Ankle-brachial Index Measurement Research Articles

Improving Foot Peripheral Blood Circulation with Indicators of Ankle Brachial Index (ABI) through Diabetic Foot Spa in Diabetes Mellitus Patients of Type 2

This work aims to analyse the impact of foot peripheral blood circulation with indicators of Ankle Brachial Index (ABI) through diabetic foot spa in diabetes mellitus patients of type 2. The research design involved experimental research with a one-group pre-post-test layout. The samples comprised 62 respondents, and the purposive sampling technique was employed. The intervention was in the form of presenting a diabetic foot spa procedure, which was carried out by means of foot exercises, which were carried out by means of foot exercises, skin cleansing, and foot massage, which were carried out for 45 minutes every day, for 5 days. The instrument used to measure blood circulation in the feet is used by the Ankle Brachial Index (ABI) measurement tool by comparing the measurement of ankle temperature measurement (right or left) with the highest systole measurement value on the right or left. The statistical test for the paired t-test obtained a p value of 0.001. This demonstrates that diabetic foot spa that was effective in improving peripheral blood circulation in patients with type DM diabetes. Therefore, the diabetic foot spa can be used as an alternative in improving peripheral blood circulation in diabetes mellitus patients of type 2.

Occupational class differences in ankle-brachial index and pulse wave velocity measurements to detect subclinical vascular disease.

Background: High pulse wave velocity (PWV) and low ankle brachial index (ABI) have been proposed as surrogate end-points for cardiovascular disease (CVD). Objectives: In a cross-sectional setting, we aimed at assessing the distributions of PWV and ABI among occupational classes (OC) in a population-based ever-employed salaried sample. Methods: We enrolled 1388 salaried CVD-free workers attending a CVD population-based survey, the RoCAV study, and classified them into four OC, based on current or last job title: manager/director (MD), non-manual (NMW), skilled-manual (SMW) and (UMW) unskilled-manual workers. We derived brachial-ankle PWV and ABI from four-limb blood pressures measurements, then carotid-femoral PWV (cfPWV) was estimated. We estimated the OC gradients in cfPWV and ABI using linear and logistic regression models. Results: Compared to MD (reference category), UMW had higher age- and BMI-adjusted cfPWV mean values both in men (0.63 m/s; 95%CI:0.11-1.16) and women (1.60 m/s; 0.43-2.77), only marginally reduced when adjusting for CVD risk factors. Decreased ABI mean values were also detected in lower OC. The overall detection rate of abnormal cfPWV (≥12 m/s) or ABI (≤0.9) values was 28%. Compared to MD, the prevalence of abnormal cfPWV or ABI was higher in NMW (OR=1.77; 95%CI:1.12-2.79), SMW (1.71; 1.05-2.78) and UMW (2.72; 1.65-4.50). Adjustment for CVD risk factors used in risk score equations did not change the results. Discussion: We found a higher prevalence of abnormal values of arterial stiffness measures in lower OC, and these differences were not explained by traditional CVD risk factors. These may be presumably determined by additional work- and environmental-related risk factors.

Use of ABI to detect peripheral arterial disease in diabetes - A recommendation for primary care physicians.

Background:India is considered the diabetes capital of the world. As per current practice, most of the diabetes patients go to primary care physicians for their monitoring and follow up. One of the dreaded complications of long-term diabetes is peripheral arterial disease.Methods:A cross-sectional observational study was conducted in a diabetes workshop. Totally, 48 patients were selected who satisfied the inclusion criteria. All were subjected to ankle-brachial index measurement (ABI) and doppler ultrasound was done to assess patency of the lower extremity arteries. The results were compared. The ankle-brachial index of less than 0.99 was considered abnormal.Results:Out of a total of 48 included patients 26 patients had normal ABI and 22 patients were found to have abnormal ABI. Out of those with normal ABI, 2 patients had features of peripheral arterial disease proved by doppler, whereas 3 patients with abnormal ABI had no feature of peripheral arterial disease in doppler. MedCalc software was used for statistical comparison.Conclusion:In the selected diabetic population prevalence of peripheral arterial disease was found to be 56.25%. Measurement of ABI was found to be quite a sensitive and specific method for diagnosing peripheral arterial disease of diabetics.

