Ankle Brachial Pressure Index Values Research Articles

Arterial involvement of lower limbs in peripheral artery disease - the difference between diabetics and non-diabetics.

To detect peripheral artery disease in diabetic and non-diabetic individuals. The case-control study was conducted from October 2018 to September 2019 at Ruth K.M. Pfau Civil Hospital, Karachi, and comprised diagnosed diabetic patients with random blood sugar ≥200mg/dl in group A, and healthy non-diabetic subjects in group B. Ankle brachial pressure index was measured and mean luminal diameters of lower limb arteries were compared using colour Doppler ultrasonography. Data was analysed using SPSS 21. Of the 82 subjects, 41(50%) were in each of the 2 groups. The sample had 42(51.2%) males and 30(48.8%) females with overall mean age of 53.9±5.07 years (range 44-60 years). There was significant difference in the ankle brachial pressure index values between the groups (p=0.004). There was also a significant difference in the mean luminal diameters of distal arteries (p=0.001), while there was no significant difference in proximal arteries (p>0.05). The diabetics were more prone to developing peripheral arterial disease than nondiabetics.

AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH MEDIAL ARTERIAL CALCIFICATION

Objective: Several studies have shown that reduced ankle-brachial pressure index (ABI) is a reliable warning sign of increased cardiovascular risk. But also ABI values above 1.3 in the presence of medial arterial calcification (MAC) are associated with increased mortality due to cardiovascular causes. Aim of the study was in a group of patients with MAC using ambulatory blood pressure monitoring (ABPM) to document frequent occurence of arterial hypertension, with also frequent diurnal pattern loss, as significant factors in patients prognosis. Design and method: We examined 41 patients (25 men, 16 women) with identified MAC. Mean age 59 years (50-79 years). All patients have been treated for diabetes mellitus, type 2, most of them, 23 (56.1 %) with insulin. The mean duration of diabetes was 12.6 years. MAC was detected by the BOSO, ABI system 100 (Germany), using the oscillometric method of measuring blood pressure. ABI value was calculated as the ratio of the value of higher pressure in the leg to a higher pressure on the upper extremities. ABPM was performed with the Cardiosoft-Tonoport V, General Electric (USA). Results: 35 patients (85,4 %) had arterial hypertension, most of them, 20 (48,8 %) grade 3 hypertension (according to ESC/ESH Guidelines). 14 patients (40 %) had a preserved diurnal rhythm (dipping), 18 (51.4 %) had it disturbed (non-dippers or risers). In 3 patients (8.6 %) we did not determine the diurnal sign for night vigil. Conclusions: In patients with MAC, we found a high prevalence of arterial hypertension, and a diurnal rhythm disorder was also very frequent. This fact may also contribute to the worsened cardiovascular prognosis of these patients. Therefore ABPM in patients with MAC is highly recommended, since subsequent cardiology management can improve their prognosis.

Influence of Lower Limb Ischemia on Skeletal Muscle Mass Depletion in Patients with Peripheral Artery Disease

The aim of the study was to determine the change in skeletal muscle mass over time by bioelectrical impedance analysis (BIA) in patients with peripheral artery disease (PAD). Patients with symptomatic PAD visiting Tokyo Medical University Hospital between January 2018 and October 2020 were retrospectively analyzed. PAD was diagnosed based on ankle brachial pressure index (ABI)<0.9 with either leg and confirmed by duplex scan and/or computed tomography angiography as needed. Patients undergoing endovascular treatment, surgery, or supervised exercise therapy were excluded before and during the study period. Skeletal muscle mass of the extremities was measured using BIA. The sum of skeletal muscle masses in the arms and legs was calculated as skeletal muscle mass index (SMI). Patients were scheduled to undergo BIA at an interval of 1year. Of 119 patients, 72 patients were included in the study. All patients were ambulatory and had symptoms of intermittent claudication (Fontaine's stage II). SMI significantly decreased from 6.98±1.30 at baseline to 6.83±1.29 at 1-year follow-up. Individual skeletal muscle mass of the ischemic leg was significantly reduced after 1year, but not in the nonischemic leg. A decrease in SMI (defined as SMI ≥0.1kg/m2 per year) was independently associated with low ABI. The optimal cut-off value of ABI for the decrease in SMI was 0.72. These results suggest that lower limb ischemia due to PAD, especially if ABI is<0.72 or less, may result in a decrease in skeletal muscle mass that affects health and physical function.

