Normal Ankle-brachial Index Group Research Articles

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.

Ultrasound-detected tibial artery calcification as a marker of cardiovascular and lower-limb risk in asymptomatic patients with type-2 diabetes.

Medial arterial calcification (MAC) is a vascular disease distinct from atherosclerosis. Recently, several studies have demonstrated that MAC is an important marker of cardiovascular events. We aim to assess the presence of MAC during ultrasound screening of lower-limb vasculature and its association with both cardiovascular (CV) and lower-limb events in patients with type-2 diabetes. A retrospective cohort study was conducted on 1119 patients with type-2 diabetes free from CV disease. A CV work-up, including vascular ultrasound, was performed for each patient. The presence of MAC was assessed on posterior tibial arteries and ankle-brachial index (ABI) was measured. Major acute CV events (MACEs) and lower-limb events (MALEs) were recorded as a composite endpoint for a 5-year period. We identified MAC among 212 (18.9%) patients. The independent determinants of MAC were age and diabetic retinopathy. Over a period of 5 years, 125 MACEs and 22 MALEs occurred. MAC was significantly associated with the composite outcome MACE + MALE (HR = 1.94; 95% CI: 1.23, 3.08, p = 0.005) or with MACE (HR = 1.85; 95% CI: 1.16, 2.95, p = 0.010). Adjusted for ABI and diabetic foot wound, MAC remained a determinant of MALE (HR = 5.49; 95% CI: 2.19, 13.76, p < 0.001). Considering each ABI group, MAC was associated with both MACE and MALE in the normal ABI group. Ultrasound-detected MAC on tibial arteries seems to be a determinant of both CV and lower-limb events, independent from ABI. MAC helps to refine the CV risk in patients with normal ABI.

Lower Limb Arterial Ischemia: An Independent Risk Factor of Sudomotor Dysfunction in Type 2 Diabetes.

As an early manifestation of diabetic peripheral neuropathy (DPN), sudomotor dysfunction significantly increases the risk of diabetic foot ulcer. The pathogenesis of sudomotor dysfunction is still unclear. Lower limb ischemia may be related to sudomotor dysfunction, but few studies have explored it. The purpose of this study is to explore the relationship between sudomotor function and comprehensive lower limb arterial ischemia including large arteries, small arteries and microvascular in type 2 diabetes mellitus (T2DM). 511 T2DM patients were enrolled in this cross-sectional study. Sudomotor function was assessed qualitatively and quantitatively by Neuropad. Lower limb arterial ischemia was defined as any abnormality of the ankle brachial index (ABI), toe brachial index (TBI) or transcutaneous oxygen tension (TcPO2). In this study, 75.1% of patients had sudomotor dysfunction. Compared with normal sudomotor function, patients with sudomotor dysfunction had a higher incidence of lower limb arterial ischemia (51.2% vs 36.2%, p = 0.004). Similarly, compared with the non-arterial ischemia group, the proportion of sudomotor disorders was higher in the arterial ischemia group (p = 0.004). Low TBI and low TcPO2 groups also had a higher proportion of sudomotor disorders (all p < 0.05).Compare with normal groups, low ABI, low TBI, and low TcPO2 groups had lower Slop4 which quantitatively reflecting Neuropad discoloration. Arterial ischemia was an independent risk factor for sudomotor dysfunction [OR = 1.754, p = 0.024]. Low TcPO2 also independently increased the risk of sudomotor disorders [OR = 2.231, p = 0.026]. Lower limb arterial ischemia is an independent risk factor of sudomotor dysfunction. Especially below the ankle (BTA) small arteries and microvascular ischemia may also be involved in the occurrence of sudomotor disorders.

Serum Adipocyte Fatty-Acid Binding Protein as an Independent Marker of Peripheral Artery Disease in Patients with Type-2 Diabetes Mellitus.

The adipocyte fatty-acid binding protein (A-FABP) is predominantly expressed in macrophages and adipocytes and is an essential mediator of inflammation and atherosclerosis pathogenesis. Atherosclerosis is an aggravating factor for peripheral arterial disease (PAD). Our study intended to study the association between PAD and serum A-FABP levels in type-2 diabetes mellitus (T2DM) patients. One hundred and twenty T2DM subjects were enrolled in the study. Fasting blood samples were collected to determine biochemical data and A-FABP levels. By the automatic oscillometric method, the ankle–brachial index (ABI) was measured. Low ABI was defined as any value < 0.9. Twenty participants with T2DM (16.7%) were included in the low ABI group. Low ABI T2DM participants had an increased mean body mass index, body fat mass, systolic blood pressure, C-reactive protein, urine albumin–creatinine ratio, and A-FABP levels compared to those in the normal ABI group. After variables significantly associated with PAD were adjusted by multivariate logistic regression analyses, circulating A-FABP levels (odds ratio [OR]: 1.138; 95 percent confidence interval [CI]: 1.023–1.266; p = 0.017) were identified as the independent marker of PAD. In conclusion, fasting serum A-FABP value has positive association with PAD in T2DM patients.

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

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

MO740: Decrease Serum IgG anti-oxLDL Antibodies Levels are Associated with Peripheral Arterial Disease IN PATIENTS WITH PERITONEAL DIALYSIS

Abstract BACKGROUND AND AIMS Antibodies to oxidized LDL (anti-oxLDL antibodies) were found to indicate protection from coronary artery disease and possibly major adverse cardiovascular and cerebral events. Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with increased mortality in patients on peritoneal dialysis (PD). The present study aimed to determine the relationship between serum IgG anti-oxLDL antibodies level and PAD in PD patients. METHOD The present cross-sectional, a single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were determined by available enzyme-linked immunosorbent assays. ABI values were measured using an automated oscillometric device. Patients with ABIs of &amp;lt; 0.9 were categorized into the low ABI group. RESULTS In the study cohort, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010), older age (P = 0.006) as well as the serum levels of fasting glucose (P &amp;lt; 0.001), triglyceride (P = 0.008) and C-reactive protein (P &amp;lt; 0.001) were higher, while IgG anti-oxLDL antibodies (p &amp;lt; 0.001) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of IgG anti-oxLDL antibodies [odds ratio (OR) 0.978, 95% confidence interval (95% CI) 0.958–1.000; P = .046) and C-reactive protein (each 0.1 mg/dL increase, OR 1.662, 95% CI 1.151–2.398; P = 0.007) were independently associated with PAD in PD patients. The area under the curve plotted to estimate the optimal level of IgG anti-oxLDL antibodies predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.687 (95% CI 0.580–0.780; P = 0.0022). CONCLUSION Lower serum IgG anti-oxLDL antibodies together with higher C-reactive protein were associated with PAD in PD patients.

MO172: Correlation of Serum Adipocyte Fatty Acid Binding Protein Level and Peripheral Arterial Disease in Chronic Kidney Patients

Abstract BACKGROUND AND AIMS Adipocyte fatty acid-binding protein (A-FABP) is expressed in adipocytes, dendritic cells and macrophages and it was thought to be involved in insulin resistance, chronic inflammation and atherosclerotic processes. Peripheral arterial disease (PAD) is associated with all-cause mortality, cardiovascular events and a key pathological process is atherosclerosis. The present study aimed to determine the relationship between serum A-FABP level and PAD in patients with non-dialysis chronic kidney disease (CKD). METHOD Fasting blood samples and baseline characteristics were obtained from 260 non-dialysis CKD patients (CKD stage 1–5). Ankle-brachial index (ABI) values were measured using an automated oscillometric device. Patients with ABIs of &amp;lt;0.9 were categorized into the low ABI group. Serum A-FABP levels were measured using a commercial enzyme immunoassay assay. RESULTS In the study cohort, 32 of the 260 non-dialysis CKD patients (12.3%) had low ABIs. The rates of diabetes mellitus (P = .037), smoking (P = .030), older age (P = .002) as well as the serum levels of A-FABP (P = .003) were higher in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of A-FABP [odds ratio (OR): 1.223, 95% confidence interval (CI): 1.068–1.401, P = .004], older age (OR: 1.064, 95% CI: 1.026–1.104, P = .001) and smoking (OR: 4.438, 95% CI: 1.493–13.198, P = .007) were the independently associated with PAD in patients with CKD. By receiver operating characteristic (ROC) curve analysis, the area under the receiver operating characteristic curve of A-FABP level was 0.662 (95% CI: 0.601–0.719, P = .0004) for predicting PAD in non-dialysis CKD patients. CONCLUSION In this study, serum A-FABP levels were associated with PAD in patients with non-dialysis CKD.

Positive Correlation of Serum Resistin Level with Peripheral Artery Disease in Patients with Chronic Kidney Disease Stage 3 to 5.

Chronic kidney disease (CKD) is associated with higher risk of cardiovascular disease-related ischemic events, which includes peripheral arterial disease (PAD). PAD is a strong predictor of future cardiovascular events, which can cause significant morbidity and mortality. Resistin has been found to be involved in pathological processes leading to CVD. Therefore, we aim to investigate whether resistin level is correlated with PAD in patients with non-dialysis CKD stage 3 to 5. There were 240 CKD patients enrolled in this study. Ankle-brachial index (ABI) values were measured using the automated oscillometric method. An ABI value < 0.9 defined the low ABI group. Serum levels of human resistin were determined using a commercially available enzyme immunoassay. Thirty CKD patients (12.5%) were included in the low ABI group. Patients in the low ABI group were older and had higher resistin levels as well as higher diabetes mellitus, hypertension and habit of smoking, and lower estimated glomerular filtration rate than patients in the normal ABI group. After the adjustment for factors that were significantly associated with PAD by multivariate logistic regression analysis, age and serum resistin level were independent predictors of PAD. A high serum resistin level is an independent predictor of PAD in non-dialysis CKD stage 3 to 5.

Ankle-brachial index predicts renal outcomes and all-cause mortality in high cardiovascular risk population: a nationwide prospective cohort study in CORE project.

Low ankle-brachial index (ABI) related ischemic events are common among individuals with chronic kidney disease (CKD). It is also associated with an increased risk of rapid renal function decline. The presence of peripheral artery disease (PAD) with low ABI among patients with high cardiovascular (CV) risk increases limb loss and mortality. To estimate the association between abnormal ABI and renal endpoints and all-cause mortality. A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. The subjects were divided into 3 groups based on ABI at baseline > 1.3, 0.91-1.3, and ≤ 0.9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15mL/min/1.73m2, doubling of serum creatinine and initiation of dialysis. The secondary outcome was all-cause mortality. Cox regression analysis and Kaplan-Meier curve were performed. A total of 5543 subjects (3005 men and 2538 women) were included. Cox proportional hazards model showed a significant relationship of low ABI (ABI ≤ 0.9) and primary composite outcome and all-cause mortality. Compared with the normal ABI group (ABI 0.91-1.3), subjects with low ABI at baseline significantly had 1.42-fold (95% CI 1.02-1.97) and 2.03-fold (95% CI 1.32-3.13) risk for the primary composite outcome and all-cause mortality, respectively, after adjusting for variable factors. Our study suggested that PAD independently predicts the incidence of renal progression and all-cause mortality among Thai patients with high CV risk.

Positive correlation of serum indoxyl sulfate level with peripheral arterial disease in hemodialysis patients.

Indoxyl sulfate, known for its cardiovascular toxicity, is associated with vascular and coronary artery diseases and increased mortality. Peripheral arterial disease, defined by low ankle-brachial index, is associated with increased mortality in patients on hemodialysis. The present study aimed to determine the relationship between the serum indoxyl sulfate level and peripheral arterial disease in patients on maintenance hemodialysis. The present cross-sectional, single-center study included 75 patients on maintenance hemodialysis. Serum indoxyl sulfate levels were determined by high-performance liquid chromatography-mass spectrometry. Ankle-brachial index values were measured using an automated oscillometric device. Patients with ankle-brachial indexes of < 0.9 were categorized into the low ankle-brachial index group. In the study cohort, 12 of the 75 patients (16.0%) had low ankle-brachial indexes. The rates of diabetes mellitus (p = 0.010) as well as the serum levels of C-reactive protein (p < 0.001) and indoxyl sulfate (p < 0.001) were higher in the low ankle-brachial index group than the normal ankle-brachial index group. The multivariable logistic regression analysis revealed that serum levels of indoxyl sulfate (odds ratio = 1.123, 95% confidence interval 1.011-1.249, p = 0.031) and C-reactive protein (each 0.1mg/dL increase, odds ratio = 1.169, 95% confidence interval 1.018-1.343, p = 0.027) were independently associated with peripheral arterial disease in patients on maintenance hemodialysis. Serum indoxyl sulfate levels were associated with peripheral arterial disease in patients on maintenance hemodialysis.

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm.

Objective Since patients with thoracic aortic aneurysm (TAA)/abdominal aortic aneurysm (AAA) are often complicated with coronary artery disease, it is common for those patients to undergo percutaneous coronary intervention (PCI). The ankle brachial index (ABI) is usually measured in patients with TAA/AAA to screen the presence of peripheral arterial disease. The present study investigated the association between the ABI and clinical outcomes following PCI in patients with TAA/AAA. Methods We divided 200 TAA/AAA patients who underwent PCI into a normal ABI group (n=137) and an abnormal ABI group (n=63) according to the ABI cut-off level of 1.00. The primary endpoint was one-year major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fetal myocardial infarction, stroke, target vessel revascularization, and hospitalization for heart failure. Results Mean ABIs in the normal and abnormal ABI groups were 1.12±0.09 and 0.86±0.11, respectively (p<0.01). Kaplan-Meier curves showed MACE were more frequent in the abnormal ABI group than in the normal ABI group (p=0.01). A multivariate Cox hazard analysis revealed that an abnormal ABI was significantly associated with 1-year MACE (vs. ABI ≥1.0: HR 3.02, 95% confidence interval 1.00-9.08, p=0.049). Conclusion Among patients with TAA/AAA who underwent PCI, abnormal ABI was significantly associated with 1-year MACE, suggesting the utility of the ABI measurement in this high-risk population.

Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity.

To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.

Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

Osteoprotegerin (OPG) is a potential biomarker of cardiovascular disease complications and severity. Peripheral arterial disease (PAD) is associated with an increased risk of death in patients on peritoneal dialysis (PD). Therefore, this study aimed to evaluate the relationship between serum OPG levels and PAD by measuring the ankle-brachial index (ABI) of patients on PD. A commercial enzyme-linked immunosorbent assay kit was used to measure OPG values. Left or right ABI values of <0.9 were categorized as the low ABI group. Among 70 patients on PD, 13 (18.6%) were categorized in the low ABI group. Patients in the low ABI group had higher prevalence of diabetes mellitus (p = .044) and higher serum C-reactive protein (CRP) (p < .001) and OPG levels (p < .001) but lower creatinine (p = .013) and peritoneal Kt/V (p = .048) levels than those in the normal ABI group. Results of multivariable logistic regression analysis revealed that OPG [adjusted odds ratio (aOR) 1.027, 95% confidence interval (CI) 1.010–1.045, p = .002] and CRP (aOR 1.102, 95% CI 1.006–1.207, p = .037) levels were independent predictors of PAD in patients on PD. OPG can also be used to predict PAD development with the area under the receiver operating characteristic curve of 0.823 (95% CI: 0.714–0.904, p < .001) in patients on PD. Therefore, serum OPG and CRP levels can be considered as risk factors for PAD development in patients on PD.

P694Evaluation of preclinical atherosclerosis in chronic myeloid patients continuously treated with tyrosine kinase inhibitors

Abstract In tyrosine kinase inhibitors (TKIs) era chronic myeloid leukemia (CML) became from fatal to well controlled chronic disease. Meanwhile it seems that some TKIs may have cardiovascular (CV) effects. The aim of the study was to assess signs of preclinical atherosclerosis (PA) on different TKIs in CML patients (pts). Patients and method In our study 126pts with CML obtained TKIs as any line at least 6mos were included. Males were 56 (44,5%). The median age was 52 (20–76)yrs. Pts with previous history of atherosclerotic CV events were excluded. There were 115 (91%), 61 (48%), 48 (38%), 12 (11%) pts ever obtained Imatinib (IMA), Nilotinib (NILO), Dasatinib (DASA) or Bosutinib (BOSU) with median treatment duration 22mos, 14mos, 16mos and 15,5mos, respectively. Median time since the first TKI was 48 mos. There are 79, 46, 12 pts obtained 2, 3 or 4 TKIs. To assess PA ankle-brachial index (ABI) and intima media thickness (IMT) were measured. To evaluate ABI Vascular Screening System VaSera VS-1500 was used. Normal values for ABI and IMT were &gt;0,9 and ≤1,1. Results ABI was abnormally low in 14/108 (13%) evaluable pts. Previous TKIs of IMA, NILO, DASA and BOSU were in 12 (86%) and 87 (93%), 9 (64%) and 41 (43%), 5 (35%) and 29 (31%), 1 (7%) and 9 (10%) pts with or w/t low ABI. All NILO its were pretreated with IMA. Only 2 pts previously obtained other TKIs. Median time on NILO was 23 mos and 15mos in pts with or w/t abnormal ABI, respectively. Median age for pts with or w/t low ABI was 53 and 52 yrs. The proportion of male pts were lower in abnormal vs normal ABI group – 29% and 44%. In NILO group 2 pts were male and median age for all pts was 51yrs. IMT was evaluable in 86 pts. The median value of IMT was 0,8mm for all pts. It was abnormal in 12 (14%) pts with median thickness 1,3mm. All pts previously ever obtained IMA. NILO, DASA and BOSU were exposed in 5 (42%) and 33 (46%), 5 (42%) and 23 (31%), 1 (8%) and 7 (10%) pts with or w/t IMT abnormalities. The proportion of males was 4 (33%) and 34 (46%) among pts with or w/t abnormal IMT. Pts with high vs normal IMT were older with median age 64 vs 44yrs. TKIs2 were ever obtained in 13/14 (93%) and 11/12 (92%)pts with abnormal ABI and IMT&lt; respectively. Both ABI and IMT were abnormal only in 4 pts. Heart SCORE was high and very high only in 18/80 (22,5%) pts. Median age for low vs high risk pts were much lower (40 vs 52yrs). There were no differences between treatment groups according to SCORE distribution. Overall 9/50 (18%) and 3/32 (9%), 5/38 (13%) and 3/28 (11%)pts on NILO and DASA, had abnormal ABI and IMT. Conclusion CML pts heavily pretreated with different TKIs were included In the study. The most pts with abnormal ABI and IMT have ever been obtaining TKIs2. Pts with NILO more frequently experienced low ABI. There were not significant differences among TKIs groups regarding heart SCORE or IMT. It seems that extended PA is low on TKIs including NILO in CML pts w/t previous SVEs. Acknowledgement/Funding Funded from government assignment

Low ankle brachial index predicts poor outcomes including target lesion revascularization during the long-term follow up after drug-eluting stent implantation for coronary artery disease

BackgroundPeripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD). The ankle-brachial index (ABI) is widely used for the screening for PAD. Low ABI is associated with short-term clinical outcomes in patients receiving coronary drug-eluting stent (DES) implantation. However, there is no report to examine the relationship between lower ABI and long-term clinical outcomes after DES implantation. Thus, we investigated the clinical long-term impact of low ABI after DES implantation. MethodsThis retrospective analysis included 181 CAD patients treated with DES from April 2010 to March 2013 in our institute. Based on ABI values, we divided the subjects into the low-ABI group (ABI<0.9, n=29) and the normal ABI group (0.9≤ABI<1.4, n=152). The incidence of target lesion revascularization (TLR), all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiac death, myocardial infarction, stroke, and any repeat revascularization, were compared between the 2 groups. ResultsDuring the median follow-up period of 43 months, the incidences of TLR, all-cause mortality, and MACCE were significantly higher in the low ABI group than in the normal ABI group (TLR: 41.4% vs 9.9%, p<0.001, all-cause mortality: 31.0% vs 3.9%, p<0.001, MACCE: 48.3% vs 11.2%, p<0.001, respectively). ConclusionsLow ABI may predict poor long-term outcomes, including TLR, in CAD patients treated with DES.

Negative correlation of serum adiponectin level with peripheral artery occlusive disease in hemodialysis patients.

Objective:Adiponectin is a fat-derived hormone that secretes exclusively by adipocytes and has antiatherosclerotic effects. Peripheral arterial occlusive disease (PAOD) is associated with an increased risk of death in hemodialysis (HD) patients. The aim of this study was to evaluate the relationship between serum adiponectin levels and PAOD by ankle–brachial index (ABI) in HD patients.Materials and Methods:Blood samples were obtained from 100 HD patients. Serum adiponectin levels were measured using a commercial enzyme-linked immunosorbent assay kit. ABI values were measured using the automated oscillometric method (VaSera VS-1000). ABI values that <0.9 were included in the low ABI group.Results:Among the 100 HD patients, 18 of them (18.0%) were in the low ABI group. Compared with patients in the normal ABI group, the patients in the low ABI group had a higher prevalence of diabetes (P = 0.043), older age (P = 0.027), and lower serum adiponectin level (P = 0.003). In addition, the multivariable logistic regression analysis showed that adiponectin (Odds ratio [OR]: 0.927, 95% confidence interval [CI]: 0.867–0.990, P = 0.025) and age (OR: 1.054, 95% CI: 1.002–1.109, P = 0.043) were the independently associated with PAOD in HD patients.Conclusion:In this study, serum adiponectin level was found to be associated with PAOD in HD patients.

Abstract P399: Abnormal Ankle-Brachial Index Values are Associated With a Greater Prevalence of Left Ventricular Hypertrophy, Renal Impairment and Relevant Vascular Findings in Diabetic Hypertensive Patients

Few studies have examined the correlation between the presence of peripheral artery disease diagnosed by ankle-brachial-index (ABI) and cumulative target organ damage (kidney, heart and vessels) in hypertensive patients with diabetes. For this purpose, we evaluated the prevalence of target organ damage as evidenced by an echocardiogram, Doppler carotid scan, retinography and glomerular filtration rate according to ABI values in 99 hypertensive diabetic patients. The patients were classified into a normal ABI group (1.4 ≥ ABI &gt; 0.9) and abnormal ABI group (ABI ≤ 0.9 or ABI&gt;1.4). From the data obtained, we analysed cumulative number, mean and frequency (mean) of lesions in target organs. The mean age of the patients was 65.4 ±7 years, and 61.6% were women. There were no differences concerning age, gender, race, body mass index, and metabolic profile between the normal (49 patients) and abnormal ABI group (50 patients), but higher levels of systolic blood pressure were observed in abnormal ABI group compared to normal ABI group (170.3 ± 26 vs. 153.3 ± 18; p = 0.002). In patients with abnormal ABI, it was observed a higher prevalence of left ventricular hipertrophy (56% vs. 26,5%, p = 0,003), internal carotid stenosis &gt; 50% (13,7% vs. 3,2%, p = 0,009) and glomerular filtration rate &lt; 60ml/1,73m 2 /min (33,3% vs. 12,8%, p = 0,018). Abnormal ABI group has a higher frequency of 2 or more lesions (54% vs. 20.4%, p &lt; 0.001), a greater mean number of lesions (2.37 ± 1 vs. 0.71 ± 0.7, p &lt; 0.001), as well as a higher frequency of target organs damage (0.36 ± 0.31 vs. 0.19 ± 0.19, p = 0.001). Multiple linear regression analysis revealed abnormal ABI as an independent factor related to the higher frequency of target organ damage (OR = 13.22; 95% CI = 1.81-24.63; p = 0.024). In conclusion, hypertensive diabetic patients with abnormal ABI values had a higher prevalence of single and cumulative target organ damage.

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.

High Serum Leptin Level is Associated with Peripheral Artery Disease in Geriatric Individuals

Summary Background Leptin contributes to the pathogenesis of atherosclerosis, endothelial dysfunction, and thrombosis. Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and is expected to prevail among geriatric individuals. The present study aimed to determine whether serum leptin level is associated with PAD in a geriatric group. Methods Blood samples were obtained from 60 participants in the study who were >65 years of age. Ankle-brachial index (ABI) values were measured using the automated oscillometric method. PAD was considered to be present if the left or right ABI values were less than 0.90, and these participants were included in the low ABI group. Serum leptin levels were measured using a commercial enzyme immunoassay kit. Results Of these geriatric participants, ten (16.7%) were in the low ABI group. Compared with the elderly participants in the normal ABI group, those in the low ABI group were current smokers (p = 0.048) and had higher serum C-reactive protein (CRP, p = 0.018) and leptin levels (p = 0.005). Multivariate logistic regression analysis of the factors significantly associated with PAD demonstrated that leptin (odds ratio: 1.078, 95% confidence interval: 1.021–1.138, p = 0.006) was an independent predictor of PAD. Female (p = 0.001), body mass index (p = 0.008), and a logarithmically transformed CRP (log-CRP, p = 0.035) were found to be associated with serum log-leptin levels among geriatric participants after multivariate forward stepwise linear regression analysis. Conclusion High serum leptin level is a risk marker for PAD in geriatric individuals.