Ankle brachial index in patients with type II diabetes mellitus undergoing coronary angiography

ObjectiveThe aim was to determine the relation between ankle-brachial index (ABI) with angiographic stenosis and major cardiovascular risk factors in type II diabetes mellitus (DM) patients.BackgroundThe role of DM in relation to coronary artery disease (CAD) was believed to be as important as CAD itself. Patients with DM were frequently combined with peripheral arterial disease. ABI is a noninvasive tool for identifying atherosclerosis, CAD.Patients and methodsPatients under study were those admitted to Menoufia University Hospital and who had undergone coronary angiography. A total of 80 patients over 35 years of age with suspected CAD had been enrolled. All patients were subjected to ABI measurements and coronary angiography and risk factor. Patients had been divided into four groups according to ABI measurements and type II DM.ResultsABI is a simple, inexpensive method for diagnosing patients with peripheral arterial disease. ABI is a sensitive, noninvasive predictor of CAD in diabetic patients.ConclusionABI is a sensitive, noninvasive predictor of CAD in diabetic patients. It needs other markers for better specificity for predicting CAD.

Change in ankle–brachial index and mortality among individuals with chronic kidney disease: findings from the Chronic Renal Insufficiency Cohort Study

Patients with chronic kidney disease (CKD) have an increased risk of peripheral arterial disease (PAD). The ankle-brachial index (ABI), a noninvasive measure of PAD, is a predictor of adverse events among individuals with CKD. In general populations, changes in ABI have been associated with mortality, but this association is not well understood among patients with CKD. We conducted a prospective study of 2920 participants in the Chronic Renal Insufficiency Cohort Study without lower extremity revascularization or amputation at baseline and with at least one follow-up ABI measurement (taken at annual visits) during the first 4 years of follow-up. The ABI was obtained by the standard protocol. In Cox proportional hazard regression analyses, we found a U-shaped association of average annual change in ABI with all-cause mortality. After adjusting for baseline ABI and other covariates, compared with participants with an average annual change in ABI of 0-<0.02, individuals with an average annual change in ABI <-0.04 or ≥0.04 had multivariable-adjusted hazard ratios (HRs) of 1.81 [95% confidence interval (CI) 1.34-2.44) and 1.42 (95% CI 1.12-1.82) for all-cause mortality, respectively. Compared with the cumulative average ABI of 1.0-<1.4, multivariable-adjusted HRs for those with a cumulative average ABI of <0.9, 0.9-<1.0 and ≥1.4 were 1.93 (95% CI 1.42-2.61), 1.20 (0.90-1.62) and 1.31 (0.94-1.82), respectively. This study indicates both larger decreases and increases in average annual changes in ABI (>0.04/year) were associated with higher mortality risk. Monitoring changes in ABI over time may facilitate risk stratification for mortality among individuals with CKD.

Upstroke Time Is a Useful Vascular Marker for Detecting Patients With Coronary Artery Disease Among Subjects With Normal Ankle-Brachial Index.

BackgroundUpstroke time is the transit time from the nadir to peak of the waveform of pulse volume recording. The purpose of this study was to determine whether upstroke time at the ankle is a useful vascular marker for detecting patients with advanced atherosclerosis in combination with ankle‐brachial index (ABI).Methods and ResultsWe measured upstroke time and ABI in 2313 subjects (mean age, 61.2±15.3 years). The prevalence of coronary artery disease (CAD) was significantly higher in patients with prolonged upstroke time (≥180 ms) than in subjects with normal upstroke time (<180 ms) (29.6% versus 11.8%; P<0.001), with a significant association between prolonged upstroke time and an increased risk of CAD (odds ratio [OR], 1.61; 95% CI, 1.07–2.44; P=0.02). In 1954 subjects with normal ABI (1.00 ≤ ABI ≤ 1.40), the prevalence of CAD was significantly higher in patients with prolonged upstroke time than in subjects with normal upstroke time (29.5% versus 10.6%; P<0.001), with a significant association between prolonged upstroke time and CAD (OR, 2.33; 95% CI, 1.41–3.87; P=0.001), whereas there was no significant association between upstroke time and CAD in subjects with low ABI (<1.00) (OR, 1.24; 95% CI, 0.72–2.16; P=0.44).ConclusionsUpstroke time may be a useful vascular marker for detecting patients with CAD, especially in subjects with normal ABI who are usually considered not to have advanced atherosclerosis by ABI measurement alone. More attention should be paid to upstroke time for detecting patients with advanced atherosclerosis.RegistrationURL: https://www.umin.ac.jp; Unique identifier: UMIN000039512.

