Ankle-brachial Index Values Research Articles

Diabetes Mellitus Foot Exercise Increase ABI (Ancle Brachial Index) Value in Type II DM Patients in The Puskesmas Cipondoh at Tangerang City

This study aims to determine the effect of diabetic foot gymnastics on the value of Ankle Brachial Index (ABI) in Type II Diabetes Mellitus patients in the Cipondoh Health Center, Tangerang City. The design used is Quasi experiment with a pre–test–post–test approach. The population of this study was 42 dm type II patients in the puskesmas work area in Tangerang city. Samples were taken using purposive sampling techniques and divided into 2 groups, 20 people in intervention groups and 22 control groups. The average ABI before diabetic foot exercises of the intervention group was 0.87 and the average ABI after diabetic foot exercises were 0.93. The results of statistical analysis showed that there was a significant difference in ABI values between the intervention and control groups after diabetic foot exercises (p-value = 0.003). It was concluded that implementing diabetic foot exercises could increase the value of ABI in type II DM patients. This study recommends that diabetic foot exercises are expected to be performed for type II DM patients and ABI examinations can be used as additional examinations, especially in DM patients who go to the Health Center.

Study of ankle–Brachial index among the patients of metabolic syndrome

Background: Metabolic syndrome (MetS) refers to a group of conditions that are associated with increased cardiovascular risk. Ankle–brachial index (ABI) is a noninvasive, inexpensive way of assessing the blood flow in the lower limbs and may be useful as an indirect marker of subclinical atherosclerosis. Aim and Objective: To study and compare ABI values between patients with MetS and patients without MetS. Materials and Methods: A total of 98 patients attending the outpatient department between October 2018 and September 2020 were included in the study. They were categorized as MetS and non-MetS as per the National Cholesterol Education Program Adult Treatment Panel III guidelines. They were tested for ABI with a handheld Doppler. The ABI values were compared between the two groups. Results: Among 98 patients, 49 were cases and 49 as controls. ABI values were found to be 1.09 ± 0.12 among the cases and 1.22 ± 0.05 among the controls and were found to be statistically significant (P < 0.001). Conclusion: The patients with MetS had lower ABI compared with the patients who did not have MetS. ABI can be used as an indirect marker of atherosclerosis and can be used in routine clinical assessment for identifying patients at a higher cardiovascular risk.

New Approach to Measuring the Ankle and Toe Brachial Indices as New Markers for Early Detection of Lower Extremity Peripheral Artery Disease

Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.

Decreased Physical and Daily Living Activities in Patients with Peripheral Arterial Disease on Hemodialysis.

Decreased physical activity and activities of daily living (ADL) in patients on hemodialysis (HD) are associated with a poor prognosis. Additionally, comorbid peripheral arterial disease is associated with further deterioration. We conducted a cross-sectional study of ADL difficulty and life-space assessment (LSA) in three groups of patients on hemodialysis according to their ankle-brachial index (ABI) values. The 164 patients were divided into ABI Low (ABI < 0.9), Normal (0.9 ≤ ABI < 1.3), and High (1.3 ≤ ABI) groups, and compared using analysis of covariance with LSA and ADL difficulty adjusted for age. The Kihon checklist (KCL) was used to assess the presence of frailty. The LSA was lower in the Low group than in the High group (F = 3.192, p = 0.044). Similarly, the ADL difficulty was significantly lower in the Low group than in the Normal group (F = 3.659, p = 0.028). In the Low group, the proportion of patients with frailty was 47.1% and KCL physical was significantly lower, indicating that patients on HD with a lower ABI had a higher prevalence of frailty and lower LSA and ADL difficulty. In conclusion, patients on HD with decreased ABI values most likely exhibit decline in physical activity and ADL due to frailty and claudication.

