Ankle-brachial Index Measurement Research Articles

The prevalence of chronic obstructive pulmonary disease in hospitalized tobacco smokers with peripheral artery disease.

Background: Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are inflammatory diseases. These two entities often co-exist, but little is known about the prevalence of this phenomenon in patients with PAD. The objectives of this prospective cross-sectional study were to determine the prevalence of COPD in patients with PAD and to assess the frequency of COPD underdiagnosis in this group of patients. Patients and methods: Consecutive patients admitted to angiology department were evaluated. Measurements of ankle-brachial and toe-brachial index as well as peripheral arteriography were performed in all participants to confirm PAD. In tobacco smokers with PAD spirometry was performed to identified patients with COPD. Clinical information was obtained from the patients on the basis of questionnaires. Results: Eighty-eight out of 300 consecutive patients were included and assessed. COPD was diagnosed in 33 (37.5%) hospitalized smokers with PAD. COPD has not previously been diagnosed in 28 (84.8%) patients who met the criteria of the disease. Conclusions: There was high prevalence of COPD among tobacco smokers hospitalized in the angiology department. Most of them had never had spirometry performed before. The underdiagnosis rate is relatively high; therefore, all patients with PAD who smoke tobacco should have a spirometry performed, as a screening for COPD.

Nonlinear association between red cell distribution width/albumin ratio and peripheral arterial disease in the NHANES: a cross-section study with propensity score matching analysis.

Peripheral arterial disease (PAD) is a prevalent cardiovascular condition that affects up to 200 million people globally, and has significant implications for morbidity and mortality. Recent studies have identified the red cell distribution width-to-albumin ratio (RDW/ALB) as a potential systemic inflammatory marker that is correlated with several cardiovascular and inflammatory diseases including PAD. However, the comprehensive role of RDW/ALB in PAD remains underexplored. The objective of this study was to elucidate the relationship between RDW/ALB and PAD and to provide novel insights into the prevention and treatment of PAD. This retrospective cross-sectional study leveraged data from the NHANES data (1999-2004) identifying PAD using ankle-brachial index measurements (<0.90). The association with PAD was assessed using multivariable logistic regression, complemented by a restricted cubic spline for nonlinearity, and propensity score methods for robustness checks, including propensity score matching and subgroup analyses. This study included 6,421 participants, 452 of whom had PAD. The mean age was 70.1 years; the patients were predominantly male. After adjustment, the RDW/ALB ratio showed a significant association with PAD (OR 1.71, 95% CI 1.29-2.26, p < 0.001). After quartiles of RDW/ALB, the risk of PAD was determined to be 2.03 (95% CI 1.31-3.14) in the Q4 group compared with the Q1 group in the adjusted complete model. The restricted sample cubic spline of RDW/ALB and risk of developing PAD demonstrated a nonlinear relationship. The risk of PAD increased considerably with higher RDW/ALB ratios less than 4.08. Subgroup and PSM analyses underscored the consistency of these findings. The study demonstrated a significant association between RDW/ALB and PAD, with a nonlinear relationship and a threshold effect. Further prospective clinical research is required to validate the relationship between the RDW/ALB ratio and PAD.

Identifying Risk Factors for Lower Extremity Artery Disease (LEAD) in Cardiology Patients: The Role of Ankle-Brachial Index Measurement.

