High Ankle Research Articles

Association of a high ankle brachial index with microvascular diseases of diabetes

To evaluate the association of a high ankle brachial index (ABI) with microvascular diseases of diabetes and to compare its strength with that of a low ABI. ABI was obtained in 3293 patients undergoing the screening of chronic complications at the Diabetic Center, No. 306 Hospital of PLA during the period of September 2003 to June 2010. The patient profiles and laboratory data were reviewed. The associations of ABI with microvascular diseases of diabetes were determined by univariate and stepwise Logistic regression analysis. ABI was normal in 3060 patients. 44 had ABI measurements < 0.7, 139 had ABI measurements between 0.7 - 0.9, and 50 had ABI measurements > 1.3. Multivariate analysis indicated that the factors significantly associated with a high ABI were smoking (OR: 2.605; 95%CI: 1.458 - 4.656, P = 0.001) and systolic blood pressure (OR: 1.019; 95%CI: 1.005 - 1.033, P = 0.006). The conditions of nephropathy, neuropathy and retinopathy were not associated with a high ABI. Diabetics with a high ABI carry not more adverse atherosclerotic risk factors and suffer no more severe microvascular diabetic complications than those with a normal ABI.

Target Organ Damage in Hypertension

Target Organ Damage in Hypertension

Abstract P342: Demographic and Risk Factor Profiling of Patients With Abnormally High and Low Ankle Brachial Index in a Nationally Representative Cohort

Background: Ankle Brachial Index (ABI) is widely used for diagnosis and prognostication in patients with peripheral vascular disease. Both abnormally high and low ABIs have been associated with increased risk of cardiovascular events. Although multiple demographic and other risk factors have been linked to high and low ABI, differences and distribution in a national cohort has not been described previously. Methods: We did a descriptive cross sectional analysis on the cohort of continuous National Health and Nutrition Examination Survey (NHANES) between the years 1999-2006 (n=31124). We included only those with baseline ABI data on both extremities (n= 6819). Chi-square test and ANOVA were used to measure the differences for categorical and continuous variables. Results: We found 6577 people with normal ABI (0.9 to 1.4), 214 with abnormally low ABI (&lt;0.9) and 28 with abnormally high ABI (≥ 1.4). The demographic and risk factor distribution among all the 3 groups has been shown in Table 1 . Conclusion: Patients with both high and low ABI have increased prevalence of risk factors compared to cohort with normal ABI. The prevalence and distribution of these differences could be helpful for targeted health interventions. Table 1 Variable ABI &lt; 0.9(214) ABI ≥ 1.4(28) Normal ABI(6577) p value Age 71.9±10.3 61.4±12.5 59.1±12.7 &lt;0.0001 Race White Black Other 57.9 21.9 20.1 67.9 3.5 28.6 54.1 17.6 28.3 0.01 Gender -Male 47.7 42.9 48.5 0.81 BMI * 27.9±5.6 31.1±8.6 28.3±5.5 &lt;0.001 Triglyceride 166±102 137±56 162±157 &lt;0.001 Cholesterol 208±45 198±35 210±41 &lt;0.001 LDL # - cholesterol 124±41 134±26 125±35 &lt;0.001 HDL † -Cholesterol 51±16 49±12 53±16 0.09 Smoking 20 10.7 19.9 0.008 Homocysteine 12±4.6 9±2.8 9.5±4.8 &lt;0.001 Creatinine 1.1±0.5 0.84±0.3 0.88±0.4 &lt;0.001 Waist Circumference 101±14 107±18 99±14 &lt;0.001 Hypertension 69.6 39.3 39.8 0.01 Myocardial Infarction 14 7.14 3.07 &lt;0.001 Coronary Artery Disease 11.2 3.6 3.2 &lt;0.0001 Angina 6.5 7.1 2.7 0.001 Diabetes Mellitus 25.2 17.9 11.7 &lt;0.0001 Stroke 6.5 7.2 1.9 &lt;0.0001 * Body Mass Index, #Low Density Lipoprotein, † High Density Lipoprotein

Abstracts: ASUM Annual Scientific Congress 2011

Abstracts: ASUM Annual Scientific Congress 2011

A case of mitochondrial kidney disease with insulin resistance and hypoadiponectinemia

A 27-year-old woman with severe proteinuria, diabetes mellitus, sensorineural hearing impairment, and slight renal dysfunction was admitted to our hospital. The patient was diagnosed as having mitochondrial kidney disease, a rare disease with mitochondrial 3243 A to G mutation. The patient’s mother and younger sister had the same mitochondrial mutation, with the younger sister also having proteinuria. Differing from general mitochondrial diabetic patients with decreased insulin secretion, this patient showed insulin resistance. The thickening of the carotid intima-media, high brachial ankle pulse wave velocity, and ischemic change in cerebral white matter implied progressive arteriosclerosis. The patient also had hypoadiponectinemia even though she only had a small amount of visceral fat, and this hypoadiponectinemia may be one of the reasons behind the insulin resistance and arteriosclerosis. This case showed that insulin resistance cannot be the sole reason to exclude the possibility of mitochondrial kidney disease, and also showed the potential relationship between mitochondrial mutation and hypoadiponectinemia.

Metabolic syndrome associates with high and low ankle brachial index

Objectives: Abnormal ankle brachial index (ABI) is associated with morbidity and mortality of coronary heart disease and stroke. Both low (<0.90) and high ABI (>1.30) are associated with arterial disease, the former is resulted from atherosclerosis and the high ABI is related to arterial stiffness more related to diabetes and age. Metabolic syndrome has been proposed as a risk factor for cardiovascular diseases. However, few epidemiological data about relationship between ABI and the prevalence of metabolic syndrome are available. The purpose of this study is to clarify if metabolic syndrome associated with abnormal ABI. Methods: We recruited 4902 subjects, ages 40–83, from 7 communities in China. Participants were divided into 7 groups according to ABI (<0.80, 0.80–0.90, 0.90–1.00, 1.00–1.10, 1.10–1.20, 1.20–1.30, >1.30) determined by using Doppler device. Metabolic syndrome was defined by the criteria of International Diabetes Federation. The association and correlation between metabolic syndrome and ABI were examined. Results: Metabolic syndrome was associated with both low (<1.00) and high ABI (>1.30, P<0.05). After adjusting for sex, age and other cardiovascular risk factors by using multiple logistical regression analysis, the association remained, OR=0.351, 95% CI 0.162–0.76 for low ABI group (P<0.01), OR=5.77, 95% CI 1.51–22.4 for high ABI group (P=0.01). Metabolic syndrome was negatively correlated with low ABI (r=−0.78, P<0.01) but positively correlated with high ABI (r=0.73, P<0.01). Conclusion: Metabolic syndrome is associated with low and high ABI. The association is much stronger in the high ABI group than in the low ABI group.

Determination of dynamic ankle ligament strains from a computational model driven by motion analysis based kinematic data

External rotation of the foot has been implicated in high ankle sprains. Recent studies by this laboratory, and others, have suggested that torsional traction characteristics of the shoe–surface interface may play a role in ankle injury. While ankle injuries most often involve damage to ligaments due to excessive strains, the studies conducted by this laboratory and others have largely used surrogate models of the lower extremity to determine shoe–surface interface characteristics based on torque measures alone. The objective of this study was to develop a methodology that would integrate a motion analysis-based kinematic foot model with a computational model of the ankle to determine dynamic ankle ligament strains during external foot rotation. Six subjects performed single-legged, internal rotation of the body with a planted foot while a marker-based motion analysis was conducted to track the hindfoot motion relative to the tibia. These kinematic data were used to drive an established computational ankle model. Ankle ligament strains, as a function of time, were determined. The anterior tibiofibular ligament (ATiFL) experienced the highest strain at 9.2±1.1%, followed by the anterior deltoid ligament (ADL) at 7.8±0.7%, averaged over the six subjects. The peak ATiFL strain occurred prior to peak strain in the ADL in all subjects. This novel methodology may provide new insights into mechanisms of high ankle sprains and offer a basis for future evaluations of shoe–surface interface characteristics using human subjects rather than mechanical surrogate devices.

Effects of Inversion Perturbation After Step-Down on the Latency of the Peroneus Longus and Peroneus Brevis

The purpose of this investigation was to determine the effect of different types of ankle sprains on the response latency of the peroneus longus and peroneus brevis to an inversion perturbation, as well as the time to complete the perturbation (time to maximum inversion). To create a forced inversion moment of the ankle, an outer sole with fulcrum was used to cause 25 degrees of inversion at the ankle upon landing from a 27 cm step-down task. Forty participants completed the study: 15 participants had no history of any ankle sprain, 15 participants had a history of a lateral ankle sprain, and 10 participants had a history of a high ankle sprain. There was not a significant difference between the injury groups for the latency measurements or the time to maximum inversion. These findings indicate that a previous lateral ankle sprain or high ankle sprain does not affect the latency of the peroneal muscles or the time to complete the inversion range of motion.

What are the long-term consequences of botulinum toxin injections in spastic cerebral palsy?

Muscle spasticity, defined as a velocity dependent resistance to stretch, is the primary impairment of spastic cerebral palsy (CP) and is neural in origin. However, spastic muscle also undergoes significant morphological and structural alterations secondary to spasticity which contribute to muscle weakness, muscle stiffness, restricted joint range of motion, and skeletal deformity. These secondary alterations can progress with age and contribute to a gradual loss of functional capacity during development, including the ability to ambulate independently. There is consensus that intra-muscular botulinum toxin A (BoNT-A) injections can be effective in the management of lower limb spasticity in children with spastic CP. BoNT-A injections can improve gait and delay and reduce the requirement for surgical interventions to treat musculoskeletal deformities when combined with conservative treatments. The study by Alhusaini et al. is one of the first that begins to address the important clinical question of how BoNT-A injections influence the secondary effects of spasticity on joint-level mechanical properties in children with spastic CP. An attractive feature of the study was that the authors assessed ankle joint stiffness and not just joint range of motion. Alhusaini et al. showed that BoNT-A has relatively minor effects on passive mechanical properties of the ankle plantar-flexor muscles at 6-weeks post injection in children with spastic CP aged 4– 10 years with high ankle joint stiffness. This study therefore does not support the efficacy of BoNT-A for treating contractures. What remains unclear at the present time is how BoNT-A might influence other structural and neuro-mechanical properties of the muscle and ⁄or tendon, especially in the longer term. For example, how does BoNT-A affect muscle size, strength, force-length-velocity behaviour, moment arms, co-activation, and tendon compliance? Of increasing concern is evidence from animal studies that intra-muscular BoNT-A injections adversely influence muscle growth in the injected muscle as well as muscles remote from the injection site. For example, Fortuna et al. recently reported up to 95% reductions in rabbit hind limb quadriceps muscle strength following 6 months of repeated BoNT-A injections, which was accompanied by up to 60% reductions in muscle mass. Reductions in strength and mass were also reported for quadriceps muscles in the contralateral limb. These findings point to the possibility that the short-term functional benefits of BoNT-A injections reported in clinical studies in spastic CP may be offset by accelerated structural weakening of muscle. This is important because children aged 2–5 years with spastic CP that have not undergone orthopaedic surgery or commenced BoNT-A injections already have significantly lower calf muscle volume relative to their typically developed peers. BoNT-A is routinely administered to children in this age group and is often repeated over many cycles. Further muscle weakening by BoNT-A would therefore be expected to adversely influence functional capacity. BoNT-A acts to weaken overactive muscles through chemical blockade of the neuromuscular junction. It might be expected that any associated muscle atrophy could contribute to observed improvements in gait following BoNT-A injections. However, during maturation in childhood and adolescence, muscles must increase in size to cope with the increased mechanical loading associated with motor function in activities such as gait. Muscle weakening from BoNT-A could therefore be beneficial in the short-term but detrimental in the longerterm because of impeded muscle growth. Aside from the study by Alhusaini et al., to our knowledge no detailed in vivo studies of the effects of BoNT-A on the active and passive mechanical properties of muscle in children with spastic CP have been conducted. In spite of the widespread use of BoNT-A injections in children with spastic CP for almost two decades, the long-term efficacy of this treatment for improving functional outcomes in children with spastic CP remain relatively unknown. In using a short-term solution we may be creating a long-term problem which could lead to increased costs of care in spastic CP. Long-term trials of the structural and neuro-mechanical responses of muscle to BoNT-A and their consequences for motor function in spastic CP are required. New developments in musculoskeletal modeling and simulation may prove fruitful in linking muscletendon adaptation with gait function in spastic CP.

Usefulness of Baseline Obesity to Predict Development of a High Ankle Brachial Index (from the Multi-Ethnic Study of Atherosclerosis)

An abnormally high ankle-brachial index (ABI) is associated with increased all-cause and cardiovascular mortality. The relation of obesity to incident high ABI has not been characterized. The aim of this study was to investigate the hypothesis that increased obesity-quantified by body weight, body mass index, waist circumference, and waist-to-hip-ratio-is positively associated with a high ABI (≥1.3) and with mean ABI increases over a 4-year follow-up. Prevalence and incidence ratios for a high ABI were obtained for 6,540 and 5,045 participants, respectively, in the Multi-Ethnic Study of Atherosclerosis (MESA), using log-binomial regression models adjusted for demographic, cardiovascular, and inflammatory and novel risk factors. Linear regression was used to analyze mean ABI change. The prevalence and incidence of a high ABI were significantly higher for the highest compared to the lowest quartile of every baseline measure of obesity, with weight and body mass index demonstrating the highest incidence ratios (2.7 and 2.4, respectively). All prevalence and incidence ratios were positive and graded across obesity quartiles and were persistent in the subpopulation without diabetes. In those with normal baseline ABI values, 1 MESA standard deviation increase in every baseline measure of obesity was associated with significant increases in mean ABI values. In conclusion, independent, positive, and graded associations of increasing obesity with prevalent and incident high ABI and with mean increases in ABI values over time were found. Weight and body mass index seemed to be at least as strongly, if not more strongly, associated with a high ABI than were measures of abdominal obesity.

Outcome evaluation of ankle osteoarthritis treatments: Plantar pressure analysis during relatively long-distance walking

Background This study aimed to use plantar pressure analysis in relatively long-distance walking for objective outcome evaluation of ankle osteoarthritis treatments, i.e., ankle arthrodesis and total ankle replacement. Methods Forty-seven subjects in four groups: three patient groups and controls, participated in the study. Each subject walked twice in 50-m trials. Plantar pressure under the pathological foot was measured using pressure insoles. Six parameters: initial contact time, terminal contact time, maximum force time, peak pressure time, maximum force and peak pressure were calculated and averaged over trials in ten regions of foot. The parameters in each region were compared between patient groups and controls and their effect size was estimated. Besides, the correlations between pressure parameters and clinical scales were calculated. Findings We observed based on temporal parameters that patients postpone the heel-off event, when high force in forefoot and high ankle moment happens. Also based on maximum force and peak pressure, the patients apply smoothened maximum forces on the affected foot. In ten regions, some parameters showed improvements after total ankle replacement, some showed alteration of foot function after ankle arthrodesis and some others showed still abnormality after both surgical treatments. These parameters showed also significant correlation with clinical scales in at least two regions of foot. Interpretation Plantar pressure parameters in relatively long-distance trials showed to be strong tools for outcome evaluation of ankle osteoarthritis treatments.

Is Chronic Kidney Disease Associated with a High Ankle Brachial Index in Adults at High Cardiovascular Risk?

Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease (CVD) events. A high ankle brachial index (ABI), a marker of lower arterial stiffness, is associated with CVD events. It remains unknown whether high ABI is associated with CKD. The objectives of this study were to determine the association of CKD with high ABI in adults at high CVD risk. The study enrolled hospital-based patients at high CVD risk and measured kidney function and ABI. The glomerular filtration rate (GFR) was estimated using the Modification of Dietin Renal Desease (MDRD) equation and ABI was categorized as low (< 0.90), low-normal (0.90 to 1.09), normal (1.10 to 1.40), and high (≥ 1.40 or incompressible). Logistic regression was used to evaluate the associations of CKD with ABI categories. Among 6412 participants, 25% had CKD, 25% had an ABI measurement < 0.90, and 1% had an ABI > 1.40. In models adjusted for age, sex, hypertension, diabetes, body mass index, low-density and high-density lipoprotein cholesterol, and smoking, only low ABI was associated with an increased risk of CKD; however, both low ABI (OR: 2.1, 1.6-2.8) and high ABI (OR: 2.4, 1.0-6.4) were associated with an increased risk of CKD in diabetic individuals. Additionally, only low ABI was associated with advanced eGFR levels. High ABI values are associated with an increased risk of CKD in diabetic individuals at high cardiovascular risk. Future studies are required to speculate whether high ABI might lead to diminished kidney function through nonatherosclerotic pathways and to understand the mechanisms linking them to CVD events and diabetes.

Explanatory Variables for Adult Patients' Self-Reported Recovery After Acute Lateral Ankle Sprain

Longitudinal research on musculoskeletal disorders often makes use of a single measure of recovery, despite the large variation in reported recovery that exists. Patients with an acute ankle sprain often experience no pain or functional disability following treatment, yet report not being fully recovered, or vice versa. The purpose of this study was to find explanatory variables for reporting recovery by analyzing the extent to which different outcomes (eg, pain intensity) were associated with recovery and how baseline scores of different variables influence this association in adult patients after acute lateral ankle sprain. This was a cohort study based on data collected in a randomized controlled trial (RCT). This study was constructed within the framework of an RCT. One hundred two patients who incurred an acute ankle sprain were included. Recovery, pain intensity, giving way of the ankle, and Ankle Function Score (AFS) were assessed during the RCT at baseline and at 4 weeks, 8 weeks, 3 months, and 12 months postinjury. Mean differences were calculated between baseline and follow-up. Associations were calculated using linear mixed models, and the influence of baseline scores on these associations was determined using linear regression with interaction. Associations were found between recovery and the mean differences of pain during running on flat and rough surfaces (4 and 8 weeks, 3 months) and between recovery and the mean difference of giving way of the ankle during walking on a rough surface (8 weeks, 3 months). This study used data collected from an RCT. Therefore, the study was limited to the outcomes measured in that trial, and some explanatory factors easily could have been missed. This study is the first to identify explanatory variables for reporting recovery in adults after ankle sprain. Pain intensity and giving way of the ankle measured during high ankle load activities make it easier to measure and to generalize recovery in this population and should be the primary outcome measures of interest. This study indicates the huge need to reach consensus about primary outcome measures for research in patients sustaining ankle sprains.

Rehabilitation of Syndesmotic (High) Ankle Sprains

Context:High ankle sprains are common in athletes who play contact sports. Most high ankle sprains are treated nonsurgically with a rehabilitation program.Evidence Acquisition:All years of PUBMED, Cochrane Database of Systematic Reviews, CINAHL PLUS, SPORTDiscuss, Google Scholar, and Web of Science were searched to August 2010, cross-referencing existing publications. Keywords included syndesmosis ankle sprain or high ankle sprain and the following terms: rehabilitation, treatment, cryotherapy, braces, orthosis, therapeutic modalities, joint mobilization, massage, pain, pain medications, TENS (ie, transcutaneous electric nerve stimulation), acupuncture, aquatic therapy, strength, neuromuscular training, perturbation training, and outcomes.Results:Level of evidence, 5. A 3-phase rehabilitation program is described. The acute phase is directed at protecting the joint while minimizing pain, inflammation, muscle weakness, and loss of motion. Most patients are treated with some form of immobilization and have weightbearing restrictions. A range of therapeutic modalities are used to minimize pain and inflammation. Gentle mobilization and resistance exercises are used to gain mobility and maintain muscle size and strength. The subacute phase is directed at normalizing range of motion, strength, and function in activities of daily living. Progressive mobilization and strengthening are hallmarks of this phase. Neuromuscular training is begun and becomes the central component of rehabilitation. The advanced training phase focuses on preparing the patient for return to sports participation. Perturbation of support surfaces, agility drills, plyometrics, and sport-specific training are central components of this phase.Conclusion:The rehabilitation guidelines discussed may assist clinicians in managing syndesmotic ankle sprains.

STOP Sports Injuries

STOP Sports Injuries

Prevalence of high ankle–brachial index (ABI) in general population of Southern Italy, risk factor profiles and systemic cardiovascular co-morbidity: An epidemiological study

Many studies have been carried out to assess the prevalence, risk factors and co-morbidities of peripheral artery disease (PAD). By contrast, to date there is a lack of data on patients with high-ABI. This study aimed at estimating the prevalence of increased ABI (ABI > 1.4) and to evaluate the involvement of traditional cardiovascular (CV) risk factors and the atherosclerotic burden (peripheral and carotid arteries) of these patients in a population of Southern Italy. We invited 9647 subjects, age ranging from 30 to 80, by letters to undergo an ABI measurement. Consequently, in patients with ABI > 1.4, an ultrasound evaluation of the peripheral and carotid arteries was performed. An ABI > 1.4 was found in 260 of 3412 subjects (7.6%). Statistically significant differences were reported in age, diabetes and hypertension, body mass index (BMI) and waist circumference (WC). No differences in sex distribution, dyslipidemia and smoke prevalence were observed. Moreover, 67.9% of ABI > 1.4 patients showed a peripheral intima–media thickness (IMT) > 0.9 mm; at linear regression it was correlated with ABI values; 25% of patients showed peripheral plaques. A carotid IMT > 0.9 mm was reported in 78.6% of high-ABI patients and 32.1% were affected by atherosclerotic plaques. The observed increased-ABI prevalence of 7.6% was higher than previously reported. This was more prevalent in an older population with diabetes, hypertension and obesity. Moreover, these patients are characterized by an extended atherosclerotic involvement. Further studies are needed to clarify this evidence, a longitudinal observation of this clinical outcome, as we are performing, could provide a number of interesting elements.

Ice Hockey

Ice hockey is an exciting sport that is growing in popularity in the United States. Injuries are a common part of the sport, with more injuries occurring in games compared with practice. Higher levels of competition have been shown to correlate with increased frequency of injury. Most frequently, injuries occur to the face, head, and neck, including concussions, contusions, lacerations, and dental injury. Lower extremity injuries include medial collateral ligament injury, meniscus tear, and high ankle sprains. Upper extremity injuries include acromioclavicular joint injury, glenohumeral dislocation, and various contusions and sprains. Groin and lower abdominal strains also are common. Women's hockey participation is increasing, with data that suggest injuries similar to those seen in men's hockey.

The influence of soccer cleat design on resultant joint moments

Footwear traction has previously been associated with lower extremity injury such as ankle and knee sprains. Recent changes in soccer shoe cleat design such as the introduction of bladed cleats have the potential to dramatically affect footwear traction. Therefore, the purpose of this study was to determine how soccer cleats of different designs and traction influence resultant ankle and knee joint moments during soccer movements. Two traditional soccer cleat designs and one bladed cleat design were compared to a standard running shoe as the control condition. Translational and rotational traction of the shoes on artificial turf were measured using a Stewart platform. Ankle and knee joint moments were quantified on a group of 12 recreational soccer players while performing cutting and turning movements at 4.0 m s−1 on the same artificial turf. All soccer shoes had significantly higher rotational traction than the running shoe but there were no significant differences between cleat designs. The bladed cleat design had significantly higher translational traction than the traditional cleat designs. As a result, the bladed cleat design that was tested appears effective at decoupling translational and rotational traction characteristics of soccer shoes, which could potentially be beneficial in reducing injuries. There were no significant differences in resultant ankle and knee joint moments between the shoes during the cutting movement. During the turning movement, the cleated shoes had significantly higher ankle and knee rotation moments than the control running shoe. Thus, increased rotational traction increases ankle and knee joint loading which in turn could lead to a greater incidence of injury, however, it is important to note that this was only true during a rotational movement.

