Determination Is Related to Age: A Population-Based Study.

Background Information on the association between earlobe crease (ELC) and peripheral artery disease is limited. We assessed this association in community-dwelling older adults. Study Design A total of 294 Atahualpa residents aged ≥60 years were enrolled. ELC were visually identified by two raters. The ankle-brachial index (ABI), used as a surrogate of peripheral artery disease, was categorized using American Heart Association criteria. Using logistic regression and probability models, adjusted for demographics and cardiovascular risk factors, we assessed the relationship between ELC and abnormal ABI determinations, as well as the influence of age on this association. Results ELC was identified in 141 (48%) individuals, and abnormal ABI determination was carried out in 56 (19%). The association between ELC and abnormal ABI was nonsignificant in logistic regression and probability models with individuals stratified according to their median age. Conclusions The association between ELC and abnormal ABI determinations is probably attenuated by the high prevalence of both conditions in older persons. ELC might not be useful for identifying candidates for ABI determination.

The Secret of Preserved Quality of Life in Elderly Patients with Peripheral Artery Disease and Decreased Ankle-Brachial Index

Summary Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment. Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test. Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02). Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.

Clinical significance of an elevated ankle-brachial index differs depending on the amount of appendicular muscle mass: the J-SHIPP and Nagahama studies.

Clinical implication of a high ankle-brachial index (ABI) is not well known. Based on our previous study, we suspected that body composition may be a determinant of a high ABI and may consequently modulate the clinical significance of a high ABI. Datasets of two studies with independent cohorts, the anti-aging study cohort (n = 1765) and the Nagahama study cohort (n = 8,039), were analyzed in this study, in which appendicular muscle mass was measured by computed tomography and bioelectrical impedance analysis, respectively. Brachial and ankle blood pressures were measured using a cuff-oscillometric method. In the anti-aging study cohort, thigh muscle area (β = 0.387, p < 0.001), but not fat area, showed a strong positive association with the ABI independent of the body mass index (p = 0.662) and other possible covariates, including systolic brachial blood pressure (p = 0.054), carotid hypertrophy (p = 0.559), and arterial stiffness (β = 0.102, p = 0.001). This positive association was replicated in the Nagahama cohort. When the subjects were subdivided by the 75th percentiles of the ABI and appendicular muscle mass, multinomial logistic regression analysis identified insulin resistance as an independent determinant of an elevated ABI in subjects with normal muscle mass (coefficient = 0.134, p = 0.010), whereas insulin resistance was inversely associated with an elevated ABI in subjects with high muscle mass (coefficient = -0.268, p = 0.001). Appendicular muscle mass was a strong determinant of the ABI. The clinical background, particularly insulin resistance, of individuals with an elevated ABI may differ based on the amount of muscle mass.

Validity and reliability of the ankle-brachial index by oscillometric blood pressure and automated ankle-brachial index.

Background:This study was conducted to assess the validity and reliability of ankle-brachial index (ABI) by oscillometric blood pressure (BP) measurement as compared with an automated ABI as a gold standard.Materials and Methods:This study was conducted at Golden Jubilee Medical Center, Thailand. All the data were collected from 303 patients at risk of peripheral arterial disease (PAD) who were 45 years of age or above and who underwent treatment at the outpatient medical clinic between June and December 2015. Patients who were followed up at the medical clinic had both oscillometric BP measurement (Terumo, ES-P600) and an automated ABI (oscillometric method) at the same time. Sensitivity, specificity, positive predictive value, and negative predictive value of the oscillometric BP measurements to predict an abnormal ABI (<0.90) were determined using the automated ABI as the gold standard.Results:ABI values were similar between the two methods. The oscillometric BP method for determining an ABI (cutoff point <0.90) on the right side had a sensitivity of 88.89%, specificity of 99.32%, an accuracy of 99.01%, a positive predictive value of 80%, and a negative predictive value of 99.32% whereas ABI on the left side had a sensitivity of 69.23%, a specificity of 99.66%, an accuracy of 98.35%, a positive predictive value of 90%, and a negative predictive value of 98.63%. Reliability of the oscillometric BP method by Kappa statistics was 0.84 on the right side and 0.77 on the left side (P = 0.000).Conclusion:The oscillometric BP method is a reliable and useful alternative to conventional automated ABI determination in patients with no severe arterial occlusion for estimation of the prevalence and screening of PAD in primary health-care settings.