Validation of a Standardised Duplex Ultrasound Classification System for the Reporting and Grading of Peripheral Arterial Disease

Duplex ultrasound (DUS), a non-invasive means of arterial mapping, allows for the reliable diagnosis of peripheral arterial disease (PAD). One of the authors (C.P.O.), developed a standardised DUS based scoring system, devised for rapid detection and reporting of PAD. The purpose of this study was to validate this system, and to determine the diagnostic performance both overall and per disease severity. In total, 250 participants were recruited, based on diagnosis of (n= 125) or absence of PAD (n= 125) from general practice registers. Right and left legs per subject were handled as independent readings, determining actual PAD status via ankle brachial pressure index (ABPI) < 0.9, and then further grading disease severity using suggested ABPI ranges. Data were excluded if no corresponding ABPI value was obtained per DUS determination or if the ABPI reading was > 1.4, owing to the risk of false negatives due to incompressible vessels. Diagnostic sensitivity and specificity were obtained overall, and per severity classification. Furthermore, inter-rater agreement between ABPI and DUS determined PAD severity was determined by linear weighted Cohen's kappa. The sensitivity and specificity in the detection of disease overall was 81.0% (95% confidence interval [CI] 73.4 - 87.2) and 86.3% (95% CI 82.3 - 89.8), respectively. From mild to severe PAD, sensitivity increased from 71.1% (95% CI 55.7 - 83.6) to 89.3% (95% CI 71.8 - 97.7). Furthermore, a Cohen's kappa value of 0.63 (95% CI 0.57 - 0.69) was obtained, indicating moderate agreement between the two diagnostic methods. The findings of this study validate the diagnostic performance of the standardised DUS scoring system, as well as its capacity to grade severity of disease, offering a potential tool for the identification of PAD in community/research settings following initial screening methods. Confirmatory work could include a comparison of DUS determined disease with gold standard methods of non-invasive angiography, and novel tools such as toe flex near infrared spectroscopy and multisite photoplethysmography.

The effects of foot exercise with audiovisual and group support foot exercises to diabetes mellitus patients.

This study aimed to analyze the effect of audiovisual and group support foot exercises on the Ankle Brachial Pressure Index and foot sensation. This study used a quasi-experimental design. The sample number of this study was 156 using a purposive sampling technique. The research group was divided into three groups. The variables measured in this study were ABPI, foot sensation, and foot exercise experience. The statistical analysis was conducted by a paired-sample t-test, an independent-sample t-test, and a two-way Manova. The results showed that each group had a difference in how ABPI and foot sensation were influenced (p = 0.000). Additionally, audiovisual and group support foot exercises have been shown to influence ABPI (p = 0.000) and foot sensation (p) = 0.000). Audiovisual and group support foot exercises significantly influenced the Ankle Brachial Pressure Index value and foot sensation in diabetic mellitus patients. This intervention is encouraged for diabetic mellitus patients who would like to see the benefits of exerciseand group support.

Relationship between olive oil consumption and ankle-brachial pressure index in a population at high cardiovascular risk

Background and aimsThe aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome. MethodsWe performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure. ResultsAmong 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48]). ConclusionsIn a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed.

Genetic Variants in Selenoprotein Genes Selenos, GPX4, and SEPP1, but not Selenoprotein Levels, are Associated with the Development of Peripheral Artery Disease and the Inter-individual Variation in the Ankle-Brachial Index