Abstract 14374: Peripheral Artery Disease and Gait Speed in Women With and at Risk for HIV

Introduction: Peripheral artery disease (PAD) is associated with decreased physical function and increased mortality in the general population. PAD is common in women with and at risk for HIV infection, but its association with functional decline is unclear. We examined the contribution of PAD to gait speed in the Women’s Interagency HIV Study, controlling for traditional cardiovascular risk factors and HIV-related factors. Methods: 1,839 participants (72% HIV+) with measured ankle-brachial index (ABI) and 4-meter gait speed were included in analysis. ABI scores were categorized as: &lt;0.7, moderate-severe PAD; 0.7-&lt;0.9, mild PAD; 0.9-&lt;1.0, borderline PAD; 1.0-&lt;1.1, low-normal; 1.1-1.4, normal. Longitudinal regression models with repeated measures were used to examine the association of PAD category with log-transformed gait speed after controlling for demographic, behavioral, and cardiovascular disease risk factors, and HIV and HCV status. Coefficients represented percentage differences. Results: Median age was 50 years, &gt;70% were Black. Figure 1 shows median gait speed by PAD group. In univariate analysis, compared to normal ABI, each category of PAD severity was associated with slower gait speed: 6% slower for low-normal (95% confidence interval [CI]:4%, 9%), 10% for borderline (95% CI:6%, 13%), 14% for mild (95% CI:9%, 18%), and 16% for moderate-severe (95% CI:5%, 25%). In multivariate analysis, PAD severity remained associated with 6% (95% CI:4%, 9%), 10% (95%CI:7%, 14%), 12% (95%CI:8%, 17%), and 11% (95%CI: -1%, 22%) slower gait speed, respectively. HIV/HCV coinfection reduced gait speed by 9% (95%CI:4%, 14%). Among HIV+ women, neither CD4 count nor HIV viral load was associated with gait speed. Conclusions: In middle-aged women with and at risk for HIV, greater PAD severity is associated with progressively slower gait speed. ABI measurement may be a simple and clinically useful tool for early assessment of functional declines.

Abstract 14735: Volatile Organic Compounds Are Associated With Lower Ankle-Brachial Indexes in African Americans of the Jackson Heart Study

Introduction: Cigarette smoking is associated with peripheral artery disease (PAD) in African Americans (AA), but the association between cigarette constituents and PAD remain inadequately studied. We evaluated the effect of volatile organic compounds (VOC) acrolein and crotonaldehyde on ankle-brachial index (ABI) as well as related biomarkers in AA participants of the Jackson Heart Study. Methods: Urinary VOC concentrations were measured in a subset of participants at baseline including 345 self-reported current smokers and 718 never smokers. Multivariable linear regression assessed the association between ABI and VOC concentrations after adjustment for acute (cotinine) and chronic (pack-years) smoking measures in models 1 and 2, respectively. The degree of association was assessed after adjusting for possible mediation (Baron &amp; Kenny procedure) by C-reactive protein (CRP), fibrinogen, and homocysteine (HCY) concentrations. VOC concentrations were natural log transformed for normal distribution and all models adjusted for relevant covariates. Results: The mean age of included participants was 52 years and 49% women. Individuals who smoked were more likely to be men, less educated, have prevalent cardiovascular disease, and lower mean ABI. In model 1, ABI was inversely associated with urinary acrolein and crotonaldehyde concentrations. Model 2 retained the inverse ABI association for both VOC. Crotonaldehyde was directly associated with CRP and HCY in models 1 and 2. In model 1, acrolein was associated with HCY (Table). Biomarker mediation of the VOC-ABI relationship was insignificant. Conclusions: Acrolein and crotonaldehyde concentrations are associated with lower ABI and higher measures of inflammation and thrombosis in a community-based sample of AA. These findings suggest reduction in VOC exposure may reduce the risk of PAD in AA who smoke cigarettes.

Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women

Background and aimsAnkle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women. MethodsWe developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories. ResultsIn the base-case analysis, FRS + ABI reported an additional cost of € 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of € 27.986/QALY, when compared to FRS alone. The ICER improved to €1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy. ConclusionsThe addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment.

Comparison of Color Doppler Ultrasound and Ankle-Brachial Pressure Index Measurement in Peripheral Vascular Diseases

Peripheral vascular diseases (PVD) are a group of common degenerative (organic) and vasospastic (functional) disease processes that result in significant morbidity and are strong predictors of subsequent mortality. It is diagnosed by definitive history of intermittent claudication or if one or more of peripheral pulses are absent in one or both lower limbs. A variety of non-invasive techniques, viz., ankle-brachial pressure index (ABPI) test and color Doppler imaging, are available to diagnose the presence of PVD as well as to localize areas of stenosis, assess severity of disease, and follow patients for disease progression or response to therapy. Therefore, the focus of this study is to compare color Doppler ultrasound and ABPI individually and in combination in diagnosing cases of peripheral vascular diseases, considering CT angiography the gold standard investigation. Patients were assessed on the basis of history; clinical examination and relevant investigations done were noted in the data sheet according to the proforma including the Edinburgh Claudication Questionnaire. Comparison of color Doppler ultrasound and ankle-brachial pressure index measurement in peripheral vascular diseases was determined using relevant statistical tests. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for comparison of ABPI and color Doppler imaging with CT angiography. Color Doppler ultrasound proved to be a better modality as compared to the ankle-brachial pressure index for diagnosis of peripheral vascular disease, considering CT angiography the gold standard investigation.

Association between ankle-brachial index and cognitive function in participants in the PREDIMED-Plus study: cross-sectional assessment

Introduction and objectivesThe ankle-brachial index (ABI) is an indicator of peripheral artery disease (PAD). The aim of this study was to assess the association between PAD, measured with the ABI, and cognitive function in persons with overweight or obesity and metabolic syndrome. MethodsCross-sectional study conducted with baseline data from the PREDIMED-Plus study, which included 4898 participants (after exclusion of those without ABI measurements) aged between 55 and 75 years, and with overweight or obesity and metabolic syndrome. At the baseline assessment, we measured the ABI with a standardized protocol and assessed the presence of other cardiovascular risk factors (eg, diabetes, dyslipidemia, hypertension). Cognitive function was evaluated using several tests validated for the Spanish population (mini-mental state examination [MMSE], phonological and semantic verbal fluency test, WAIS-III working memory index [WMI], parts A and B of the trail making test (TMT), and clock drawing test). Generalized linear models were used to assess the association between the ABI and cognitive function. ResultsAmong the participants, 3.4% had PAD defined as ABI ≤ 0.9, and 3.3% had arterial calcification defined as ABI ≥ 1.4. PAD was associated with age, systolic blood pressure and obesity indicators, while arterial calcification was also associated with obesity and diabetes. No significant associations were observed between cognitive function and ABI or PAD. ConclusionsIn our sample, the presence of PAD increased with age, blood pressure, and obesity. No significant association was observed between ABI, PAD, or cognitive function.

Getting Ready for Wound Certification: Assessing and Managing Lower Extremity Venous Disease.

Getting Ready for Wound Certification: Assessing and Managing Lower Extremity Venous Disease.