Outcomes of Surgical Revascularization for Acute Limb Ischemia in COVID-19 Patients Comparing to Noninfected Cohort: A Single-Center Observational Prospective Study

The purpose of the study was to compare the clinical presentation, management, and outcomes of surgical revascularization for acute limb ischemia (ALI) in 2 groups of patients-with and without SARS-CoV-2 infection. During the 2years (01.01.2020-31.12.2021) all consecutive patients diagnosed with ALI and treated with urgent revascularization were prospectively enrolled. Based on the results of polymerase chain reaction swab for SARS-CoV-2 infection patients were allocated to group A-infected or group B-noninfected. Demographic characteristics, clinical, imaging, laboratory data, and details of treatment were collected prospectively. The composite endpoint of major amputation and/or death at 30days after surgery was defined as main study outcome. The postoperative ankle-brachial index value, reinterventions, complications, and length of hospital stay were considered as secondary outcomes. Overall, 130 patients (139 limbs with ALI) were analyzed-21 patients (23 limbs) in group A and 109 patients (116 limbs) in group B. The anatomical site of arterial occlusion, duration, and severity of ischemia did not differ significantly between the groups. Patients with COVID-19 had significantly shorter time from ALI onset till administration of the first dose of anticoagulant: 8 (2.5-24) hr vs. 15.7 (6-72) hr in group B, P=0.02. Vascular imaging was performed before intervention only in 5 (23.8%) infected patients compared to 78 (71.5%) patients in group B, P<0.001. The main outcome was registered in 38 (29.2%) patients, significantly more frequent in infected cohort: 12 (57.1%) patients in group A versus 26 (23.8%) in group B, P=0.003. Difference was preponderantly caused by high mortality in group A-9 (42.8%) patients, compared to 17 (15.5%) patients in group B, P=0.01. The difference in the rate of limb loss was not statistically significant: 4 (17.3%) limbs were amputated in COVID-19 patients and 12 (10.3%) limbs-in noninfected patients (P=0.3). Combination of ALI and COVID-19 resulted in increased 30-day mortality-risk ratio (RR) 2.7 (95% confidence interval [CI]: 1.42-5.31), P=0.002, but did not lead to significantly higher amputation rate-RR 1.6 (95% CI: 0.59-4.75), P=0.32. In group A initial admission of the patient in the intensive care unit was an independent risk factor for amputation/death. Excepting systemic complications which were more frequently registered among COVID-19 patients: 7 (33%) cases vs. 14 (12.8%) in group B, P=0.04; no differences in other secondary outcomes were observed between the groups. Study demonstrates the significant negative impact of COVID-19 upon the 30-day amputation-free survival in patients undergoing urgent surgical revascularization for ALI. The difference in outcome is influenced by higher rate of mortality among infected patients, rather than by the rate of limb loss. Severity of COVID-19, namely requirement of intensive care, mostly determines the outcome of ALI treatment.

The Effect of Endovascular Revascularization on Ankle Brachial Index (ABI) Value in Patients with Peripheral Artery Disease: A Systematic Review

Background: Peripheral arterial disease (PAD) is the presence of a lesion that decreases the flow of arteries that supply blood to the limbs. In a study involving Asian countries including Indonesia in 2006, the prevalence of peripheral arterial disease was 9.7%. Endovascular revascularization is one of the treatment options for patients with PAD. One of the criteria for assessing PAD patients can be seen from the Ankle Brachial Index (ABI) value. Objective: To determine the effect of endovascular revascularization on ABI value in patients with PAD. Methods: This study uses a systematic review approach, collecting data from previous studies. Data were collected from the UI library database, PubMed NCBI, and Science Direct. The article search method uses the characteristics of PICO (Population, Intervention, Comparison, Outcome), then compiled using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. Results: From 24 research articles that were reviewed, there were significant increases in the mean value of ABI when compared between pre-treatment and post-treatment, which were more than 0.10. Additionally, in several studies that were followed up on patients for a period of time to assess patency and restenosis, the mean value of ABI decreased to less than 0.15. Types and technologies of endovascular revascularization used in the 24 studies were also varied. Conclusion: There were significant increases in the ABI value in patients who received endovascular revascularization. So, when viewed from the ABI value, this treatment is effective. Further studies with data from the clinical improvement of patients or patients receiving bypass surgery are still needed to discover the appropriate treatment method for patients with PAD.&nbsp; Keywords: Endovascular, Revascularization, Ankle Brachial Index &nbsp