Ankle-brachial index determination for assessment of intracranial atherosclerosis

Ankle-brachial index determination for assessment of intracranial atherosclerosis

The burden of diabetes-related foot disorders in community-dwellers living in rural Ecuador: Results of the Atahualpa Project

Background/objectivesPrevalence of diabetes-related foot disorders (DRFD) in rural areas of developing countries is unknown. The burden of these conditions in Atahualpa, a rural Ecuadorian village, were assessed. MethodsUsing a population-based design, Atahualpa residents aged ≥40 years with diabetes mellitus were identified. Ankle brachial index determinations were used to assess presence of peripheral arterial disease, and the Michigan Neuropathy Screening Instrument was used to estimate peripheral neuropathy. Ulcers in the foot/ankle as well as history of amputations were considered as evidence of active diabetic foot disease. Using a linear model of risk, factors that independently correlated with DRFD, were assessed. ResultsMean age of 110 participants was 64±12years (59% women). Peripheral arterial disease was diagnosed in 24% of cases and peripheral neuropathy in 59% (15% had both conditions). In the adjusted model, increasing age and being men increased the risk for DRFD. Active diabetic foot disease was noted in 7% of participants, and another 60% were at moderate-to-high risk for developing this complication (according to NHS Borders Foot Classification System). ConclusionsThe prevalence of DRFD is high in rural Ecuador, and most of the affected individuals are at risk for developing active diabetic foot disease.

The use of oscillometric higly accurate blood pressure monitor for the determination of the ankle-brachial index in examination of patients at suspicion on lower limbs arteries atherosclerosis

Atherosclerotic involvement of lower limbs arteries is a common disorder associated with a high risk of cardiovascular morbidity and mortality, requiring an early start of the comprehensive therapy. Typical clinical manifestations of this disease are found only in some patients that encumbers to make timely diagnosis. Determination of ankle-brachial index (ABI) is a reliable approach of the assessment of the state of blood flow in the lower extremities, but the classical technique requires the participation of specially trained personnel and expensive equipment. In the article there is discussed the use of widely available oscillometric blood pressure monitors for the determination of ABI. In a group of 39 patients with high risk of the development of atherosclerosis there was performed a comparison of the results of the determination of ABI with the help of oscillographic blood pressure monitors and ABI evaluated by the method of volumetric sphygmography. There was shown the sufficient accuracy of the determination of ABI with the aid of oscillographic blood pressure monitors and the interrelationship of this index with the risk of detection ofsignificant atherosclerotic involvement of lower limbs arteries according to Doppler ultrasound data. There was demonstrated that this method can be used at the stage of outpatient examination of patients with a high risk for atherosclerotic involvement of lower limbs arteries.

The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged men

Background and objectiveThe ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45 and 55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. Patients and methodsTwo hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index <10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. ResultsWe detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (p=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (p<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2–28.3), smoking (p=.018) (OR 2.7; 95% CI 1.2–6.2) and abdominal obesity (p=.005) (OR 2.8; 95% CI 1.3–5.9). ConclusionsThe population group analysed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency.

The association of ankle-brachial index with silent cerebral small vessel disease: results of the Atahualpa Project.