Introduction - Selenium (Se) is an essential micronutrient with important functions in human health and relevance to several pathophysiological conditions. The biological effects of Se are largely mediated by Se-containing proteins, referred to as selenoproteins. To date, a total of 25 selenoproteins have been identified in humans. The concentration of selenoproteins has been documented to correlate with a range of inflammatory markers and glucose homeostasis, which suggests their role in the pathogenesis of atherosclerotic peripheral arterial disease (PAD). In this study we analyze the relationships of single nucleotide polymorphisms (SNPs) in SEPP1, SELENOS, TXNRD1, TXNRD2, GPX4, and SOD2 genes as well as selenoprotein P (SeP) and thioredoxin (Trx) concentrations with the development of PAD and the values of ankle-brachial pressure index (ABI), a noninvasive marker of this disease. Methods - The two study samples were evaluated: 503 PAD patients and 594 controls in the discovery phase, and 408 PAD patients and 933 controls in the replication phase. All individuals were of Caucasian origin. SNPs were ascertained using pre-designed TaqMan SNP assays, and plasma selenoprotein levels with the ELISA immunoassay method. The main effects of each SNP and SNP-covariate interactions were assessed. Results - The SELENOS rs34713741T (recessive model: OR=1.49, 95%CI: 1.01-2.18, P=.043) and GPX4 rs713041T (dominant model: OR=1.31, 95%CI: 1.02-1.68; P=.035) alleles were associated with PAD, with a stronger effect in type 2 diabetes mellitus (T2DM; respective ORs: 2.77 95%CI: 1.00-7.68, P=.043 and 2.05, 95%CI: 1.19-3.53; P=.009). T2DM was related to 2.09-fold (95%CI: 1.56-2.78; P<.0001) increase in PAD risk. The association of the GPX4 SNP with PAD was confirmed in both a replication (P=.049) and a combined analysis (the discovery plus replication samples; P=.002), while the SELENOS SNP in a combined analysis only (P=.039). The influence of these SNPs on PAD risk suggested SNP-T2DM interaction (SELENOS x T2DM: ORObserved=5.47 > ORExpected=2.32; GPX4 x T2DM: ORObserved =2.87 > ORExpected= 1.53). The simultaneous presence of both risk genotypes with T2DM resulted in a 9.71-fold increase in PAD risk (95% CI: 2.21-42.45; P=.0002). Additionally, the SEPP1 rs7579A allele was associated with the presence of T2DM in PAD. All these associations, were independent of the influence of conventional cardiovascular risk factors distribution, except for the influence of GPX4 SNP on PAD, as this effect became nonsignificant after adjustment for T2DM. The SELENOS rs34713741T and SEPP1 rs7579A alleles, were the independent predictors of ABI in PAD in a multivariable analysis (allele dose: β= - 0.250, P=.003 and β= - 0.232, P=.006, respectively), explaining a total of 12.4% of the inter-individual variation in ABI. SeP concentration was decreased in T2DM (5.20 ±2.45 mg/ml, N=50 vs 3.99 ±2.51 mg/ml, N=26; P=.049), while being positively correlated with blood cholesterol levels, especially HDLC (r= 0.422, P=.0001). Conclusion - We found a link between the SeP levels and the occurrence of a more favorable profile of cardiometabolic risk factors in PAD. The SELENOS, SEPP1 SNPs contributed to the inter-individual variation in ABI, while the SELENOS, GPX4, SEPP1 SNPs were associated with PAD related to T2DM. These results confirmed the complex genetic architecture of PAD and ABI, in which candidate gene SNP main effects and SNP-covariate interactions contribute to the risk.

Investigation of Pulse Rate and ABPI (Ankle-Brachial Pressure Index) in Relax Condition and after Exercise

Earth gravitational field influences physiological systems such as the cardiovascular and circulatory systems. Therefore changing the body position (standing, sitting, or supine) affects blood pressure. In addition to pressure, pumping blood throughout the body is also affected by the contraction of the hearts ventricles. The number of heartbeat per minute (pulse rate) for each person varies and is affected by physical activity. In this work, blood pressure and pulse rate for subjects in relax condition when supine, sitting, and standing positions are read using a set of digital sphygmomanometer OMRON type JPN-1. Blood pressure and pulse rate for subject after exercise are read in sitting position. From 14 subjects of this work, it was obtained that the blood pressure in brachial is lower than ankle in supine, sitting, and standing positions. The fluctuation range of ankle is about 7,4% - 67,33% which much higher than that in brachial about 0,7% - 14,89%. Furthermore, the difference magnitude value between brachial and ankle in sitting and standing positions is higher than in supine position. The ratio of the systolic blood pressure at the ankle to the systolic pressure at brachial is calculated for the ankle-brachial pressure index (ABPI). It was obtained that in relax condition the ABPI value of all subjects was relatively normal, meanwhile the results on post-exercise indicated that 2 smoker subjects were in risky condition of PAD. The human circulatory system in the arteries is analysed using the Bernoulli equation to estimate the mass density of the blood from the slope of a blood pressure to altitude curve. The blood density of 2 subjects is higher than the reference normal density (1060 kg/m3) and the other 12 subjects have lower value.

Holter ECG findings in diabetics with medial arterial calcification.

Medial arterial calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance. The disease most commonly occurs in diabetes mellitus. Decreased ankle-brachial pressure index (ABI) is a well-known marker of increased cardiovascular mortality. However, also the values of ABI above 1.3, typical in MAC, are associated with increased mortality. By means of Holter ECG monitoring, we investigated 41 patients (25 men, 16 women) with mean age of 59±8 years, suffering of type 2 diabetes mellitus and identified as having MAC, and Holter ECG monitoring with an average duration of recording 22.36 hours, was carried out by GE-Marquette MARS ECG Holter system. We found frequent incidence of cardiac arrhythmias and myocardial ischemia in 22 patients (53.7 %). Only 19 patients (46.3 %) had normal Holter ECG recordings. ABI values were significantly higher in patients with abnormal ECG Holter recordings. Our results confirm the importance of ABI estimation in clinical practice. As the central goal of therapy for patients with myocardial ischemia and/or complex forms of cardiac arrhythmias is the reduction or elimination of these episodes. Ambulatory Holter ECG monitoring plays an important role in the management of these patients (Tab. 7, Ref. 16).

Comparative study of ankle-brachial pressure index in male smokers of Western India

Background: Smoking is prevalent among the masses, yet the smokers are ignorant about the influence of smoking on peripheral arterial disease (PAD). Smoking is associated with atherosclerosis which in lower limb leads to PAD. The beginning stages of PAD are often asymptomatic, and early symptoms are often dismissed by subjects as “just leg pain.” Identifying patients with asymptomatic PAD are essential to reduce morbidity and mortality. Ankle-brachial pressure index (ABPI) is a test, which can be used routinely to screen asymptomatic PAD patients. The cutoff value of ABPI

Assessment of ankle–brachial pressure index in elderly patients as screening for lower extremity ischemia in the context of medical test method used

ABSTRAKTWstęp: Wskaźnik kostka–ramię (ABI) wyraża stosunek ciśnienia skurczowego w tętnicach zlokalizowanych na podudziach, tj. tętnicy piszczelowej tylnej bądź tętnicy grzbietowej stopy, do ciśnienia panującego w tętnicy ramiennej.Celem niniejszej pracy było porównanie wartości ABI mierzonego za pomocą detektora dopplerowskiego fali ciągłej (DDFC) oraz urządzenia BOSO ABI-SYSTEM 100 (ABIs) u seniorów, a także próba określenia czynników determinujących wyniki badań w porównaniu z pacjentami młodszymi.Materiały i metody: Przedmiotem przeprowadzonego badania był pomiar ABI przy użyciu DDFC oraz urządzenia ABIs wśród pacjentów z przewlekłą niewydolnością żylną, niedokrwieniem kończyn dolnych oraz cukrzycą. Badania przeprowadzono po uzyskaniu zgody Komisji Bioetycznej nr KB 523/2016 z dnia 28.06.2017 r. przy Uniwersytecie Mikołaja Kopernika w Toruniu, Collegium Medicum w Bydgoszczy w okresie 28.06.2016–6.04.2017 r. Miejscem realizacji badań była Poradnia Leczenia Ran Przewlekłych w Szpitalu Uniwersyteckim nr 1 im. Ludwika Rydygiera w Bydgoszczy.Wyniki: Średnia wartość ABI wśród wszystkich badanych wyniosła w kończynach: prawej – 0,999 (DDFC), 0,954 (ABIs), lewej – 0,980 (DDFC) i 0,945 (ABIs); z odchyleniem standardowym 32,9% (DDFC), 30,1% (ABIs) dla kończyny prawej i 34,2% (DDFC), 32,1% (ABIs) dla kończyny lewej wartości średniej, co świadczy o dużym zróżnicowaniu wyników. Średnio najwyższy wskaźnik uzyskali pacjenci z cukrzycą (1,163 DDFC – dla kończyny prawej, 1,196 DDFC – dla kończyny lewej), a najniższy – badani z miażdżycą (0,750 – kończyna prawa, 0,684 – kończyna lewa DDFC).Wnioski: Wyniki pomiaru ABI za pomocą DDFC oraz ABIs nie wykazują istotnych statystycznie różnic mogących wpływać na postawienie diagnozy. Płeć, wiek, wykształcenie i analiza kliniczna pacjentów częściowo określiły wyniki testu ABI. Pacjenci w wieku 61–70 lat i najstarsi mieli najniższe wartości ABI.