746 DAL COMPASS AI DATI DI REAL LIFE: UNO STUDIO CASO-CONTROLLO

Abstract Background The COMPASS trial showed that rivaroxaban plus aspirin was associated with fewer adverse cardiovascular events, but more major bleeding events, as compared with aspirin alone in patients with chronic vascular disease. The clinical benefit was particularly favorable in high-risk subgroups, who are frequently undertreated because of the fear of severe bleeding events. Purpose Our aim is to evaluate objective effects of anticoagulation strategies with rivaroxaban among patients with stable cardiovascular disease. Methods We considered a population of patients with stable cardiovascular disease (coronary and/or peripheral artery disease) which has had dual antiplatelet therapy (DAPT) for 1 year. Between them we selected 65 patients (52 males and 13 females, mean age 59±7 years) with high risk of ischemic events and low bleeding risk. We used DAPT Score and HAS BLED Score to enroll patients. We stopped them DAPT and starting a dual therapy combining rivaroxaban 2,5 mg twice daily plus aspirin 100 mg. We excluded patients with high bleeding risk and heart failure with less than 35% ejection fraction. At baseline they underwent blood tests, transthoracic echocardiography, six minutes walking test (6MWT), Kansas City Cardiomyopathy Questionnaire (KCCQ) Score, evaluation of carotid– femoral pulse wave velocity (cf-PWV) and ankle brachial index (ABI). We established 3, 6 and 12 months follow-up. Results At 3 months follow-up we evaluated 41 patients (the study is going on) repeating those exams and comparing them with the baseline ones. We observed that 35% of population had reduction of cf-PWV values and in 40% of population ABI increased. 15% of patients had also improvement of more than 100 meters in 6MWT. Particularly, reduction of cf-PWV and improvement of ABI values suggest that rivaroxaban 2,5 mg twice daily may have effects on vascular protection and arterial stiffness through different mechanisms such as improvement of endothelial functionality and fibrinolytic activity at endothelium, anti-inflammatory properties and platelet-dependent thrombin generation. Nevertheless none of the patients experienced subjective clinical improvement and the KCCQ Score was unmodified. This element indicates that patients at 3 months follow-up have imperceptible changes that can be documented only by diagnostic imaging evaluation and not by anamnestic data. Finally, an important evidence was that none of the patients at 3 months follow-up reported major bleeding events. Conclusion Preliminary data suggest that the addiction of rivaroxaban 2,5 mg to aspirin exerts vascular protection and its effects can be primarly documented by evaluation of cf-PWV and ABI. The 6MWT seems to play a minor role at 3 months assessment. The KCCQ may not be useful to fill in at 3 months follow-up because patients seem not to perceive subjective clinical improvement in this phase. If confirmed on a large cohort these results may give rivaroxaban a higher relevance not only for the power but also for the immediacy of its effects. Anyway, we are continuing our check to give our data more statistical significance and to test any role of the other parameters at 6 and 12 months follow-up.

The Peripheral Vascular Status in Individuals with Type 2 Diabetes Mellitus

Poor vascularization in individuals with diabetes will worsen blood circulation due to high glucose in the blood. One of the risk factors leading to diabetic foot ulcers (DFU) is peripheral vascular disease. This study aims to identify the peripheral vascular status in individuals with type 2 diabetes mellitus (T2DM) at Kebonsari Public Health Centre, Surabaya. The research design in this study used a quantitative descriptive approach. There were 40 respondents with an accidental sampling. The data collection was carried out for four weeks, from May to June 2020. The research instrument was an observation sheet to record the Dorsalis Pedis artery pulse and ankle-brachial index (ABI). In addition, a digital sphygmomanometer was used to measure the Dorsalis Pedis artery pulse. Most respondents had the normal Dorsalis Pedis artery pulse in the right legs (80%), 20% had bradycardia, and none had tachycardia (0%). In addition, they had the normal Dorsalis Pedis artery pulse in the left legs (70%), 20% had bradycardia, and none had tachycardia (0%). Furthermore, they had the normal ABI values in the right legs (55%), 45% had borderline ABI values, and none had ischemic and critical ischemic (0%). In addition, they had the normal ABI values in the right legs (52%), 47% had borderline ABI values, and none had ischemic and critical ischemic (0%). Most individuals with T2DM at the Kebonsari Public Health Center, Surabaya, had normal peripheral vascular status. However, few respondents had bradycardia in the Dorsalis Pedis artery pulses, and almost half had borderline ABI values.