An abnormal ankle-brachial index has been associated with overt stroke and coronary heart disease, but little is known about its relationship with silent cerebral small vessel disease. To assess the value of ankle-brachial index as a predictor of silent small vessel disease in an Ecuadorian geriatric population. Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Ankle-brachial index determinations and brain magnetic resonance imaging were performed in consented persons. Ankle-brachial index ≤0.9 and ≥1.4 were proxies of peripheral artery disease and noncompressible arteries, respectively. Using logistic regression models adjusted for age, gender, and cardiovascular health status, we evaluated the association between abnormal ankle-brachial index with silent lacunar infarcts, white matter hyperintensities, and cerebral microbleeds. Mean age of the 224 participants was 70 ± 8 years, 60% were women, and 80% had poor cardiovascular health status. Ankle-brachial index was ≤0.90 in 37 persons and ≥1.4 in 17. Magnetic resonance imaging showed lacunar infarcts in 27 cases, moderate-to-severe white matter hyperintensities in 47, and cerebral microbleeds in 26. Adjusted models showed association of lacunar infarcts with ankle-brachial index ≤ 0.90 (OR: 3.72, 95% CI: 1.35-10.27, P = 0.01) and with ankle-brachial index ≥ 1.4 (OR: 3·85, 95% CI: 1.06-14.03, P = 0.04). White matter hyperintensities were associated with ankle-brachial index ≤ 0.90 (P = 0.03) and ankle-brachial index ≥ 1.4 (P = 0.02) in univariate analyses. There was no association between ankle-brachial index groups and cerebral microbleeds. In this population-based study conducted in rural Ecuador, apparently healthy individuals aged ≥60 years with ankle-brachial index values ≤0.90 and ≥1.4 are almost four times more likely to have a silent lacunar infarct. Ankle-brachial index screening might allow recognition of asymptomatic people who need further investigation and preventive therapy.

Grado de evidencia en la utilización del índice tobillo-brazo para el diagnóstico de la Arteriopatía Periférica en diabéticos tipo 2

Atherosclerosis is a chronic and progressive inflammatory disorder that appears as the main etiological factor of Peripheral Arterial Disease. The prevalence of Peripheral Arterial Disease in the Spanish general population is between 4% and 9% and is expected to be increasing in the coming years. It has been shown that diabetics have high cardiovascular morbidity and mortality and that the ankle brachial index helps to improve cardiovascular risk stratification. In this paper a review is performed using GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluations) in PubMed, Scopus, IBECS and Cochrane Library Plus databases in order to determine the prevalence of Peripheral Arterial Disease diagnosed by the ankle brachial index, to know the existence of evidence supporting the utility of the ankle brachial index for its diagnose and to know which are the risk factors influencing a low ankle brachial index determination (< 0.90).

MULTI-CHANNEL VOLUME SPHYGMOGRAPHY IN CARDIOANGIOLOGICAL SCREENING OF THE ADULT POPULATION

Aim. To study the possibilities of using multi-channel volume sphygmography (MCVS) in prophylactic medical examination of the population. Material and methods. Simultaneous examination of 522 individuals older than 18 years was performed. Along with standard procedures provided by the prophylactic medical examination program synchronous registration of blood pressure (BP) on four extremities by MCVS was performed. At that a difference in systolic BP between arms (ΔSBParm) and legs (ΔSBPleg) and ankle-brachial index (ABI) were automatically calculated. Values of │ΔSBParm│ or │ΔSBPleg│≥15 mm Hg or ABI≤0.9 were considered as markers of atherosclerotic vascular disease. Results. Signs of peripheral arterial atherosclerotic lesions among patients ≥40 years old were found in 14.7% of the cases (95% confidence interval [CI] 11.7-18.4). Relative risks of atherosclerotic lesions in arteries increase 1.71-fold (95% CI 1.06-2.74) in arterial hypertension, 1.70-fold (95% CI 1.08-2.68) – in obesity, 1.91 fold (95% CI 1.17-3.12) – in diabetes, as well as with the increasing levels of cardiovascular risk. In patients with ischemic heart disease and a history of cerebral stroke MCVS can detect signs of multifocal atherosclerosis in 21% (95% CI 14-32) and 22% (95% CI 9-46) of the cases, respectively. Conclusion. MCVS with the determination of ΔSBParm, ΔSBPleg and ABI may be regarded as the basis for low-cost and efficient system of cardioangiological screening.

Importancia del índice tobillo-brazo en la reclasificación del riesgo cardiovascular de varones hipertensos asintomáticos de mediana edad

Background and objectiveThe ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. Patients and methodsTwo hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. ResultsWe detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). ConclusionsThe population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency.