Borderline Ankle-brachial Index Research Articles

Letter: Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study.

Letter: Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study.

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

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

Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study.

A low ankle-brachial index (ABI) has been linked to systemic inflammation and an elevated risk of cardiovascular events, most notably myocardial infarction and stroke. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, the association between low ABI and IAs has not been sufficiently investigated. Our objective was to investigate the potential connection between ABI values and the prevalence of unruptured IAs. This retrospective cohort study reviewed 2751 patients who had ABI measurements at a public tertiary hospital from January 2011 to December 2013. Patients with available cerebrovascular imaging or a diagnosis of ruptured IA were included in the study (n = 776) to examine the association between ABI and saccular IAs. The patients were classified into 4 groups: low ABI (≤0.9, n = 464), borderline ABI (0.91-0.99; n = 47), high ABI (>1.4, n = 57), and normal ABI (1.00-1.40; n = 208). The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (P < .001). There were no significant differences in the prevalence of ruptured IAs between the ABI groups (P = .277). Sex- and age-adjusted multinomial regression, including clinically relevant variables, revealed that low ABI (odds ratio [OR], 13.02; 95% CI, 4.01-42.24), borderline ABI (OR, 8.68; 95% CI, 2.05-36.69), and smoking history (OR, 2.01; 95% CI, 1.07-3.77) were associated with unruptured IAs. The prevalence of unruptured IAs was 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared with the normal ABI group. ABI measurements could be clinically relevant for identifying individuals at higher risk of IAs and may help guide screening and preventive strategies.

Abstract 18311: Low and Borderline Ankle Brachial Index Are Associated With Intracranial Aneurysms - A Retrospective Cohort Study

Background: A low ankle-brachial index (ABI) is associated with a higher risk of cardiovascular diseases, stroke, and systemic inflammation. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, there is a lack of studies that investigate the association between low ABI and IAs. Aims: To study whether low, borderline, or high ABI is associated with an increased risk of IAs compared to a normal ABI. Methods: We conducted a retrospective review of all patients (n=2751) who had ABI measurements at our tertiary hospital between 2011 and 2013. Patients with available cerebrovascular imaging or a diagnosis of a ruptured IA were included in the study (n=776) to examine the association between ABI and saccular IAs. The patients were classified into four groups as follows: low ABI (≤0.9, n=464), borderline ABI (0.91-0.99, n=47), high ABI (&gt;1.4, n=56), and normal ABI (1.00-1.40, n=209). Results: The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (p &lt;0.001). In the multinomial regression, which included clinically relevant variables, low ABI (odds ratio [OR], 11.3; 95% confidence interval [CI], 4.1-31.5; p &lt; 0.001) and borderline ABI (OR, 7.1; 95% CI, 1.9-26.6; p &lt;0.001) were the only variables significantly associated with unruptured IAs. Conclusions: Patients with low ABI and borderline ABI had a higher prevalence of IAs compared to patients with a normal ABI. The prevalence of IAs was almost 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared to the normal ABI group.

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.

Peripheral Artery Disease and Subsequent Risk of Infectious Disease in Older Individuals: The ARIC Study

ObjectiveTo quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection. MethodsAmong 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease. ResultsDuring the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7. ConclusionPeripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases.

Individual and joint effects of borderline ankle-brachial index and high plasma total homocysteine on all-cause death in hypertensive adults.

BACKGROUNDThe cardiovascular hazards of total homocysteine (tHcy) are long known. In addition, despite the acknowledgment on the importance of low ankle-brachial index (ABI) (< 0.9), borderline ABI (0.91-0.99) was once commonly overlooked. This study aims to explore the independent and joint effect of tHcy level and borderline ABI on all-cause death in hypertensive population.METHODSThis study included 10,538 participants from China H-type Hypertension Registry Study. ABI was described into two groups: normal ABI (1.00-1.40) and borderline ABI. tHcy level was also divided into two groups: < 15.02 and ≥ 15.02 μmo/L. Four groups were analyzed, using COX proportional hazard regression model, separately and pairwise to observe the independent and joint effect on all-cause death.RESULTSA total of 126 (1.2%) deaths were observed in the 1.7 years follow-up time. Borderline ABI has a higher predicted risk of death than normal ABI (HR = 1.87, 95%CI: 1.17-3.00) after adjusting for potential covariates. Compare with tHcy level < 15.02 μmo/L (low tHcy), those with tHcy ≥ 15.02 μmo/L (high tHcy) had higher risk to event outcome (HR = 1.99, 95% CI: 1.30-3.05). According to the cumulative hazard curve, group with borderline ABI and high tHcy level has significantly higher altitude and larger increasing rate over follow-up period compare to other groups. Among those with borderline ABI, participants with high tHcy had higher death risk than those with low tHcy, nevertheless, no significant different between borderline and normal ABI among those with low tHcy levels.CONCLUSIONSBorderline ABI and tHcy level both have independent predictive value on all-cause death. The combined group of borderline ABI and high tHcy has highest risk factor of outcomes, which suggested the mutual additive value of borderline ABI and tHcy. More attention should be given to the importance of borderline ABI in hypertensive population, especially with elevated tHcy level.

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI).

Background: The ankle–brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe–brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011–2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8–1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80–0.89 and 0.90–0.99 had poorer survival compared to ABI categories 1.00–1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80–0.99 vs. 1.00–1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80–0.99 vs. 1.00–1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90–0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00–1.29.

Abstract 8917: Ankle-Brachial Index and Risk of Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Sudden cardiac death (SCD) is an important public health problem. About 356,000 people suffer SCD in the U.S., accounting for 15% of all deaths. The ankle-brachial index (ABI) is a simple, non-invasive measure of subclinical atherosclerosis. The aim of this study was to determine the relation between ABI and SCD in a middle-aged biracial general population. Methods: All ARIC (Atherosclerosis Risk in Communities) study subjects with a documented ABI measurement between 1987 and 1989 were included in the study. ABI was categorized as abnormal (≤0.9), borderline (0.9-1), normal [1-1.4], and non-compressible (&gt;1.4). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual. All SCD cases were adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Results: Of the 15,135 participants followed for a median of 23.5 years, 558 (3.7%) developed SCD (1.96 cases per 1000 person-years). Abnormal or borderline ABIs were associated with an elevated risk of SCD (HRs with 95 % CIs 2.27 [1.64-3.14] and 1.52 [1.17-1.96], respectively) in comparison to normal ABI. The association between abnormal ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors, but not for borderline ABI (HR 1.63 [1.15-2.32] and 1.24 [0.94-1.63]) (Table). Conclusions: Abnormal ABI is independently associated with risk of SCD in a biracial general population. ABI could be incorporated into a future risk SCD prediction model.

Assessment of subclinical atherosclerosis with ankle-brachial index in psoriatic arthritis: A case-control study.

Objectives This study aims to evaluate subclinical atherosclerosis using the Ankle-Brachial Index (ABI) in patients with psoriatic arthritis (PsA). Patients and methods This case-control study included 51 PsA patients (24 males, 27 females; median age 47; range, 41 to 52 years) recruited at our hospital’s outpatient clinics between October 2016 and January 2017 and 50 healthy controls (24 males, 26 females; median age: 48.5; range, 40.7 to 56 years). Anthropomorphic measurements and laboratory results were recorded. In patients, the 66 swollen/68 tender joints count, dactylitis score, Leeds Enthesitis Index, Health-related Quality of Life, the Psoriasis Area and Severity Index, and Dermatology Life Quality Index were evaluated. Ankylosing Spondylitis Quality of Life and Bath Ankylosing Spondylitis Disease Activity Index were applied to patients with axial disease. Then, Composite Psoriatic Disease Activity Index was determined. A Doppler probe and a standard blood pressure cuff were used to calculate the ABI values for each participant.Results Patients had lower right ABI (median, 1.05 vs. 1.1, p<0.01), lower left ABI (1.04 vs. 1.09, p<0.01) and lower overall ABI (1.03 vs. 1.09, p<0.01) compared with healthy subjects. Twelve (23.5%) patients had borderline ABI, but none of the controls (p<0.01). Patients with borderline ABI had a longer duration of psoriasis (25 vs. 15 years, p=0.03). The distribution of borderline ABI value was statistically significant between patients with axial disease and peripheral disease only (42.1% vs. 12.5%, p=0.02). Disease activity was found as an independent risk factor for borderline ABI in a binary logistic regression (odds ratio 6.306, 95% confidence interval 1.185 to 33.561, p=0.031).ConclusionLower ABI was found in PsA patients than healthy controls even in those matched with traditional cardiovascular risk factors. All participants with borderline ABI were in the patient group. Borderline ABI was associated with disease activity and disease duration.

Predictive Value of Abnormal and Borderline Ankle-Brachial Index for Coronary Re-Intervention and Mortality in Patients with Coronary Artery Disease: An Observational Cohort Study.