Serum zinc values, ankle brachial index and mortality in hemodialysis patients

IntroductionThe atherosclerotic state of haemodialysis (HD) patients may be influenced by heavy metals. The purpose of our study was to assess the relationship between serum zinc (Zn) ankle brachial index (ABI) as a non-invasive diagnostic tool for atherosclerosis, and mortality in chronic haemodialysis (HD) patients.MethodsSixty one HD patients were included (mean age 61.2 ± 13.8 years). The ABI was measured with an automated measuring device (ABPI MD, MESI®, Slovenia). Two groups of patients were formed based on the median value of Zn (14.1 mcmol/l). The average observation time was 2.8 years. Comorbidities (arterial hypertension (AH), diabetes mellitus (DM), dyslipidaemia), smoking and oral nutritional supplements (ONS) consumption were noted. Survival rates were analysed by Kaplan–Meier and Cox regression was used to determine the influence of Zn, ABI, AH, DM, dyslipidaemia, smoking and ONS.ResultsZn values were between 9.2 and 23.5 mcmol/l (14.4 ± 2.34), ABI values ranged from 0.8 to 1.4 (1.14 ± 0.12). Patients with lower Zn values had lower ABI (p = 0.036). Mean survival time of patients with higher Zn values was 985 days ± 277 days and with lower Zn values 1055 ± 143 days. Six (19.4%) patients with lower Zn and five (16.7%) patients with higher Zn died. We found statistically insignificant lower survival in patients with higher Zn. We failed to find any predictor of all-cause mortality, except for ONS consumption (95% CI 1.6–33.3; p = 0.012).ConclusionsLower Zn is associated with lower ABI in HD patients, but we found no impact of Zn on patient survival.

The Effect of Diabetic Foot Exercises on Ankle Brachial Index Values and the Degree of Diabetic Foot Risk in Diabetes Melitus Patients

Background: The prevalence of Diabetic Foot Ulcers (DFU) in diabetics is 4-10% where this condition more often affects the elderly. DFU is a serious marker of a disease that if optimal prevention is not carried out from the start, the wound deteriorates rapidly, and the worst is amputation. Diabetic foot exercises are used as leg exercises and are beneficial in reducing pain, reducing nerve damage, controlling blood sugar and increasing blood circulation in the feet. The purpose of this study was to analyze the effect of diabetic foot exercise on the degree of risk of diabetic foot ulcers and the Ankle brachial index value in Diabetes Mellitus patients in the Work Area of the Mamboro Health Center. Methods: This type of research is quasi-experimental with a one group pretest posttest design. The sample is 16 people. The instruments used were a monofilament test, sphygmomanometer, stethoscope, and an instrument for assessing the risk of diabetic foot. Data analysis used is paired t test and Wilcoxon test. Results The results showed that diabetic foot exercise had an effect on changes in the value of blood circulation (ABI) with a p value (0.000) and a score of degrees of risk of diabetic foot with a p value (0.001). Conclusion of this study is that diabetic foot exercise has a statistical effect on both the ABI value and the diabetic foot degree score. Suggestions from this study are that nurses more often conduct DM foot exercise education in an effort to prevent DFU

Mortality Risk Assessment in Peripheral Arterial Disease-The Burden of Cardiovascular Risk Factors over the Years: A Single Center's Experience.

Atherosclerosis is the basis of the cardiovascular continuum in peripheral artery disease (PAD) patients. Limiting functional decline and increasing quality of life are the main objectives for these patients. We conducted a prospective cohort study on 101 patients with PAD admitted to a single center in Northeast Romania. We used an index score to evaluate the 10-year mortality risk assessment and based on the scores we divided the patients into two groups: a low and low-intermediate risk mortality group (49 cases, 48.5%) and a high-intermediate and high-risk mortality group (52 cases, 51.5%). We analyzed demographics, comorbidities, clinical and paraclinical parameters and we aimed to identify the parameters associated with an unfavorable prognosis. Patients in the high-intermediate and high-risk mortality group were associated more with cardiovascular risk factors. Hypertension (p = 0.046), dyslipidemia (p < 0.001), diabetes mellitus (p < 0.001), and tobacco use (p = 0.018) were statistically significant factors. Lipid profile (low-density lipoprotein cholesterol, p = 0.005) and fasting blood glucose (p = 0.013) had higher mean serum values in the high-intermediate and high-risk mortality group, with a positive correlation between them and the ankle-brachial index value (p = 0.003). A multidisciplinary assessment and, especially, correction of associated cardiovascular risk factors prevent complications, and thus, improve the prognosis in the medium and long term.

Towards noninvasive early detection and classification of peripheral arterial disease stenosis severity by perfusion dynamics and artificial intelligence

Abstract Introduction Recent guidelines suggest Ankle-Brachial Index (ABI) measurement for assessing and reducing cardiovascular risk. PAD patients suffer from generalized arterial stiffening (arteriosclerosis) and develop threatening arterial stenosis foci. ABI cannot differentiate between the two, and detecting focal stenosis is especially challenging in the elderly and diabetics suffering from severe arteriosclerosis. Thus, better diagnostic tools are required for early detection of severe arterial stenosis in order to improve patient management reduce atherosclerotic cardiovascular risk and amputation rates. Purpose We hypothesized that quantifying the peripheral perfusion dynamics would provide more sensitive indices for monitoring atherosclerotic disease severity. Thus, we compared the utility of ABI, impedance-plethysmography (IPG), and photoplethysmography (PPG) in detecting and classifying arterial-stenosis using machine learning and artificial intelligence. Methods Arterial stenosis was emulated in supine lying healthy consenting volunteers (n=31) by inflating a blood-pressure cuff around their thigh to 45 and 90 mmHg for six minutes. We quantified the perfusion dynamics by IPG and PPG signal analyses in the time-frequency domain. The induced stenosis levels were classified by artificial intelligence using novel indices. Results Hallux O2-saturation remained intact (96±3%, p=0.4) even during 90 mmHg thigh-cuff compression. The baseline ABI (1.19±0.01) remained unchanged during 45 mmHg compression, slightly declined (1.12±0.02) upon 90 mmHg compression; but, all ABI values were above the 0.9 threshold. The pulse transit time, a well-established index of arteriosclerosis, remained unchanged. Conversely, upon stenosis emulation (compression), the IPG immediately recorded a significant proportional phase delay between the compressed and contralateral legs and a significant proportional correlation decline. At baseline, the IPG phase-difference between legs over the 2–4 Hz band was 1.79±0.48° and grew to 29.5±2.4° and 71.2±1.8° upon 45 and 90 mmHg compression (p&amp;lt;0.001). The IPG inter leg correlation at the 4–6 Hz band declined from 0.962±0.005 at baseline to 0.857±0.012 and 0.676±0.015 during 45 and 90 mmHg compression (p&amp;lt;0.001). The PPG phase difference grew significantly and proportionally upon compression (p&amp;lt;0.001, n=28) but without a significant correlation decline. A neural-network classifier achieved 100% accuracy in classifying baseline and each compression level based on the IPG phase and correlation. The best classifier achieved only 81.25% accuracy, 83.33% sensitivity, and 90% Specificity based on the PPG. Conclusion Our perfusion-dynamic indices outperformed the ABI, and the IPG outperformed the PPG in detecting and classifying emulated stenosis. Differentiation between arteriosclerosis and arterial stenosis may be of immense clinical merit. Therefore, this simple, noninvasive method merits clinical evaluation. Funding Acknowledgement Type of funding sources: None.