Comparative study of diabetes foot diagnosis using ABPI

User friendly product has been developed to analyze the user condition accurately and provide a digital output with low cost product to the end user for diagnosing diabetes foot. Detecting the level of peripheral neuropathy which significantly increases the risk of sustaining a foot wound called ‘loss of protective sensation. To implement a device to detect foot diabetes in patients using the Ankle Brachial pressure index values. The proposed system was tested by conducting experiment on 9 patients and whose ABPI value measured confirms the convention-al measured values.

Infrainguinal Lesion of Peripheral Artery Disease and Levels of ω-3 Polyunsaturated Fatty Acids in Peripheral Artery Disease.

Background: Recently, reduced serum levels of ω-3 polyunsaturated fatty acids (PUFAs) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), have been focused upon as newly recognized risk factors for peripheral artery disease (PAD). The present study investigated the association between disease location and serum levels of ω-3 PUFAs in patients with PAD.Methods: We retrospectively analyzed the data of patients at Tokyo Medical University between August 2011 and November 2015. The subjects included 98 patients who were categorized into two groups: those with (n=72) and without infrainguinal lesions (n=26).Results: Univariate analysis revealed that low ankle–brachial pressure index (ABI) values, low EPA levels, low DHA levels, low triglyceride levels, and diabetes mellitus were significant risk factors for infrainguinal lesions. Multivariate analysis indicated that low ABI values [p=0.018; odds ratio, 0.043; 95% confidence interval (CI), 0.003–0.579] and low DHA levels (p=0.003; odds ratio, 0.986; 95%CI, 0.977–0.995) were significant independent risk factors for infrainguinal lesions.Conclusion: Our study demonstrated that reduced serum level of DHA may underlie the presence of infrainguinal lesions in patients with PAD.

Endothelial dysfunction in patients with Buerger disease.

We evaluated the endothelial function of patients with Buerger disease using peripheral arterial tonometry test, and examined the factors that are significantly correlated with the endothelial dysfunction in these patients. We performed the peripheral arterial tonometry test in 22 patients with Buerger disease. We recorded the patients’ characteristics, including ankle brachial pressure index and reactive hyperemia index, which reflect the endothelial dysfunction. We divided the patients with Buerger disease into the conservative treatment and lumbar sympathectomy group. While the reactive hyperemia index was not significantly different between these two groups, the ankle brachial pressure index was significantly different (1.12 versus 0.83, P=0.003). Furthermore, the reactive hyperemia index was significantly correlated with the ankle brachial pressure index value in the patients in the lumbar sympathectomy group (ρ=0.848, P=0.005). Given that patients with Buerger disease show impairment of the sympathetic nervous system, we should consider the after-effects of such an impaired system on the condition of these patients. The patients treated with lumbar sympathectomy might be more appropriate to evaluate their endothelial function by a peripheral arterial tonometry test.

Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications - a review of present guidelines.

The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently, there is a lack of clarity on contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. The project aimed to optimize prevention, treatment and maintenance approaches by recognizing contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. A literature review was conducted of current guidelines on venous leg ulcer prevention, management and maintenance. Searches took place from 29th February 2016 to 30th April 2016 and were prospectively limited to publications in the English and German languages and publication dates were between January 2009 and April 2016. Twenty Guidelines, clinical pathways and consensus papers on compression therapy for venous leg ulcer treatment and for venous disease, were included. Guidelines agreed on the following absolute contraindications: Arterial occlusive disease, heart failure and ankle brachial pressure index (ABPI) <0.5, but gave conflicting recommendations on relative contraindications, risks and adverse events. Moreover definitions were unclear and not consistent. Evidence-based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression.

Carotid Intima Media Thickness in Systemic Sclerosis Patients: Results From a Single Centre, Cross Sectional, Case-Control Study

Objective: To describe the parameters of subclinical vascular changes [Carotid Intima Media Thickness (cIMT), Flow Mediated Dilatation (FMD), Ankle Brachial Pressure Index (ABPI)] in patients with systemic sclerosis and compare them with age and sex matched controls. Methods: 50 patients of systemic sclerosis aged 20-50 years were selected and compared with the same no. of age and sex matched controls. Patients with diabetes, hypertension, dyslipidemia, smoking and thyroid disorders were excluded. cIMT, FMD and ABPI were calculated for all participants. Results: The cases and controls were well matched in terms of age, blood pressure, Body Mass Index, renal and liver functions, and lipid profiles. 34 patients had limited cutaneous SSc while 16 had diffuse cutaneous SSc. cIMT was significantly more in SSc patients as compared to controls (0.585 mm vs. 0.571 mm; p=0.001). FMD measurements in SSc patients were lower when compared to controls, but they did not achieve statistical significance (7.61% vs. 8.03%; p=0.608). ABPI values were similar in SSc patients and controls (1.056 vs. 1.036; p=0.398). cIMT did not show any correlation with age or duration of illness. ABPI showed significant inverse correlation with duration of illness (Rho=-0.385; p=0.006). However, none of these parameters varied as per the pattern of skin involvement (diffuse vs. limited), presence or absence of digital infarcts or pulmonary fibrosis. Conclusion: cIMT is increased in patients with systemic sclerosis as compared to matched controls. cIMT and ABPI may prove useful for assessing the burden of subclinical atherosclerosis and peripheral vascular disease.

The Relationship between Endothelial Dysfunction and Endothelial Cell Markers in Peripheral Arterial Disease.

IntroductionThe endothelial function plays key roles in both promoting and protecting against atherosclerotic disease. Several methods, including peripheral arterial tonometry (PAT), have been reported to be useful for investigating endothelial dysfunction. Furthermore, the level of thrombomodulin (TM) is assumed to reflect the endothelial dysfunction. In the present study, we investigated endothelial dysfunction in patients with peripheral arterial disease (PAD) by measuring their TM levels, and evaluated the correlation between TM and various parameters.Materials and MethodsWe measured the TM levels and performed PAT in 17 patients with PAD. We also recorded the patients’ demographic information, including comorbidities, and investigated their hemodynamic status by measuring the ankle brachial pressure index (ABI). The PAT results were used to calculate the reactive hyperemia index (RHI), which reflected the patients’ level of endothelial dysfunction.ResultsThe RHI and ABI values and the serum level of creatinine were found to be significantly correlated with the TM level (P = 0.040, 0.041 and 0.005, respectively). After setting an RHI value of 1.67 as the cut-off, the patients with RHI values of <1.67 were found to have significantly higher TM levels (median, 20.3 U/mL) than the patients with RHI values of ≥1.67 (median, 13.7 U/mL) (P = 0.023).ConclusionsThe degree of endothelial dysfunction, as calculated by the TM level, might influence the prognostic value of the RHI, which is determined by PAT. The measurement of the TM level and PAT might both be useful methods of measuring endothelial dysfunction in patients with PAD.

Endothelial Dysfunction of Patients with Peripheral Arterial Disease Measured by Peripheral Arterial Tonometry.

Objective. Endothelial dysfunction plays a key role in atherosclerotic disease. Several methods have been reported to be useful for evaluating the endothelial dysfunction, and we investigated the endothelial dysfunction in patients with peripheral arterial disease (PAD) using peripheral arterial tonometry (PAT) test in this study. Furthermore, we examined the factors significantly correlated with PAT test. Methods. We performed PAT tests in 67 patients with PAD. In addition, we recorded the patients' demographics, including comorbidities, and hemodynamical status, such as ankle brachial pressure index (ABI). Results. In a univariate analysis, the ABI value (r = 0.271, P = 0.029) and a history of cerebrovascular disease (r = 0.208, P = 0.143) were found to significantly correlate with PAT test, which calculated the reactive hyperemia index (RHI). In a multivariate analysis, only the ABI value significantly and independently correlated with RHI (β = 0.254, P = 0.041). Conclusion. This study showed a significant correlation between RHI and ABI. The PAT test is a useful tool for evaluating not only endothelial dysfunction but also the hemodynamical state in patients with PAD.