A High Ankle Brachial Index Is Associated With Greater Left Ventricular Mass: MESA (Multi-Ethnic Study of Atherosclerosis)

This study sought to determine the association of high ankle brachial index (ABI) measurements with left ventricular (LV) mass, and to compare its strength with that of low ABI with LV mass. Arterial stiffness leads to LV mass through nonatherosclerotic pathways in mice. In humans, a high ABI indicates stiff peripheral arteries and is associated with cardiovascular disease (CVD) events. Whether high ABI is associated with LV mass in humans and whether this might reflect consequences of arterial stiffness, atherosclerosis, or both is unknown. Among 4,972 MESA (Multi-Ethnic Study of Atherosclerosis) participants without clinical CVD, we used linear regression to evaluate the association of low (<0.90) and high (>1.40 or incompressible) ABI with LV mass by cardiac magnetic resonance imaging (MRI). Intermediate ABIs served as the reference category. To determine the effect of subclinical atherosclerosis, models were adjusted for common and internal carotid intima media thickness (cIMT) and natural log-transformed coronary artery calcification. Compared with subjects with intermediate ABI, LV mass was higher with either low (2.70 g/m(2) higher, 95% confidence interval: 0.65 to 4.75) or high ABI (6.84 g/m(2) higher, 95% confidence interval: 3.2 to 10.47) after adjustment for traditional CVD risk factors, kidney function, and C-reactive protein. However, further adjustment for cIMT and CAC substantially attenuated the association of low ABI with LV mass index (1.24 g/m(2) higher, 95% confidence interval: -0.84 to 3.33), whereas the association of high ABI was minimally altered (6.01 g/m(2) higher, 95% confidence interval: 2.36 to 9.67). High ABI is associated with greater LV mass; an association that is not attenuated with adjustment for subclinical atherosclerosis in nonperipheral arterial beds. High ABI might lead to greater LV mass through nonatherosclerotic pathways.

Relation of the Ankle Brachial Index to Left Ventricular Ejection Fraction

Low and high ankle brachial index (ABI) values are both a marker of peripheral arterial disease and associated with greater cardiovascular disease event rates. The objective of the present study was to determine whether the ABI is associated with left ventricular (LV) systolic function. We studied 175 patients (age 67 +/- 13 years, 58% men) referred for ABI determination who had had the LV ejection fraction (EF) determined using echocardiography within 14 days. The mean LVEF was 47 +/- 13%, mean ABI for the right leg was 0.93 +/- 0.32, and the mean ABI for the left leg was 0.94 +/- 0.26. Of the 175 patients, 91 (52%) had a low, 69 (39%) had a normal, and 15 (9%) had a high ABI. The mean LVEF increased in a stepwise manner from the low, to normal, to abnormally high ABI groups (43 +/- 13% vs 51 +/- 12% vs 57 +/- 5%, respectively; p <0.01). On ordinal regression analysis, ABI status was independently related to LVEF. For each 1% increase in LVEF, the odds of being in the higher category of ABI increased by 1.08 (95% confidence interval 1.02 to 1.12, p = 0.002). No significant interaction was seen between coronary artery disease and LVEF on the ABI (p = 0.48). In conclusion, the ABI might be influenced by LV systolic function, independent of coronary disease. LVEF should be considered when ABI values are used to evaluate and monitor cardiovascular risk in patients.