Chemerin in coronary artery disease patients

Abstract Background Chemerin – a recently described hormone is secreted by adipose tissue. It exerts proinflammatory action, leads to insulin resistance, but also has potentially favorable effects: it increases eNOS activity and is pro-angiogenic. Increased serum concentrations of chemerin was observed in patients with coronary artery disease (CAD). The role of chemerin in pathogenesis of CAD is not well understood. Purpose The aim of this pilot study was to assess the role of chemerin in pathogenesis of atherosclerosis, its impact on condition of large arteries and prognosis in CAD. Methods We included in the study patients with stable CAD who underwent percutaneous coronary intervention (PCI) in the past. Chemerin levels were measured with ELISA method. All patients had routine blood tests and insulin levels measured. Patients without history of diabetes also had OGTT. Status of large arteries was evaluated with carotid ultrasound, pulse-wave velocity (PWV) and ankle-brachial index (ABI). Body composition was assessed wit DEXA method. Anatomical severity of CAD was evaluated with SYNTAX score. One-year composite endpoint included death, myocardial infarction, revascularization, stroke and hospitalization for cardiovascular reasons. Results The study group comprised 163 patients (mean age 59.8± years, 26% of females, n=43). Mean chemerin level was 284.8 ng/ml. There was no significant difference in chemerin concentrations between patients with diabetes and remaining ones (with prediabetes and with normal glucose levels) 306.8±121 vs 274.15±109 pg/ml, p=0.1. In Spearman test chemerin level correlated with total fat mass (R=0.15, p=0.047), trunk fat mass (R=0.16, p=0.039), android fat mass (R=0.16, p=0.036), and BMI (R=0.18, p=0.028). Chemerin also correlated with white blood cells (WBC) count (R=0.34, p&amp;lt;0.0001), hsCRP (R=0.16, p=0.03), total cholesterol (R=0.17, p=0.028), LDL cholesterol (R=0.19, p=0.01), HDL cholesterol (R=−0.21, p=0.006), triglicerides (R=0.3, p&amp;lt;0.0001), platelet count (R=0.23, p=0.002), fasting insulin (R=0.22, p=0.004) and c-peptide (R=0.26, p=0.0005). There was no significant difference in chemerin levels between patients with carotid atherosclerosis (n=93) and patients with normal carotid arteries (n=70), (300±124 vs 263±94 ng/ml, p=0.07). There were no significant associations between chemerin levels and PWV, ABI measurements, SYNTAX score, or 1-year prognosis. Conclusions This is the first study to show that in patients with CAD chemerin levels correlate with WBC and with android fat tissue mass. Additionally, chemerin levels positively correlated with other inflammation or insulin resistance markers, and with unfavourable lipid profile. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Science Centre

Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

Statin use associated with lower mortality in very elderly patients with peripheral arterial disease

Abstract Introduction Given the potential side effects and the lack of data on its efficacy, the role of statins in the very elderly (age 75+) with peripheral arterial disease (PAD) is uncertain. Previous studies have shown significant mortality benefit in very elderly patients with coronary artery disease, but the effect in PAD has not been evaluated. Methods Very elderly patients aged 75 to 80 with at least five years of follow-up who underwent ankle-brachial index (ABI) measurement were included. PAD was defined as either low ABI &amp;lt;0.90 or high ABI &amp;gt;1.40. Demographic, medication use, comorbidity and mortality data was obtained using the electronic medical record. Univariate and multivariate Cox proportional hazard analyses were performed. Results In total, 4,560 very elderly subjects with PAD were included in the analysis. The median age was 77 (interquartile range 76–79) and 39% were female. 3,462 (76%) had low ABI while 1098 (24%) had high ABI. Univariate analysis showed that patients on statins were more likely to be male, have diabetes, have coronary artery disease, and have hyperlipidemia. Overall, 1,355 (30%) patients died in the five-year period. Unadjusted all-cause mortality hazard ratios for patients with low or high ABI with statin use was 0.66 (95% confidence interval [CI]: 0.57–0.75) and 0.80 (95% CI: 0.66–0.97), respectively. After adjusting for age, sex, coronary artery disease and diabetes, statin use in low and high ABI was still associated with significant reductions in risk of all-cause mortality of 0.59 (95% CI: 0.51–0.67) and 0.66 (95% CI: 0.54–0.80), respectively. The survival curve for very elderly patients with PAD by statin use is shown in Figure 1. Conclusion Statin use in the very elderly was associated with lower risk of all-cause mortality in the five-year period after diagnosis of PAD. There appears to be a mortality benefit with statin use in the very elderly with PAD, though careful consideration of benefits and side effects should be individualized in this age group. Figure 1 Funding Acknowledgement Type of funding source: None

Prevalence of Lower Extremity Arterial Disease as Measured by Low Ankle-Brachial Index in Patients with Acute Cerebral Ischemic Events.