Background and aims: Lower Extremity Artery Disease (LEAD) is a predictor of atherosclerotic plaques in other locations and significantly increases the risk of death from cardiovascular events. This study aimed to identify cardiology patient subpopulations that should undergo Ankle-Brachial Index (ABI) measurement. Methods: A total of 800 patients hospitalized in the Department of Cardiology were included. Inclusion criteria were age over 40 years for men and over 45 years for women, with the ability to measure ABI. Results: The study group was divided into two subgroups based on ABI values, with LEAD (ABI ≤ 0.9) detected in 61 patients (7.6%). Among these, 45% exhibited symptoms of intermittent claudication. LEAD was significantly more common in patients with a lower ejection fraction, a history of myocardial infarction, coronary artery disease, coronary atherosclerosis, heart failure, hypercholesterolemia, diabetes, and in those with a past diagnosis of atherosclerosis. There was no statistical association with the incidence of ischemic stroke, renal failure, hypertension or a family history of cardiovascular disease. Average living conditions and financial status increased LEAD likelihood (p = 0.029; p = 0.018), while physical activity reduced it (p < 0.001). LEAD occurred more often in both current and former smokers. Patients with LEAD were more likely to be on statin therapy (p = 0.002). Higher hemoglobin A1c levels significantly increased the risk of LEAD. Conclusions: Identifying patients with risk factors for LEAD suggests that ABI measurement should be performed to detect LEAD early and implement appropriate diagnostic and therapeutic strategies.

Effectiveness of spinal cord stimulation in diabetic patients with chronic limb-threatening ischemia: small cohort study

BackgroundChronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD. This is a retrospective small cohort analysis of patients with diabetes and the long-term treatment effect of spinal cord stimulation.MethodsAs the main outcome of the study, we evaluated the survival and amputation of 13 diabetic patients with chronic lower-limb ischemia who were not eligible for surgical or interventional therapy. Secondary outcomes included ankle-brachial index (ABI), ischemic pain intensity, quality of life, use of analgesic medications and skin wound outcomes analyzed during long-term follow-up.ResultsBetween January 2010 and January 2017, 13 patients underwent SCS implantation in our vascular center. At 1-year follow-up, the limb salvage rate was 92.3% (12 of 13 patients), and limb ulcers healed in 75% of patients (6/8). No patient died during the one-year follow-up. A total of 4 of patients (31%) experienced major amputation during long-term follow-up, all of them were Fontaine stage IV. Pain intensity and quality of life improved significantly at 6-month follow-up (p &amp;lt; 0.05). ABI measurements were unaffected by SCS treatment. There were no complications related to the procedure or device.ConclusionsSCS is a promising treatment option for diabetic patients unsuitable for endovascular or surgical revascularization. The method improves limb survival in diabetic patients with critical limb ischemia, provides significant pain control, and improves patients' quality of life. However, more studies are needed to clarify the indications for SCS and clarify its effects on the vascular system.

Skin Perfusion Pressure Outperforms Ankle-Brachial Index in Predicting Mortality and Cardiovascular Outcomes in Hemodialysis Patients

Skin perfusion pressure (SPP) and ankle-brachial index (ABI) are useful in screening for peripheral arterial disease in patients undergoing hemodialysis (HD). We compared the prognostic abilities of the SPP and ABI in predicting the composite outcomes of mortality and atherosclerotic vascular events. This single-center prospective cohort study enrolled 258 patients undergoing HD. The patients with SPP and ABI measurements were divided into tertiles. Log-rank tests, Cox regression analyses, and discrimination parameters were used for comparisons. Over a median follow-up period of 3.7 (1.4-5.0) years, 119 composite events were recorded. The incidence rates of composite events were 27.5, 13.3, and 9.1 per 100 person years, respectively, across the SPP tertiles (log-rank: p＜0.001), and 23.2, 13.2, and 11.6 per 100 person years across the ABI tertiles (p=0.003). With the 3rd tertiles as references, the 1st tertiles of the SPP and ABI were significantly associated with the composite outcome (adjusted hazard ratio [aHR]: 2.58, 95% confidence interval [CI]: 1.57-4.23 and aHR: 1.70, 95% CI: 1.06-2.73, respectively). Adding the tertiles of the SPP to a predictive model with established risk factors significantly improved the model performance. This improvement was larger than that of the ABI in terms of net reclassification (0.330 vs. 0.275) and integrated discrimination (0.045 vs. 0.012). Furthermore, in patients with a normal ABI, the 1st SPP tertile (＜71 mmHg) was significantly associated with the outcome (aHR, 1.97; 95% CI, 1.13-3.41) when compared to the 3rd tertile. Even patients with a normal ABI have a poor prognosis if their SPP levels are low. SPP outperformed ABI in predicting mortality and cardiovascular outcomes in HD patients.