Can we boost screening for peripheral arterial disease?

Abstract Despite the high prevalence of peripheral artery disease (PAD), the diagnosis is often delayed. The delayed diagnosis is due in part to comorbidities which can mask PAD symptoms, and in large part to the low use of conventional diagnostic tools. For PAD diagnostics, the guidelines recommend Doppler-based ankle-brachial index (ABI). The method is time consuming and requires skills. The toe pressure measurement which helps to eliminate the falsely elevated ankle pressures due to mediasclerosis is an almost neglected method for screening. In recent years, automatic, oscillometric four-limb blood pressure monitors have become available that provide data within minutes. We aimed to compare an automatic four limb blood pressure monitor with devices regularly used in our department. Methods Blood pressure was measured in 92 individuals (mean age 65±14 years) using a Doppler device (Hadeco) and a conventional manual sphygmomanometer on all four limbs, as well as an automatic, four-limb pressure monitor (BOSO ABI system-100 PWV) which also measured pulse wave velocity (PWV). Toe pressure was measured with a laser Doppler fluxmeter (Periflux 5000) and a photophlethysmography based toe pressure monitor (Systoe). Patients without known PAD but with at least one abnormal test result underwent a vascular imaging including ultrasound, CT or digital subtraction angiography. Among the 92 individuals there were patients with confirmed PAD, persons at high or very high cardiovascular risk, patients with non-ischaemic cardial diseases and healthy volunteers. Results ABI values of the posterior tibial artery at the corresponding side measured by Doppler and BOSO showed a strong correlation with each other (Pearson's r: 0.8 and 0.7), while the Doppler ABI values of the dorsal pedal artery showed a moderate or weak correlation with BOSO ABI values (r: 0.63 and 0.27). The toe pressure measured by laser Doppler and Systoe did not differ significantly. The ROC curve analysis of the Periflux TBI values supported 0.6 as a cut-off level (91.6% sensitivity, 84% specificity). Of the 52 individuals with high or very high cardiovascular risk, 15 with Doppler, 12 with BOSO and 29 with Periflux could be considered as abnormal, the vascular imaging confirmed PAD in 12 of them. Doppler ABI was abnormal in 96%, BOSO ABI in 69%, BOSO ABI combined with PWV in 92%, Periflux and Systoe toe brachial index (TBI) in 100–100% in 72 limbs with confirmed PAD. In control subjects, ABI, TBI, and PWV were normal; in subjects with high or very high risk, PWV was 58% abnormal, in confirmed PAD, 85%. All patients with abnormal PWV showed atherosclerotic lesions by the vascular imaging. Summary For detection of PAD, the measurement of TBI had the highest sensitivity. PAD screening of a large population may be possible using automatic four limb blood pressure monitors. By combining with additional features (e.g. PWV) the detection ratio can be improved to the level of the Doppler ABI method. Funding Acknowledgement Type of funding sources: None.

Efektifitas Senam Kaki Diabetik terhadap Ankle Brachial Index pada Pasien Diabetes Melitus: Literature Review

Diabetes mellitus is known as "the silent killer" because it can affect all body organs and cause complications, including complications in the feet. These complications can increase the rate of amputations and are life-threatening. Prevention can be done by doing foot exercises. In principle, leg exercises are done by moving all the joints of the legs to improve blood circulation. Blood circulation in the leg area can be measured through the Ankle Brachial Index examination. &#x0D; This study was to identify the effectiveness of diabetic foot exercise.&#x0D; The article search begins with conducting a PICO analysis, then continues with an electronic search for articles using Google Scholar, the year the article was published from 2016 to 2020. The keywords used are "Diabetes Mellitus" and "Leg exercise.” Screening is carried out through inclusion and exclusion criteria to determine the articles to be reviewed. So that articles were obtained that matched the inclusion criteria for review. &#x0D; Results showed nursing interventions for foot exercise on the ankle-brachial index in patients with type II Diabetes Mellitus can be categorized as safe and effective interventions that are given five times a week or for 30 minutes for 5 days or 6x2 a week to reduce the risk of injury to the ankle. foot. Performing effective foot exercises can increase the value of the Ankle Brachial Index to normal. 30-minute foot exercise for 5 days or 6x2 a week should be promoted and implemented as a routine to reduce the risk of injury in patients with diabetes mellitus.&#x0D; In conclusion, foot exercise in type II DM patients can increase the Ankle Brachial Index value which tends to be low to normal.