Background: Low ankle–brachial index (ABI) of ≤0.9 is diagnostic of lower extremity arterial disease (LEAD). It is also a strong marker of generalized atherosclerosis. The objective of this study was to assess the prevalence of low ABI in patients with acute cerebral ischemic events (ACIE): ischemic stroke (IS) or transient ischemic attack (TIA). Methods: We compared 150 inpatients with ACIE to 50 inpatient controls and assessed risk factors, ABI measurements, and Duplex ultrasound of the cervical vessels. Results: Low ABI was seen in 69 patients (46%) in the ACIE group and in 8 (16%) in the control group; p < 0.01. The mean and median ABI values in the ACIE group were 0.88 (SD = 0.22) and 0.91 (0.24–1.33), which were significantly lower than in the control group: 1.04 (SD = 0.16) and 1.0 (0.66–1.36); p < 0.0001, respectively. Coronary artery disease, carotid stenosis of ≥50% and smoking were risk factors, which were associated with significantly lower ABI in the study group; the ABI with risk factors vs. without was 0.85 vs. 0.92 (coronary artery disease); p < 0.05, 0.7 vs. 0.92; (carotid stenosis) p < 0.001 and 0.83 vs. 0.98; (smoking) p < 0.001, respectively. Conclusion: Our study demonstrated that patients with ACIE have significantly higher involvement of another vascular bed as LEAD. Coronary artery disease, carotid stenosis ≥50% and smoking were main risk factors associated with coexistence of LEAD and ACIE.

Prevalence of peripheral arterial diseases in patients with large artery ischemic stroke and its prognostic value

BackgroundPeripheral artery disease (PAD) can be an important predictor of comorbid cerebrovascular disease (CVD). However, it is not sufficiently investigated or considered in the management and prevention of stroke.ObjectivesTo study the prevalence of peripheral arterial disease in large artery ischemic stroke patients and its impact on prognosis.MethodsThis is a prospective cohort study. A total of 100 patients with large artery ischemic stroke were enrolled with assessment for signs of PAD; duplex on both lower limb arteries and measurement of ankle-brachial index (ABI), carotid duplex, and/or C.T angiography brain and neck and/or conventional angiography; functional assessment by NIHSS at days 0, 7, and 30; and follow-up for recurrence or death after 6 months.ResultsPeripheral arterial disease was found in 42% of cases. Fifty percent of patients with lower extremity arterial disease were asymptomatic. Fifty percent had significant carotid stenosis (stenosis > 50%), and 48% of patients with significant carotid stenosis had peripheral arterial disease. During our study, 8 cases had a recurrence of large artery ischemic stroke, and 5 cases (62.5%) had PAD. The recurrence rate of stroke was the highest in the asymptomatic PAD group with 19%.ConclusionThe prevalence of PAD in large artery ischemic stroke patients is high. Asymptomatic PAD has a risk potential for large artery ischemic stroke recurrence and mortality more than symptomatic PAD and non-PAD patients.

Asociación entre índice tobillo-brazo y rendimiento cognitivo en participantes del estudio PREDIMED-Plus: estudio transversal

Introduction and objectivesThe ankle-brachial index (ABI) is an indicator of peripheral artery disease (PAD). The aim of this study was to assess the association between PAD, measured with the ABI, and cognitive function in persons with overweight or obesity and metabolic syndrome. MethodsCross-sectional study conducted with baseline data from the PREDIMED-Plus study, which included 4898 participants (after exclusion of those without ABI measurements) aged between 55 and 75 years, and with overweight or obesity and metabolic syndrome. At the baseline assessment, we measured the ABI with a standardized protocol and assessed the presence of other cardiovascular risk factors (eg, diabetes, dyslipidemia, hypertension). Cognitive function was evaluated using several tests validated for the Spanish population (mini-mental state examination [MMSE], phonological and semantic verbal fluency test, WAIS-III working memory index [WMI], parts A and B of the trail making test (TMT), and clock drawing test). Generalized linear models were used to assess the association between the ABI and cognitive function. ResultsAmong the participants, 3.4% had PAD defined as ABI ≤ 0.9, and 3.3% had arterial calcification defined as ABI ≥ 1.4. PAD was associated with age, systolic blood pressure and obesity indicators, while arterial calcification was also associated with obesity and diabetes. No significant associations were observed between cognitive function and ABI or PAD. ConclusionsIn our sample, the presence of PAD increased with age, blood pressure, and obesity. No significant association was observed between ABI, PAD, or cognitive function.