Prognostic Value of Toe Pressure Measurements in Patients with Diabetic Foot Ulcers and Medial Arterial Calcification.

Diabetic foot ulcers (DFUs) are one of the most serious chronic diabetes-related complications. Since medial arterial calcification (MAC) can be present in patients with a DFU, toe pressure (TP) measurements are advised to grade potential ischemia. However, the value of TP to predict clinical outcomes in this group of patients is poorly understood. Therefore, the primary aim of this study was to investigate the relationship between TP values and ulcer healing in patients with DFU and concomitant MAC. A single-center retrospective cohort study was conducted. Patients were included if they were 18years or older, presented with a DFU, had a TP measurement and concomitant MAC in the same limb. MAC was defined as an ankle-brachial index (ABI) above 1.30, or incompressible arteries during ABI measurement. Multistate models were fitted to analyze the outcomes of interest (ulcer healing, revascularization, amputation, and mortality). In total, 148 patients were included. During the 180days follow-up, the cumulative incidence of a healed ulcer was 34% (95% confidence interval [CI]: 27-42%), whereas 32% (95% CI: 26-41%) of patients had a persisting open wound. An approximately positive linear correlation was observed between TP values and the probability of ulcer healing, regardless of whether patients had undergone a revascularization procedure. However, the absolute healing rate was low, and no clear distinction could be made for intermediate TP values (between 30 and 80mm Hg). Lower TP values are correlated with nonhealing of a DFU in patients with MAC, but clear absolute differences in healing are only seen between very low (below 30mm Hg) and high (above 80mm Hg) measurements. For intermediate TP values, the predictive strength of ulcer healing is weak. This should be of particular importance when grading ischemia in this subgroup of patients in wound classification systems.

Associations of Circulating ANGPTL3, C-Terminal Domain-Containing ANGPTL4, and ANGPTL3/8 and ANGPTL4/8 Complexes with LPL Activity, Diabetes, Inflammation, and Cardiovascular Mortality.

ANGPTL3/4/8 (angiopoietin-like proteins 3, 4, and 8) are important regulators of LPL (lipoprotein lipase). ANGPTL8 forms complexes with ANGPTL3 and ANGPTL4. ANGPTL4/8 complex formation converts ANGPTL4 from a furin substrate to a plasmin substrate, and both cleavages generate similar C-terminal domain-containing (CD)-ANGPTL4 fragments. Whereas several studies have investigated associations of free ANGPTL proteins with cardiovascular risk, there are no data describing associations of the complexes and CD-ANGPTL4 with outcomes or describing the effects of the complexes on LPL bound to GPIHBP1 (glycosylphosphatidylinositol HDL-binding protein 1). Recombinant protein assays were used to study ANGPTL protein and complex effects on GPIHBP1-LPL activity. ANGPTL3/8, ANGPTL3, ANGPTL4/8, and CD-ANGPTL4 were measured with dedicated immunoassays in 2394 LURIC (Ludwigshafen Risk and Cardiovascular Health) study participants undergoing coronary angiography and 6188 getABI study (German Epidemiological Trial on Ankle Brachial Index) participants undergoing ankle brachial index measurement. There was a follow-up for cardiovascular death with a median (interquartile range) duration of 9.80 (8.75-10.40) years in the LURIC study and 7.06 (7.00-7.14) years in the getABI study. ANGPTL3/8 potently inhibited GPIHBP1-LPL activity and showed positive associations with LDL-C (low-density lipoprotein cholesterol) and triglycerides (both P<0.001). However, in neither study did ANGPTL3/8 correlate with cardiovascular death. Free ANGPTL3 was positively associated with cardiovascular death in the getABI study but not the LURIC study. ANGPTL4/8 and especially CD-ANGPTL4 were positively associated with the prevalence of diabetes, CRP (C-reactive protein; all P<0.001), and cardiovascular death in both studies. In the LURIC and getABI studies, respective hazard ratios for cardiovascular mortality comparing the third with the first ANGPTL4/8 tertile were 1.47 (1.15-1.88) and 1.68 (1.25-2.27) when adjusted for sex, age, body mass index, and diabetes. For CD-ANGPTL4, these hazard ratios were 2.44 (1.86-3.20) and 2.76 (2.00-3.82). ANGPTL3/8 potently inhibited GPIHBP1-LPL enzymatic activity, consistent with its positive association with serum lipids. However, ANGPTL3/8, LDL-C, and triglyceride levels were not associated with cardiovascular death in the LURIC and getABI cohorts. In contrast, concentrations of ANGPTL4/8 and particularly CD-ANGPTL4 were positively associated with inflammation, the prevalence of diabetes, and cardiovascular mortality.

