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Importance of Ankle/Brachial Pressure Index in Saudi Patients with Coronary Artery Disease  [PDF]
Abdullah M. Alshehri, Mohamed Elsharawy
World Journal of Cardiovascular Surgery (WJCS) , 2013, DOI: 10.4236/wjcs.2013.36036
Abstract: Background: The ankle/brachial pressure index (ABPI) has been shown to be a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the importance of measuring ABPI in Saudi patients with coronary artery disease (CAD). METHODS: This is a hospital based cross-sectional study which was conducted on all Saudi patients who underwent coronary angiography without symptoms of peripheral arterial disease at King Fahd Hospital of the University, Al-Khobar Saudi Arabia. All patients underwent measurement of their ABPI. The study was carried out between December 2010 and November 2011. RESULTS: During the study period, two hundred and five patients were included. Fifty-nine (28.8%) patients were Group II (ABPI ≤ 0.90) and the rest was Group I (ABPI > 0.90). Significant correlation was also found between low ABPI and the extent of CAD (mean number of arteries involved in Group I was 1.78 ± 0.83 compared to 2.10 ± 0.736 in Group II p = 0.011). Nevertheless, the correlation between low ABPI, and the severity of presentation of CAD were also significant (Incidence of myocardial infarction with congestive heart failure was 0.5% in Group I compared to 12% in Group II p < 0.001). CONCLUSION: The ABPI is an important prognostic indicator for Saudi patients with CAD.
Association of blood inflammatory markers with ankle brachial pressure index in patients with type 2 diabetes mellitus  [cached]
Rama Prakasha S,Rakshatha Nayak,Suchetha Kumari N,Ganesh Kumar S
International Journal of Biomedical Research , 2013, DOI: 10.7439/ijbr.v3i7.541
Abstract: Background: A significant positive correlation exists between the inflammatory markers, hs-CRP (C reactive protein) and ferritin and the parameters of dyslipidemia in patients with type 2 diabetes. Not much is known regarding diabetes, inflammation and vasculopathy especially in relation to ferritin from this region. Aim: To correlate serum CRP and ferritin levels with Ankle Brachial Pressure Index (ABPI) in type 2 diabetic patients. Methodology: Descriptive observational study of 50 diabetic patients done at K. S. Hegde Medical College Hospital, Mangalore, Karnataka, India. Results: ABPI correlated negatively with serum ferritin values; with a Pearson correlation value and p value of - 0.187 and 0.194 respectively. Also, ABPI negatively correlated with CRP, and this correlation was statistically significant (-0.382, P=0.006). Conclusion: Measurement of ABPI is a simple and clinically useful tool in identifying peripheral arterial disease in patients at risk of accelerated atherosclerosis. ABPI negatively correlated with serum ferritin and CRP levels in this study, though the association with ferritin was statistically not significant. Further large scale studies are needed to elucidate the association of ferritin as a nonconventional risk factor of atherosclerosis and PAD in type 2 diabetes mellitus.
Oxidized low-density lipoprotein and ankle-brachial pressure index in patients with clinically evident peripheral arterial disease
Rosoky, Ruben Miguel Ayzin;Wolosker, Nelson;Nasser, Michel;Zerati, Antonio Eduardo;Gidlund, Magnus;Puech-Le?o, Pedro;
Clinics , 2010, DOI: 10.1590/S1807-59322010000400006
Abstract: objectives: to investigate whether oxidized low-density lipoprotein is a suitable predictor of peripheral arterial disease severity. the role of oxidized low-density lipoprotein in the pathogenesis of atherosclerosis has already been investigated. its relevance as a predictor of the appearance and worsening of coronary arterial disease is also well known. however, the same is not true regarding peripheral arterial disease. method: eighty-five consecutive patients with an ankle-brachial pressure index (abpi) < 0.9 and the presence of either intermittent claudication or critical lower leg ischemia were included. the plasma level of igg autoantibodies against oxidized low-density lipoprotein was evaluated through an enzyme-linked immunosorbent assay. the results were categorized into quartiles according to the ankle-brachial pressure index (a marker of peripheral arterial disease severity), and significant differences were investigated with the kruskal-wallis test. results: there was no significant difference between the quartiles for this population (p = 0.33). no correlation was found between the ankle-brachial pressure index and oxidized low-density lipoprotein levels in subjects with clinically evident peripheral arterial disease with a wide range of clinical manifestations. conclusions: oxidized low-density lipoprotein is not a good predictor of peripheral arterial disease severity.