When Is an Orthopedic Intern Ready to Take Call?

While orthopedic residency training varies among programs, an inevitable phenomenon is a transition for interns from consistent oversight to independent call with indirect supervision. It is therefore crucial to reliably assess trainees' ability to perform basic procedures. The objective of the study was to evaluate the utility of a novel Orthopaedic Intern Skills Assessment (OISA) to assess skill level. In a cohort study, participants were evaluated on their ability to complete eleven skills in a simulated environment. Using a standardized patient and/or cadaveric specimen, we assessed skeletal traction, joint aspiration, joint injection, laceration repair, ankle brachial index measurement, compartment pressure monitoring, upper and lower extremity splinting, informed consent, spine trauma exam, and cervical spine clearance abilities. The assessment took place in a medical simulation lab at the Oregon Health & Science University in Portland, Oregon. Third- or fourth-year medical students interested in orthopedics, incoming interns (preinterns), and residents within 1 month of completing their intern year (postinterns) were invited to participate in the study. All interested individuals were included. Of the 20 individuals contacted, 14 (70%) consented: 4 medical students (40%), 5 preinterns (100%), and 5 postinterns (100%). All consenting individuals finished their participation in the research. Postintern skill completion rate was significantly higher than preinterns (p = 0.006) and medical students (p < 0.001). Completion rates for preinterns were also significantly higher rate than medical students (p = 0.035). Our OISA found that postinterns had reached a basic orthopedic skill level expected of a junior resident without in-house supervision. Our OISA also highlighted areas of training that needed further attention, which will help orthopedic training programs verify an appropriate level of skill as trainees' progress from a supervised intern year to taking indirectly supervised junior resident call, and help identify areas where increased training is needed.

Correlation of obesity indices with QTc interval and Ankle Brachial Index in young adult population

Background: In recent times, obesity has acquired an epidemic status world over and in India. The association of obesity with vulnerability to cardiovascular ailments and peripheral vascular disease are well defined. The present study was designed to correlate between chosen obesity indices with electrocardiographic variables, Ankle brachial index(ABI) and systolic and diastolic blood pressure in asymptomatic young adults. Materials and Methods: A cross-sectional study performed on 100 subjects, with equal number of male and female participants. Blood pressure, Electrocardiogram, pulse rate were recorded in the participants after resting for ten minutes. Waist circumference, hip circumference, height and weight were measured using standard protocols defined by WHO. Student’s t test, ANOVA test and Pearsons correlation test were used to find the significance. Results: Among the randomly selected 100 subjects, 46% of male and female subjects were in the obese category (Body Mass Index >25.0). Almost 38% of male and 60% of female subjects had a Waist circumference more than the cut-off value. 28% of male and 88% of female subjects were found to have a Conicity Index (CI) more than the cut-off value. Leftward shift of the mean QRS axis correlated significantly with increasing obesity indices in both sexes. A persistent increase in systolic and diastolic blood pressure was observed among obese individuals. Results in male subject show that CI correlated with QTc interval (r=0.71; p=0.001) and diastolic blood pressure (r=0.32; p=0.02). Results among female subjects show that BMI correlated significantly with systolic(r=0.34; p=0.01) and diastolic blood pressure (r=0.35;p=0.01), WC positively correlated with systolic blood pressure(r=0.32; p=0.02) and there was a significant negative correlation between WC and ABI (r= -0.42; p=0.002) and CI correlated negatively with ABI (r= -0.36; p=0.01). Conclusion: Abdominal obesity is increasingly prevalent among young adults. The measurement of anklebrachial index by using oscillometric blood pressure instrument can be used in primary health centers and relatively unequipped clinics for provisional diagnosis of Peripheral arterial disorder and related disorders.