The effects of glucocorticoid treatment on cardiovascular system in patients with systemic lupus erythematosus.

This study aims to assess variables concerning arterial stiffness including carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity, ankle-brachial index, and the advancement of atherosclerosis development. Between October 2016 and December 2020, a total of 43 consecutive patients with systemic lupus erythematosus (SLE) (4 males, 39 females; mean age: 57±8 years; range, 42 to 65 years) were prospectively included in the study. All data were compared between the group treated with glucocorticoids and that not treated with these agents. The study group consisted of 43 patients with SLE, while 22 (51%) patients were treated with glucocorticoids. The mean duration of SLE was 12.3±5.3 years. Patients treated with glucocorticoids had lower values of ankle-brachial index compared to those who were not treated with glucocorticoids (p=0.041), although the values were within the range. A similar situation was reported for the carotid-femoral artery pulse wave velocity (p=0.032). However, carotid-radial artery pulse wave velocity was not significantly different between both groups (p=0.12). Properly selected therapy is important in the prevention of CVD.

Prognostic Value of Ankle-Brachial Index in Prediction of Cardiovascular Events in an Asian Population with Multiple Atherosclerotic Risk Factors.

We aimed to evaluate the incremental prognostic value after incorporation of the ankle-brachial index (ABI) into the 10-year pool cohort equation (PCE) risk model in patients with multiple risk factors (MRFs). A total of 4332 MRFs patients were divided into 2 groups as ABI ≤.9 or >.9. The primary outcome was hard cardiovascular events (hCVE: including cardiovascular death, myocardial infarction, or ischemic stroke) over a median follow-up of 36months. The Cox proportional hazards survival model, C-statistic, and net reclassification indices (NRI) were used. The occurrence of the primary outcome in the ABI ≤.9 group (3.7%) was significantly greater than in the ABI > .9 group (1.3%), P < .001. ABI is an independent predictor of hCVE in addition to the variables in the standard risk model (age, gender, and smoking status). ABI modestly improved the C-index when added to the PCE risk model (PCE .70 vs ABI+PCE .74). The addition of ABI to the PCE risk model did not significantly improve the classification of patients (NRI -.029; 95% CI: -.215 to .130). Despite ABI being one of the independent predictors of hCVE, integration of ABI into the PCE model did not improve the efficacy of risk reclassification in patients with MRFs.

Impaired functional exercise capacity and greater cardiovascular response to the 6-min walk test in congenital generalized lipodystrophy

BackgroundCongenital Generalized Lipodystrophy (CGL) is an ultra-rare disease characterized by metabolic disorders. However, the evaluation of functional exercise capacity, cardiovascular (CV) response to exercise, and peripheral arterial disease (PAD) in CGL is scarce. Here we evaluated the performance and CV response to exercise and their association with PAD in CGL compared to healthy individuals.MethodsTwelve CGL and 12 healthy subjects matched for age and gender were included. Functional exercise capacity, CV response, and PAD were measured using the six-minute walk test (6MWT) and ankle-brachial index (ABI), respectively.ResultsAt baseline, CGL subjects showed reduced predicted walked distance (6MWD) (p = 0.009) and increased heart rate (HR), systolic (SBP), and diastolic (DBP) pressures compared to healthy subjects (p < 0.05). Most CGL subjects presented normal ABI values (1.0 ≤ ABI ≤ 1.4). Only 25% (n = 3) had ABI ≤ 0.9. CGL subjects did not present changes in ABI and blood pressure 12 months after metreleptin (MLP) replacement, but they walked a greater 6MWD than baseline (p = 0.04). Further, 6MWD and right ABI measurements were positively correlated in CGL subjects (p = 0.03). Right ABI negatively correlated with glucose, triglycerides, and VLDL-c (p < 0.05).ConclusionsWe observed that CGL subjects had lower functional exercise capacity and higher cardiovascular effort for similar performance of 6MWT, suggesting that strategies for decreasing exercise effort in this population should be essential. Furthermore, better physical performance was associated with high ABI in CGL. Additional studies are needed to clarify leptin's role in preserving functional exercise capacity in CGL.