Common Carotid Intima Media Thickness and Ankle-Brachial Pressure Index Correlate with Local but Not Global Atheroma Burden: A Cross Sectional Study Using Whole Body Magnetic Resonance Angiography  [PDF]
Jonathan R. Weir-McCall, Faisel Khan, Matthew A. Lambert, Carly L. Adamson, Michael Gardner, Stephen J. Gandy, Prasad Guntur Ramkumar, Jill J. F. Belch, Allan D. Struthers, Petra Rauchhaus, Andrew D. Morris, J. Graeme Houston
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099190
Abstract: Background Common carotid intima media thickness (CIMT) and ankle brachial pressure index (ABPI) are used as surrogate marker of atherosclerosis, and have been shown to correlate with arterial stiffness, however their correlation with global atherosclerotic burden has not been previously assessed. We compare CIMT and ABPI with atheroma burden as measured by whole body magnetic resonance angiography (WB-MRA). Methods 50 patients with symptomatic peripheral arterial disease were recruited. CIMT was measured using ultrasound while rest and exercise ABPI were performed. WB-MRA was performed in a 1.5T MRI scanner using 4 volume acquisitions with a divided dose of intravenous gadolinium gadoterate meglumine (Dotarem, Guerbet, FR). The WB-MRA data was divided into 31 anatomical arterial segments with each scored according to degree of luminal narrowing: 0 = normal, 1 = <50%, 2 = 50–70%, 3 = 70–99%, 4 = vessel occlusion. The segment scores were summed and from this a standardized atheroma score was calculated. Results The atherosclerotic burden was high with a standardised atheroma score of 39.5±11. Common CIMT showed a positive correlation with the whole body atheroma score (β 0.32, p = 0.045), however this was due to its strong correlation with the neck and thoracic segments (β 0.42 p = 0.01) with no correlation with the rest of the body. ABPI correlated with the whole body atheroma score (β ?0.39, p = 0.012), which was due to a strong correlation with the ilio-femoral vessels with no correlation with the thoracic or neck vessels. On multiple linear regression, no correlation between CIMT and global atheroma burden was present (β 0.13 p = 0.45), while the correlation between ABPI and atheroma burden persisted (β ?0.45 p = 0.005). Conclusion ABPI but not CIMT correlates with global atheroma burden as measured by whole body contrast enhanced magnetic resonance angiography in a population with symptomatic peripheral arterial disease. However this is primarily due to a strong correlation with ilio-femoral atheroma burden.
Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia  [cached]
Chen Pamela Y,Lawford Kaye M,Shah Naiya,Pham Julie
Journal of Foot and Ankle Research , 2012, DOI: 10.1186/1757-1146-5-19
Abstract: Background The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists. Methods This study was a cross sectional survey which evaluated the perceptions of the ABI amongst registered podiatrists in Western Australia. The study sample was obtained from the register of podiatrists listed with the Podiatrists Registration Board of Western Australia. Podiatrists were contacted by telephone and invited to participate in a telephone questionnaire. Chi-square tests were performed to determine if there was a statistically significant relationship between use of the ABI and podiatrists’ profile which included: sector of employment; geographical location; and length of time in practice. Results There is a statistically significant relationship (p=0.004) between podiatrists’ profile and the use of ABI, with higher usage in the tertiary hospital setting than in private practice. Length of time spent in practice had no significant impact on ABI usage (p=0.098). Time constraints and lack of equipment were key limiting factors to performing the ABI, and no preferred technique was indicated. Conclusion Western Australian podiatrists agree that the ABI is a useful tool for lower limb vascular assessment, however, various factors influence uptake in the clinical setting. This study suggests that a podiatrists’ profile has a significant influence on the use of the ABI, which may be attributed to different patient types across the various settings. The influence of time spent in practice on ABI usage may be attributed to differences in clinical training and awareness of lower limb pathology over time. The authors recommend publication of ‘best practice’ guidelines to ABI performance, as well as further education and financial rebates from health organizations to facilitate increased utility of the ABI based on the findings of this study.
Predictive value of the ankle-brachial index in the evaluation of intermittent claudication
Wolosker, Nelson;Rosoky, Ruben A;Nakano, Lívio;Basyches, Márcio;Puech-Le?o, Pedro;
Revista do Hospital das Clínicas , 2000, DOI: 10.1590/S0041-87812000000200005
Abstract: the purpose of this study was to determine whether the ankle-brachial index (abi) could be used to predict the prognosis for a patient with intermittent claudication (ic). we studied 611 patients prospectively during 28 months of follow-up. we analyzed the predictive power of using various levels of abi - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). we found that using an abi of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.