PurposeThis study aimed to investigate the abnormal and borderline ABIs for predicting coronary re-intervention and mortality in patients with coronary artery disease (CAD).Materials and MethodsData from a previous study were obtained and used to investigate the prevalence of peripheral arterial disease among Korean patients with CAD (n=285) in 2010. All patients underwent follow-up coronary angiography as scheduled (asymptomatic: 2-, 5-, and 7-month intervals) or as clinically indicated (symptomatic).ResultsIn total, 33 patients had an abnormal ABI (ab-ABI: <1.0 or >1.4), and 252 had a normal ABI (nl-ABI: 1.0≤ABI≤1.4). The mean follow-up was 47 months. The mortality was significantly higher in the ab-ABI group than in the nl-ABI group (18.2% vs. 6.7%, P=0.0233). MACEs were significantly more common in the ab-ABI group (60.6% vs. 34.5%, P=0. 0036). Moreover, the ab-ABI group had a greater CAD progression than the nl-ABI group (48.5% vs. 31.3%, P=0.0496). The incidence of clinically indicated coronary re-intervention was significantly higher in the ab-ABI group than in the nl-ABI group (33.3% vs. 13.1%, P=0.0025). After adjusting for age, diabetes, dyslipidemia, dialysis, smoking, and obesity, the incidence of clinically indicated re-intervention was significantly higher in the ab-ABI group than in the nl-ABI group (HR, 2.80; 95% CI, 1.24 to 6.34).ConclusionAbnormal and borderline ABI significantly increased the incidence of clinically indicated coronary revascularization and all-cause mortality during a 4-year follow-up among patients with CAD. Hence, ABI could be used to stratify extremely high-risk patients with CAD who may require aggressive surveillance or treatment.

Association between Resting Heart Rate and Borderline Ankle-Brachial Index Among the Health Screen Examinees

Association between Resting Heart Rate and Borderline Ankle-Brachial Index Among the Health Screen Examinees

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up.

BackgroundGuidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population.AimThe aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk.Design and settingA population-based prospective cohort study was performed in the province of Barcelona, Spain.MethodA total of 3,786 subjects >49 years were recruited from 2006–2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events.Results3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI.In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes.Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI.The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py).Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02–2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment.ConclusionThe results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.

Risk factors for asymptomatic peripheral arterial disease in Korean population: lessons from a community-based screening.

PurposePeripheral arterial disease (PAD) is a common vascular problem and has serious morbidity and mortality in advanced situations. However, the prevalence and risk factors for PAD in Korea have not been reported. The purpose of this study was to evaluate the prevalence and risk factors of PAD in the Korean population.MethodsThe study was processed by visiting community welfare centers. Inclusion criteria were people who participated in this study. Screening was performed by history taking followed by the measurement of ankle brachial index (ABI). PAD was defined when an ABI of 0.9 or less was found in one or both legs. All statistical analyses were conducted with SPSS ver. 22.0.ResultsBetween January 2008 and December 2012, a total of 2,044 participants were included with 810 men (39.6%) and 1,234 women (60.4%). PAD was detected in 95 (4.6%). Borderline ABI (0.91–0.99) showed in 212 (10.4%), and severe decreased ABI defined as 0.5 or less showed in 3 (0.1%). Significant risk factors for PAD were old age (odd ratio, 1.952; P = 0.045), hypertension (odd ratio, 1.645; P = 0.050), and cardiovascular disease (odd ratio, 2.047; P = 0.039). Significant risk factors for borderline PAD were old age (odd ratio, 1.019; P = 0.024), hypertension (odd ratio, 1.461; P = 0.038), and chronic obstructive lung disease (odd ratio, 3.393; P = 0.001).ConclusionThe prevalence of PAD in the Korean population was 4.6%. Old age, hypertension, and cardiovascular disease were significant risk factors for PAD. Further nationwide study is needed.

Comparison of leg loader and treadmill exercise for evaluating patients with peripheral artery disease.

The exercise ankle-brachial index (ABI) helps diagnose lower extremity peripheral artery disease (PAD). Patients with comorbidities may be unable to perform treadmill exercise, the most common stress loading test. While the active pedal plantar flexion (APP) test using the leg loader, simple and easy stress loading device, could be an alternative, there are no data comparing the leg loader and treadmill exercise. Therefore, we aimed to compare APP using the leg loader and treadmill exercise to evaluate PAD. A total of 27 patients (54 limbs) diagnosed with PAD with intermittent claudication and considered for angiography and/or endovascular treatment were recruited prospectively, and both the leg loader and treadmill were performed. There was a strong correlation (r = 0.925, p < 0.001) between the leg loader ABI and treadmill ABI; however, the decrease rate of the leg loader ABI was significantly less than that of treadmill ABI (14.0% [5.6, 30.1] vs. 25.8% [6.1, 53.1], p < 0.001). The number of patients who terminated the exercise prematurely due to dyspnea was four during the treadmill and zero during the leg loader. There was a good correlation between the leg loader ABI and treadmill ABI. Although leg loader, a simple, safe, and easy method, could be an alternative to diagnose PAD, further studies are needed to evaluate the diagnostic value of the leg loader in patients with borderline ABI or those unable to perform the treadmill.

Combination of the ankle-brachial index and percentage of mean arterial pressure to improve diagnostic sensitivity for peripheral artery disease

The ankle-brachial index (ABI) is a noninvasive method for screening for peripheral artery disease (PAD). However, false-negative findings of the ABI may limit its clinical use. The percentage of mean arterial pressure (%MAP) calculated from pulse volume recording has been reported to predict all-cause mortality. We hypothesized that the %MAP would be helpful to screen for PAD in subjects with a normal ABI. We examined whether using a combination of the ABI and %MAP would provide greater diagnostic sensitivity for PAD than using the ABI alone.In this cross-sectional study, we retrospectively reviewed the medical records of patients who had undergone multiple detector computed tomography (MDCT) angiography of the lower extremities following measurement of the ABI with pulse volume recording. PAD was diagnosed based on MDCT angiography.A total of 215 lower extremities of 114 patients were included in our analyses. An optimal cut-off %MAP value of 42.5% was used to diagnose PAD based on MDCT in patients with an ABI > 0.90. Using a combination of an ABI < 0.90 and a %MAP ≥ 42.5% as diagnostic criteria for PAD resulted in better sensitivity (76.9%) than using the ABI alone (56.5% for an ABI < 0.90 and 63.4% for an ABI < 1.00). Using logistic regression analysis, we found that patients having both an ABI < 0.90 and an ABI > 0.90 with a %MAP ≥ 42.5% had a significantly higher risk of PAD than those having an ABI > 0.90 with a %MAP < 42.5% (odds ratio = 7.165, P = .006; odds ratio = 12.544, P < .001; respectively).Both the sensitivity and specificity were better when using a combination of an ABI ≤ 0.90 and a %MAP ≥ 42.5% than when using a low or borderline ABI. The %MAP is helpful for PAD screening in subjects with an ABI > 0.90.

Clinical Impact of the Ankle-Brachial Index in Patients Undergoing Successful Percutaneous Coronary Intervention.

Several studies have reported a relationship between clinical outcomes and the ankle-brachial index (ABI) in different populations. However, the relationship in Japanese patients or in patients undergoing percutaneous coronary intervention (PCI) has not been examined well.Methods and Results:The subjects were 1,857 patients who underwent PCI from July 2007 to May 2010 and in whom the carotid and renal arteries and abdominal aorta were examined simultaneously by ultrasonography and ABI. We investigated the relationship between ABI and major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, and stroke). The median follow-up was 1,322 days (interquartile range: 1,092-1,566 days). Patients with low (<0.9), borderline (0.9-1.0) and high ABI (>1.4) had significantly higher incidence of MACE at 4 years (31%, 15%, 10%, and 29% for the low, borderline, normal, and high groups, respectively; log-rank P<0.0001) and all-cause mortality at 4 years (22%, 12%, 6.9%, and 29%, respectively; P<0.0001) compared with the normal ABI group (1.0≤ABI≤1.4). The adjusted hazard ratios for MACE were 2.35 (1.72-3.20), 1.27 (0.89-1.80) and 1.87 (0.81-3.79) for low, borderline and high ABI, respectively. This study suggested that ABI provides additional information for cardiovascular disease risk stratification in Japanese patients undergoing PCI, even it is borderline ABI.

An exploratory factor analysis of inflammatory and coagulation markers associated with femoral artery atherosclerosis in the San Diego Population Study

Background and aimsSeveral biomarkers of inflammation and coagulation have been implicated in lower extremity atherosclerosis. We utilized an exploratory factor analysis (EFA) to identify distinct factors derived from circulating inflammatory and coagulation biomarkers then examined the associations of these factors with measures of lower extremity subclinical atherosclerosis, including the ankle-brachial index (ABI), common and superficial femoral intima-media thickness (IMT), and atherosclerotic plaque presence, burden, and characteristics. MethodsThe San Diego Population Study (SDPS) is a prospective, community-living, multi-ethnic cohort of 1103 men and women averaged age 70. Regression analysis was used to assess cross-sectional associations between the identified groupings of biomarkers (factors) and the ABI and femoral artery atherosclerosis measurements. ResultsTwo biomarker factors emerged from the factor analysis. Factor 1 consisting of C-reactive protein (CRP), interleukin (IL)-6, and fibrinogen was significantly associated with higher odds (OR = 1.99, p < 0.01) of a borderline ABI value (0.91–0.99), while Factor 2 containing D-dimer and pentraxin (PTX)-3 was significantly associated with higher common femoral artery (CFA) IMT (β = 0.23, p < 0.01) and lower ABI (β = −0.03, p < 0.01). ConclusionsTwo groupings of biomarkers were identified via EFA of seven circulating biomarkers of inflammation and coagulation. These distinct groups are differentially associated with markers of lower extremity subclinical atherosclerosis. Our findings suggest that high inflammatory and coagulation burden were better markers of more severe lower-extremity disease as indicated by low ABI rather than early atherosclerotic lesion development in the femoral artery.

Factors affecting the validity of the oscillometric Ankle Brachial Index to detect peripheral arterial disease.

The use of oscillometric Ankle Brachial Index (ABI) to diagnose peripheral arterial disease (PAD) has raised concern, especially due to a lack of agreement and sensitivity. This study aimed to evaluate those factors affecting the validity of oscillometric ABI in comparison to Doppler ABI to detect PAD. Through univariate and multivariate linear regression, we studied those factors affecting the differences between oscillometric and Doppler ABI; through univariate and multivariate logistic regression we analyzed the false negative rate of oscillometric ABI to detect PAD. We analyzed 197 consecutive subjects (394 legs) from two settings: Primary Care and Vascular Service. The means of oscillometric ABI and Doppler ABI were 1.094 (95% CI: 0.843-1.345) and 1.073 (95% CI: 0.769-1.374) (P<0.001), respectively. In men, covariates explaining the differences between oscillometric and Doppler ABI were Doppler ankle blood pressure (β=-0.610, P<0.001), ankle circumference (β=0.176, P=0.004) and oscillometric brachial blood pressure (β=0.136, P=0.037); in women, those were weight (β=0.351, P<0.001) and Doppler ankle blood pressure (β=-0.318, P<0.001). Sensitivity and specificity of oscillometric ABI to detect PAD were 80.6% and 97.4%, respectively, and covariates explaining the rate of false negatives in PAD population were setting (Exp(β)=17.21, P=0.009) and tobacco (packs/year) (Exp(β)=1.049, P=0.002). Although some factors influencing the lack of agreement between oscillometric and Doppler ABI were identified, the correction of oscillometric ABI seems impractical, since Doppler is needed, the bias is not always uniformly distributed and its clinical relevance is small. According to sensitivity, borderline oscillometric ABI in Primary Care settings and smokers suggest PAD.

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis.

Peripheral arterial disease (PAD) remains underdiagnosed and undertreated, partly because of limitations in the Doppler ankle-brachial index (ABI), the non-invasive gold standard. This systematic review and meta-analysis aims to compare the diagnostic accuracy of the oscillometric ABI and the Doppler ABI, and to examine the influence of two approaches to analysis: legs vs subjects and inclusion of oscillometric errors as PAD equivalents vs exclusion. Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to February 2017. Random-effects models were computed with the Moses-Littenberg constant. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance. Twenty studies (1263 subjects and 3695 legs) were included in the meta-analysis. The pooled diagnostic odds ratio (dOR) for the oscillometric ABI was 32.49 (95% CI: 19.6-53.8), with 65% sensitivity (95% CI: 57-74) and 96% specificity (95%CI: 93-99). In the subgroup analysis, the "per subjects" group showed a better performance than the "per legs" group (dOR 36.44 vs 29.03). Similarly, an analysis considering oscillometric errors as PAD equivalents improved diagnostic performance (dOR 31.48 vs 28.29). The time needed for the oscillometric ABI was significantly shorter than that required for the Doppler ABI (5.90 vs 10.06minutes, respectively). The oscillometric ABI showed an acceptable diagnostic accuracy and feasibility, potentially making it a useful tool for PAD diagnosis. We recommend considering oscillometric errors as PAD equivalents, and a "per subject" instead of a "per leg" approach, in order to improve sensitivity. Borderline oscillometric ABI values in diabetic population should raise concern of PAD.