Development of a Non-Invasive Local Heating Load Test to Detect Severe Limb Ischemia Within 200seconds.

To establish a non-invasive test method for the rapid detection of severe ischemia (SI) in the limbs in patients with peripheral arterial disease (PAD). Between November 2019 and May 2021, 22 patients admitted for PAD to 2 hospitals agreed to participate in the study. All patients underwent a local heating load (LHL) test. SI was defined as at least 1 ankle-brachial index value of <.4 and/or transcutaneous oximetry value of <30mmHg. The other cases were classified as mild-to-moderate ischemia (MMI). The LHL test was performed simultaneously with 15minutes of heating and measurement by attaching a blood flow meter measuring probe combined with a warmer to the patient's dorsal foot. Evaluation consisted of 200-s periods from the start of heating to 800seconds. For each period, perfusion value (PV) was evaluated, and slope was calculated graphically based on linear regression as PV fluctuation per minute. Test accuracy was calculated using a receiver operating characteristic curve. Twenty-four limbs of 18 patients were finally evaluated; 4 patients (2 with missing data, 1 with collagen disease, and 1 with embolism) were excluded, with 13 and 11 limbs in the SI and MMI groups, respectively. The SI group showed a significantly lower slope value in the first 200seconds and lower PV at 200seconds and thereafter. From the slope value, it was possible to detect SI with 85% sensitivity and 73% specificity at 200seconds. PV could be determined with higher accuracy in periods after 200seconds, with 85% sensitivity and 82% specificity at 800seconds. Our non-invasive LHL test could be used as a rapid screening test to detect SI in limbs within 200seconds, as well as a more accurate test to detect ischemia within 800seconds.

Decrease serum anti-oxLDL antibody is an independent marker of peripheral arterial disease in peritoneal dialysis patients

Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients.Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group.Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients.Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients. Background and Aims : Autoantibodies to oxidized low-density lipoprotein (oxLDL) has an inverse associated with carotid artery atherosclerosis and predict development of future cardiovascular disease. Peripheral arterial disease (PAD), defined by low ankle-brachial index (ABI), is associated with increased mortality in patients with chronic renal failure. The present study aimed to determine the relationship between serum anti-oxLDL antibody level and PAD in peritoneal dialysis (PD) patients. Methods: The present cross-sectional, single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were measured using a commercial enzyme immunoassay. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group. Results: In the study, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010) as well as the older age (P = 0.006), serum levels of triglyceride (P = 0.008), fasting glucose (P < 0.001), and C-reactive protein (P < 0.001) were higher, while serum levels of anti-oxLDL antibody (P = 0.008) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of anti-oxLDL antibody (odds ratio [OR]: 0.978, 95% confidence interval [CI]: 0.958–1.000, P = 0.046) and C-reactive protein (each 0.1 mg/dL increase, OR: 1.662, 95% CI: 1.151–2.398, P = 0.007) were independently associated with PAD in PD patients. Conclusions: Serum anti-oxLDL antibody level is negatively associated and C-reactive protein is positively associated with PAD in PD patients.

Ferritin and iron significance in the unfavorable evolution of peripheral artery disease: A prospective study

Background and Aims : The aim of this study is to evaluate the relationship between ferritin and iron concentrations, and ankle-brachial index values at 6-12 months dynamics for peripheral artery disease (PAD) evolution predictability.