Routine Ankle-Brachial Index (ABI) measurement: a window into atherosclerosis and early left ventricular dysfunction in patients diagnosed with cancer

BackgroundCancer therapy is considered to cause accelerated ischemia. Ankle-Brachial Index (ABI) measurement is an inexpensive, simple, available test for the early diagnosis of peripheral artery disease (PAD); however, it is not performed routinely. We aimed to evaluate the role of routine ABI measurement for the diagnosis of PAD among patients diagnosed with cancer and whether it correlates with left ventricular (LV) dysfunction.MethodsA retrospective, single-center study including patients diagnosed with cancer at Tel Aviv Sourasky Medical Center. The cohort included patients performing routine ABI and LV global longitudinal strain (GLS) echocardiography. The primary endpoint was the prevalence of PAD and whether it correlates with LV dysfunction, defined by LV GLS absolute value < 19%. The secondary composite endpoint evaluated the association between reduced ABI to LV dysfunction and all-cause mortality.ResultsAmong 226 patients, PAD was diagnosed in 14 patients (6%). We revealed a positive correlation between ABI and LV GLS (r = 0.22, p < 0.01) with a reduced mean ABI score among patients with reduced LV GLS. A reduced mean ABI was observed among the positive composite endpoint group; however, it was not statistically significant (p = 0.35).ConclusionsWe report, for the first time to our knowledge, the routine use of ABI testing among patients diagnosed with cancer. ABI showed a significant correlation to LV GLS, implying a potential tool in the early diagnosis of atherosclerosis and cardiotoxicity. Considering its low cost and availability, future prospective trials are needed to integrate its role in routine assessment.

Relationship of Thyroid Volume and Function with Ankle-Brachial Index, Toe-Brachial Index, and Toe Pressure in Euthyroid People Aged 18-65.

Background and Objectives: The interrelationship between thyroid function and the state of the cardiovascular system has been investigated both in preclinical and human studies. However, it remains unclear whether there is any association between thyroid hormones and features of subclinical cardiovascular dysfunction in euthyroid patients. Material and Methods: This study involved 45 people (females: 57.8%) with no thyroid disease who, during planned hospitalization, underwent thyroid ultrasound, determination of biochemical parameters of thyroid function, and measurement of ankle-brachial index (ABI) and toe-brachial index (TBI). People with signs of acute illness or a deterioration of their health were excluded. Results: Significant correlations were found between free triiodothyronine (FT3) and several parameters of both ABI (R = 0.347; p = 0.019 for the mean ABI taken from right side and left side values) and TBI (R = 0.396; p = 0.007 for the mean TBI taken from right side and left side values), as well as the maximal toe pressure (TP) taken from right side and left side values (R = 0.304; p = 0.045). Thyrotropin (TSH) was shown to be significantly correlated only with the maximal TBI value (taken from right side and left side values) (R = 0.318; p = 0.033), whereas free thyroxin (FT4) was shown to be significantly correlated only with the minimal TBI value (taken from right side and left side values) (R = 0.381; p = 0.01). Thyroid volume (TV) was shown to be correlated with TP (R = 0.4; p = 0.008 for the mean TP taken from right side and left side values) and some parameters of TBI value (R = 0.332; p = 0.028 for the mean TBI taken from right side and left side values), but no significant correlations were found between TVand ABI parameters. Patients with a mean ABI value ≤ 1.0 or a mean TBI value ≤ 0.75 have lower TSH, FT3, FT4, and TV than the rest of the study population, but the difference was statistically significant only for FT3. Conclusions: Even in a population of euthyroid patients with no diagnosed thyroid disease, there are some significant correlations between the volume and function of the thyroid gland and the selected features of subclinical cardiovascular dysfunction such as ABI and TBI.

Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes

BackgroundThe relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.MethodsWe used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.ResultsAmong 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98–1.12), 1.17 (1.08–1.25), and 1.54 (1.54–1.65) for ankle SBP; HR 1.06 (0.99–1.14), 1.26 (1.17–1.35), and 1.48 (1.38–1.58) for ABI; and HR 1.02 (0.95–1.10), 1.15 (1.07–1.23), and 1.48 (1.38–1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90–1.21], 1.21 [1.05–1.40], and 1.93 [1.68–2.22]), and APPD (HRs 1.08 [0.93–1.26], 1.30 [1.12–1.50], and 1.97 [1.72–2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).ConclusionsInverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.Graphical abstractAnkle blood pressure indices and incidence of major cardiovascular outcomes. Expanded MACE, a composite of death from cardiovascular causes, myocardial infarction,hospitalization for heart failure, or stroke. BP, blood pressure; CV, cardiovascular; HHF, hospitalization for heart failure; HR, Hazard ratio (for the lowest fourth of blood pressure indice compared to the highest); MACE, major adverse cardiovascular events; MI, myocardial infarction; Total, fatal and non-fatal MI or stroke.

Long-term clinical efficacy of drug-coated balloon angioplasty for TASCII C/D femoropopliteal lesions in older patients with chronic limb-threatening ischemia: A retrospective study.

This study aimed to evaluate the long-term clinical outcomes of drug-coated drug (DCB) angioplasty for long femoropopliteal lesions in older patients with chronic limb-threatening ischemia (CLTI). In this multi-center retrospective study, we enrolled 119 patients with CLTI due to Trans-Atlantic Inter-Society Consensus (TASCII) C/D femoropopliteal lesions who underwent DCB angioplasty. A total of 119 patients with 122 limbs (TASCII C = 67, 54.9%; TASCII D = 55, 45.1%) were enrolled. At 36-month follow-up, primary patency, assisted primary patency, secondary patency, and freedom from target lesion revascularization were 47.3%, 49.8%, 59.5%, and 62.7%, respectively, and there was a significant improvement over baseline in Rutherford class (P < .001) and ankle-brachial index measurements (P < .001). Complex target lesions (P = .017) and 1 stenosis-free outflow vessel (P = .001) were risk predictors of freedom from clinically driven target lesion revascularization. Complex target lesions (P = .044), diabetes (P = .007), and 1 stenosis-free outflow vessel (P = .003) were risk predictors of restenosis. At 2 months, the ulcer healing rate was 96.3% (26/27). At 36 months, the limb salvage and survival rates were 85.8% and 83.3%, respectively. DCB angioplasty were safe and effective for older patients with CLTI attributable to femoropopliteal TASCII C/D lesions.