Does non-protease inhibitor based anti-retroviral therapy modify peripheral arterial disease? A vision from eastern India

AimAssess the effects of ART on PAD over a follow up period of 12 months. BackgroundHIV induced endothelial dysfunction may manifest as peripheral arterial disease (PAD). Reports of follow up study showing the change of PAD in people living with HIV before and after initiation of non-protease inhibitor based ART (NPI-ART) are scarce. Materials and methodsART clinic based longitudinal study conducted at a tertiary care hospital in eastern India, 193 consecutive ART eligible HIV positive subjects of age between 18–49 years underwent ankle brachial pressure index (ABPI) measurement before ART initiation and after one year of receiving NPI-ART to examine the effect of ART on PAD. ABPI values of 0.90 or less were defined as PAD. ResultsProportion of subjects with PAD among treatment naive subjects was 30.57%. It dropped to 12.95% after 6 months and to 3.62% after 1 year of NPI-ART. Not a single new case of PAD was diagnosed during the study period. Traits like normal BMI and no alcoholism were found to be independently associated with PAD in ART naïve subjects. Interestingly significant improvement of PAD was also seen among normal BMI subjects and never alcoholics (p<0.05). ABPI improvement was also significant among people who were asymptomatic, belonged to urban population and never used tobacco (p value <0.05). ConclusionPrevalence of PAD decreased significantly after one year of ART. Routine ABPI measurement and early initiation of NPI-ART reduced PAD morbidity and improved quality of life.

Comparison of colour Doppler ultrasound and ankle-brachial pressure index measurements in peripheral vascular disease in type 2 diabetic patients with foot infection

Background: Peripheral vascular disease is diagnosed by definitive history of intermittent claudication or if one or more of peripheral pulses are absent in one or both lower limbs. Diagnostic testing for peripheral vascular disease must be accurate, inexpensive, widely accessible, easy to perform and preferably non-invasive. A variety of non-invasive techniques are available to detect the presence of peripheral vascular disease as well as to localize areas of stenosis, assess severity of disease and follow patients for disease progression or response to therapy. In this study we compare the specificity and sensitivity of ankle brachial pressure index with colour Doppler ultrasound for diagnosis of peripheral vascular disease in type 2 diabetes. Methods: This prospective study was carried out in the department of General surgery, GMCH, Udaipur, Rajasthan, India, from September 2014 to February 2016 after taking the permission from institutional ethical committee. A total of 50 patients were selected. The selected patients were evaluated by detailed clinical history, physical examination, local examination, ankle brachial pressure index (ABPI), colour doppler study and other relevant investigations. The ABPI ratio was calculated in every patient and an ABPI less than 0.9 in either foot was defined to have PVD. Colour duplex ultrasound was done in all selected patients. Imaging of peripheral arteries of the lower limbs was done using high resolution colour duplex ultrasound. PVD was diagnosed if the stenosis in the artery was greater than 50% or presence of occlusion. Results: Total 50 patients having type 2 diabetes mellitus with foot infection were included and most of the patients were between 40-60 years of age (68%) with males preponderance. In our study 12 (24%) patients had normal ABPI of 1.0 to 1.29 and 22 (44%) patients were in the range of mild to moderate PVD with ABPI between 0.41 to 0.90. Colour doppler was used as a standard diagnostic test for PVD & out of 50 patients, 36 (72%) showed involvement of arteries and among them both anterior and posterior tibial arteries were involved in 12 (24%) patients. In our study colour doppler ultrasound was used as standard diagnostic method for PVD. The sensitivity, specificity, positive predictive value and negative predictive value of ABPI against colour duplex ultrasound were calculated. Conclusions: In our study it’s concluded that ABPI is a good initial screening tool for peripheral vascular disease, but some patients with significant stenosis or in whom collaterals have developed in lower extremity would be missed, if ABPI measurement alone is used for diagnosis of peripheral vascular disease.