Predictive value of the ankle-brachial index in the evaluation of intermittent claudication  [cached]
Wolosker Nelson,Rosoky Ruben A,Nakano Lívio,Basyches Márcio
Revista do Hospital das Clínicas , 2000,
Abstract: The purpose of this study was to determine whether the ankle-brachial index (ABI) could be used to predict the prognosis for a patient with intermittent claudication (IC). We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.
Different Ankle Brachial Index Levels in Asymptomatic Hemodialysis Patients
Saso Gelev,Goce Spasovski,Sonja Dzikova,Slavcho Tosev
Macedonian Journal of Medical Sciences , 2008,
Abstract: Resting ankle brachial systolic pressure index (ABI) level of 0.90 is 95% sensitive in detecting angiogram-positive peripheral arterial disease (PAD) and that falsely elevated pressures or incompressible arteries at the ankle level and ABI > 1.30 is caused by mediosclerosis. We evaluated 94 hemodialysis (HD) patients for the presence of PAD and mediosclerosis using ABI measurement, and the presence of atherosclerotic lesions using high resolution B-mode ultrasonography of the common carotid (CCA) and femoral arteries (FA). Asymptomatic HD patients with high ABI (mediosclerosis) and low ABI (PAD) levels were common. Patients with normal and high ABI levels had high percentage of atherosclerotic lesions. Older age, diabetes and low serum albumin, and higher doses of prescribed calcium carbonate were associated (p<0.05) with low levels of ABI in our HD patients. Male gender, higher blood pressure and presence of diabetes were associated (p<0.05) with high ABI levels. Low and high ABI levels were not associated with the specific risks such as elevated serum phosphate, calcium phosphate product and intact parathyroid hormone levels. Arterial disease in asymptomatic HD patients is frequent. Screening for atherosclerotic lesions in HD patients should be recommended even if they had no symptoms.
Endothelial function in a cardiovascular risk population with borderline ankle–brachial index
Kari Syv nen, P ivi Korhonen, Auli Partanen, et al
Vascular Health and Risk Management , 2011, DOI: http://dx.doi.org/10.2147/VHRM.S17249
Abstract: dothelial function in a cardiovascular risk population with borderline ankle–brachial index Original Research (4468) Total Article Views Authors: Kari Syv nen, P ivi Korhonen, Auli Partanen, et al Published Date February 2011 Volume 2011:7 Pages 97 - 101 DOI: http://dx.doi.org/10.2147/VHRM.S17249 Kari Syv nen1, P ivi Korhonen2, Auli Partanen3, Pertti Aarnio1 1Department of Surgery, Satakunta Hospital District, Pori, Finland; 2Central Satakunta Health Federation of Municipalities, Harjavalta, Finland; 3Department of Biostatistics, University of Turku, Turku, Finland Introduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle–brachial index (ABI). Traditionally ABI values > 1.00–1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90–1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT). Methods: We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device. Results: The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02). Conclusions: In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors.
Diagnostic value of ankle-brachial index and toe-brachial index in arterial disease of lower extremity  [cached]
Lan LI,Zhi-gang ZHAO,Zhen-cheng YAN,Yin-xing NI
Medical Journal of Chinese People's Liberation Army , 2012,
Abstract: Objective  To investigate the clinical application and its influencing factors of ankle-brachial index (ABI) and toe-brachial index (TBI) in the diagnosis of arterial disease of lower extremity. Methods  ABI and TBI were measured in 800 limbs of 402 patients with diabetes and/or hypertension hospitalized from July 2010 to February 2011. The patients were divided into narrow group (ABI < 0.9), normal group (0.9≤ABI < 1.3), and calcification group (ABI≥1.3) according to the value of ABI, and also into narrow group (TBI < 0.7) and normal group (TBI≥0.7) according to the value of TBI. The correlation of ABI with TBI was analyzed, and the differences in age, obesity parameters, biochemical indicators and other factors were compared between the groups. Influence of high-sensitivity C-reactive protein (hs-CRP) on ABI and TBI was further analyzed. Results  Only when ABI < 0.9, ABI and TBI have significant correlation (r=0.826, P < 0.01). W hen the group comparison based on ABI values, it was shown that the age and hs-CRP were significantly higher in the narrow group than in the normal group and calcification group (P < 0.01). The comparison between groups based on TBI values indicated that the age, systolic blood pressure and hs-CRP in the narrow group were significantly higher than those in the normal group (P < 0.01 or P < 0.05). ABI and TBI in the normal hs-CRP group were significantly higher than those in high hs-CRP group (P < 0.05). Conclusion  Hs-CRP may play an important role in the development and progression in peripheral arterial atherosclerosis. Therefore, ABI and TBI measurements in combination with hs-CRP level can improve early diagnosis of arterial disease of lower extremity.
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