Association between dietary fiber intake and peripheral artery disease in hypertensive patients

BackgroundAt present, no studies explored whether dietary fiber intake was associated with the risk of peripheral artery disease (PAD) in hypertensive patients. This study assessed the association between dietary fiber intake and PAD in hypertensive patients.MethodsThis cross-sectional study collected the data of 4628 participants with the measurement of ankle-brachial pressure index in the National Health and Nutrition Examination Surveys database. Univariate logistic regression analysis was applied to identify variables associated with PAD as confounding factors. Univariate and multivariable logistic regression analyses were used to explore the association between dietary fiber intake and PAD in hypertensive patients. Subgroup analysis was stratified by age, cardiovascular disease, dyslipidemia, diabetes, smoking, and physical activity.ResultsAfter adjusting for confounding factors, decreased risk of PAD was observed in hypertensive patients with dietary fiber intake > 21 g [odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.46–0.99]. Compared with people with dietary fiber intake ≤ 21 g, those with dietary fiber intake > 21 g were associated with decreased risk of PAD in hypertensive patients < 60 years (OR = 0.23, 95%CI 0.08–0.66). In hypertensive patients without dyslipidemia, dietary fiber intake > 21 g were associated with reduced risk of PAD (OR = 0.33, 95%CI 0.12–0.95). Decreased risk of PAD was also found in hypertensive patients without diabetes in dietary fiber intake > 21 g group (OR = 0.50, 95%CI 0.31–0.78). Dietary fiber intake > 21 g was linked with reduced risk of PAD in hypertensive patients in never smoke group (OR = 0.46, 95%CI 0.24–0.86).ConclusionHigher dietary fiber intake was associated with reduced risk of PAD in hypertensive patients, suggesting the importance of increase the daily dietary quality especially fiber intake in hypertensive people.

Impact of Peripheral Angioplasty on Wound Oxygenation and Healing in Patients with Chronic Limb-Threatening Ischemia Measured by Near-Infrared Spectroscopy.

Managing chronic limb-threatening ischemia (CLTI) is challenging due to difficulties in assessing tissue oxygen saturation in ulcers. Near-infrared spectroscopy (NIRS) is a non-invasive method for measuring tissue oxygen saturation (StO2). This study evaluated the effects of endovascular treatment (EVT) on StO2 and wound healing in CLTI patients, comparing NIRS to standard ankle-brachial index (ABI) measurements. Using the Duesseldorf PTA Registry, 43 CLTI patients were analyzed: 27 underwent EVT, and 16 received conservative treatment. ABI assessed macrocirculation, while NIRS measured wound, wound area, and mean foot StO2 at baseline, post-EVT, and four-month follow-up. Wound severity was classified by wound area and wound, ischemia, and foot infection (WIfI) score. Wound StO2 increased significantly (median (interquartile range (IQR)), 38 (49.3) to 60 (34.5)%, p = 0.004), as did wound area StO2 (median (IQR), 70.9 (21.6) to 72.8 (18.3)%, p < 0.001), with no significant changes in the control group by four-month follow-up. Wound area decreased significantly after EVT (mean ± SD, 343.1 ± 267.8 to 178.1 ± 268.5 mm2, p = 0.01) but not in the control group. Changes in wound StO2, wound area StO2, and WIfI score correlated with wound area reduction, unlike ABI. This small exploratory study shows that NIRS-measured StO2 improvements after EVT correlate with reduced wound area and WIfI scores, highlighting NIRS as a potential enhancement for CLTI wound management in addition to ABI.

NEUROMUSCULAR TAPING IMPROVES MICROVASCULAR CIRCULATION IN TYPE 2 DIABETES MELLITUS PATIENTS

Background: The most common complications in Diabetes Mellitus patients are foot problems and high risk for amputation. Factors that trigger problems in diabetic feet in the form of neuropathy factors, namely loss of sensory nerve function and circulatory disorders. One of the non-pharmacological therapies to prevent these problems is safe Neuromuscular Taping (NMT) which is applied to the skin with elastic plaster through a decompression method to prevent a decrease in peripheral blood circulation and improve blood circulation. Objectives: The purpose of this study was to determine the comparison of the effectiveness of Neuromuscular Taping (NMT) intervention on microvascular circulation which was assessed by Ankle Brachial Pressure Index (ABPI) measurement in type 2 Diabetes Mellitus patients. Methods: This study used a quasi-experimental research design with a pretest-posttest control group approach. The number of respondents to this study was 60 type 2 DM patients divided into treatment group respondents and control group respondents. The intervention group was given NMT intervention for 2 weeks with daily plaster changes while the control group was given standard foot care education. The data collected is an ABPI score that describes microvascular circulation using a sphygmomanometer. Analysis was carried out using paired sample t-tests which were used to determine the effectiveness of the intervention. Results: Based on the results of the study, significant changes were obtained in the microvascular circulation of the treatment group (p = 0.000) α 0.05 which is the category of normal microvascular circulation or no disturbance. Increased microvascular circulation is caused by the application of NMT for 2 weeks. Conclusion: There was an increase in microvascular circulation seen through changes in Ankle Brachial Pressure Index (ABPI) values before and after Neuromuscular Taping (NMT) intervention. There were significant differences between the intervention and control groups in changes in ABPI scores.

Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.

Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index.

Colorectal adenomas are precancerous lesions that may lead to colorectal cancer. Recent studies have shown that colorectal adenomas are associated with atherosclerosis. The cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) are noninvasive methods for evaluating atherosclerosis. This study examined the association between atherosclerosis and high-risk colorectal adenomas based on the CAVI and ABI. The data of patients aged ≥50 years who had a colonoscopy and CAVI and ABI measurements from August 2015 to December 2021 at the Kangwon National University Hospital were analyzed retrospectively. After the colonoscopy, subjects were divided into no, overall, and high-risk (size ≥1 cm, high-grade dysplasia or villous adenoma, three or more adenomas) adenoma groups based on the pathology findings. The data were subjected to univariate and multivariate logistic regression analyses. Among the 1,164 subjects, adenomas and high-risk adenomas were found in 613 (52.6%) and 118 (10.1%) patients, respectively. The rate of positive ABI (<0.9) and positive CAVI (≥9.0) were significantly higher in the high-risk adenoma group (22.0% and 55.9%) than in the no adenoma (12.3% and 39.6%) and the overall adenoma group (15.7% and 44.0%) (p=0.008 and p=0.006, respectively). Multivariate analysis revealed a positive CAVI and smoking status to be significantly associated with high-risk adenoma with an odds ratio of 1.595 (95% confidence interval 1.055-2.410, p=0.027) and 1.579 (1.072-2.324, p=0.021), respectively. In this study, a significant correlation between positive CAVI and high-risk adenomas was observed. Therefore, CAVI may be a significant predictor for high-risk colorectal adenoma.

Buerger-Allen exercises' effectiveness for improving lower limb circulation

Impaired peripheral perfusion in the legs is the most common complaint experienced by patients with type 2 Diabetes Mellitus (DM). One nursing intervention in the form of physical exercise that can be administered to DM patients to prevent peripheral perfusion disorders and increase vascularization of the lower extremities is the Buerger-Allen Exercise (BAE). The goal of this study was to analyze the effectiveness of BAE in improving lower extremity circulation. The population consisted of patients with type 2 DM. The research design employed a quasi-experiment with pre-test and post-test, including a control group. A sample of 24 respondents was divided into an intervention group and a control group. The sampling technique used was purposive sampling. Data were obtained through direct Ankle-Brachial Index (ABI) measurement using a Doppler ultrasound and an aneroid sphygmomanometer, temporary blood sugar level measurements using a glucometer, and leg sensitivity measurements using a monofilament tool. Paired T-tests and independent T-tests were used as statistical tests. The results of the Paired T-test for lower limb circulation in the intervention group yielded a p-value of 0.000, indicating a significant difference in the circulation of the lower extremities before and after the intervention. The results of the independent T-test also showed a p-value of 0.000, indicating significance. Thus, BAE can improve lower limb circulation in patients with type 2 DM.

Body surface area is positively associated with ankle-brachial index.

Ankle-brachial index (ABI) measurement is a widely used diagnostic test for lower extremity artery disease. Previously, a larger body surface area (BSA) has been associated with lower blood pressure and lower 2-h post-load glucose concentrations in the oral glucose tolerance test. Our aim was to evaluate whether BSA has an impact on ABI and the prevalence of lower ABI values. ABI measurements were performed on 972 subjects aged 45 to 70 years at high cardiovascular disease (CVD) risk. Subjects with previously diagnosed kidney disease, CVD, and diabetes were excluded. Their BSA was calculated by the Mosteller formula. Study subjects were divided into five BSA levels corresponding to 12.5th, 25th, 25th, 25th, and 12.5th percentiles of the total distribution. Effect modification by BSA in ABI between sexes was derived from a four-knot restricted cubic splines regression model. After adjustments for age, sex, pulse pressure, glucose regulation, waist circumference, alcohol intake, smoking status, leisure-time physical activity and medication, BSA level had a positive linear relationship with ABI (p for linearity <0.001). When BSA was less than 2.0 m2, there was no difference between the sexes, but when BSA was higher than 2.0 m2, men had higher ABI. BSA shows a positive linear relationship with ABI in CVD risk subjects without manifested CVD. The difference in ABI between men and women is modified by BSA and is appreciable when BSA is larger than 2.0 m2.

High Serum Galectin-3 Level as a Potential Biomarker of Peripheral Artery Disease in Patients Undergoing Hemodialysis.

Galectin-3 is implicated in the pathogenesis of inflammation and atherosclerosis. Peripheral arterial disease (PAD), characterized by a reduced ankle-brachial index (ABI), is a prognostic marker for mortality in patients on hemodialysis. We investigated the relationship between serum galectin-3 levels and PAD in patients undergoing regular hemodialysis. We carried out a cross-sectional study at a medical center, involving 92 participants. Serum galectin-3 levels were assessed by a commercially available enzyme-linked immunosorbent assay. ABI measurement was done with an automatic device based on oscillometry. Participants were categorized into two groups, normal and low ABI, based on a 0.9 cut-off point. Eighteen patients (19.6%) exhibited a low ABI. In individuals with low ABIs, we observed a greater prevalence of diabetes mellitus, elevated serum C-reactive protein (CRP) levels, increased galectin-3 levels, and lower serum creatinine levels. Furthermore, serum galectin-3 levels (odds ratio [OR]: 1.056, 95% confidence interval [CI]: 1.003-1.112, p = 0.037) and CRP (per 0.1 mg/dL increment, OR: 1.195, 95% CI: 1.032-1.383, p = 0.017) were identified as independent predictors of PAD. Serum galectin-3 and log-transformed CRP levels were also independently and significantly negatively correlated with the left and right ABI values. Serum galectin-3 levels correlate with PAD in patients undergoing maintenance hemodialysis.

Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The ARIC Study.

Sudden cardiac death (SCD) is a significant global public health problem accounting for 15% to 20% of all deaths. A great majority of SCD is associated with coronary heart disease, which may first be detected at autopsy. The ankle-brachial index (ABI) is a simple, noninvasive measure of subclinical atherosclerosis. The purpose of this study was to examine the relationship between ABI and SCD in a middle-aged biracial general population. Participants of the ARIC (Atherosclerosis Risk in Communities) study with an ABI measurement between 1987 and 1989 were included. ABI was categorized as low (≤0.90), borderline (0.90-1.00), normal (1.00-1.40), and noncompressible (>1.40). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual and was adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Cox proportional hazards models were used to evaluate the associations between baseline ABI and incident SCD. Of the 15 081 participants followed for a median of 23.5 years, 556 (3.7%) developed SCD (1.96 cases per 1000 person-years). Low and borderline ABIs were associated with an increased risk of SCD (demographically adjusted hazard ratios [HRs], 2.27 [95% CI, 1.64-3.14] and 1.52 [95% CI, 1.17-1.96], respectively) compared with normal ABI. The association between low ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors (HR, 1.63 [95% CI, 1.15-2.32]). Low ABI is independently associated with an increased risk of SCD in a middle-aged biracial general population. ABI could be incorporated into future SCD risk prediction models.