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Martín-Rubio I, Marín-García B, Romero-Velasco E, Thuissard-Vasallo IJ, Bautista-Hernández A, Abad-Pérez D. [Oscillometric devices vs. arterial Doppler in measuring the ankle-arm index for the diagnosis of peripheral arterial disease]. Med Clin (Barc) 2024; 163:128-131. [PMID: 38643026 DOI: 10.1016/j.medcli.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Peripheral arterial disease is a marker of vascular damage that is diagnosed by measuring the ankle-brachial index. The aim of this study was to determine the validity and agreement of the MESI ABPI-MD and Microlife WatchBP® office-ABI oscillometric devices with respect to the gold standard arterial Doppler. MATERIALS AND METHODS Observational, cross-sectional, descriptive study of inpatients who underwent ABI measurement with the three devices. Values are considered normal between 1-1.4, indeterminate between 0.91-0.99 and pathological ≤0.9 and >1.4. RESULTS A total of 187 patients (54.4% male) with a mean age of 66 years were included. The Doppler results were inferior to those of the oscillometric devices (median [IQR] 1.1 [0.2] vs. 1.2 [0.2], P<.05), with no significant differences between the automated devices (P=.29 for the right lower limb and P=.342 for the left lower limb). Both devices had high specificity (96.5-99.2%) and low sensitivity (29.5-45.4%). The correlation of the results was good-moderate for MESI and moderate for Microlife. The agreement between the two was acceptable-moderate. CONCLUSION Automated oscillometric devices could be useful in asymptomatic patients as an alternative to arterial Doppler.
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Affiliation(s)
- Irene Martín-Rubio
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - Beatriz Marín-García
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Elisa Romero-Velasco
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España
| | | | | | - Daniel Abad-Pérez
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, España; Universidad Europea de Madrid, Madrid, España
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Accuracy of Ankle-Brachial Index, Toe-Brachial Index, and Risk Classification Score in Discriminating Peripheral Artery Disease in Patients With Chronic Kidney Disease. Am J Cardiol 2021; 160:117-123. [PMID: 34583809 DOI: 10.1016/j.amjcard.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
The accuracy of ankle-brachial index (ABI) and toe-brachial index (TBI) in discriminating lower extremity peripheral artery disease (PAD) has not been evaluated in patients with chronic kidney disease (CKD). We measured ABI, TBI, and Doppler ultrasound in 100 predialysis patients with CKD without revascularization or amputation. Leg-specific ABI was calculated using higher systolic blood pressure (SBP) in posterior tibial or dorsalis pedis artery divided by higher brachial SBP; alternative ABI was calculated using lower SBP in posterior tibial or dorsalis pedis artery. PAD was defined as ≥50% stenosis detected by Doppler ultrasound. PAD risk classification score was calculated using cardiovascular disease risk factors. The area under the curve (AUC, 95% confidence interval [CI]) for discriminating ultrasound-diagnosed PAD was 0.78 (0.69 to 0.87) by ABI, 0.80 (0.71 to 0.89) by alternative ABI, and 0.74 (0.63 to 0.86) by TBI. Sensitivity and specificity were 25% and 97% for ABI ≤0.9, 41% and 95% for alternative ABI ≤0.9, and 45% and 93% for TBI ≤0.7, respectively. AUC (95% CI) of PAD risk classification score was 0.86 (0.78 to 0.94) with sensitivity and specificity of 95% and 60% for risk score ≥0.10, 76% and 76% for risk score ≥0.25, and 43% and 95% for risk score ≥0.55. Combining risk score with ABI, alternative ABI, and TBI increased AUC (95% CI) to 0.89 (0.82 to 0.96), 0.89 (0.80 to 0.98), and 0.87 (0.78 to 0.96), respectively. In conclusion, current ABI and TBI diagnostic criteria have high specificity but low sensitivity for classifying PAD in patients with CKD. PAD classification risk score based on cardiovascular disease risk factors improves the accuracy of PAD classification.
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Bakhshi H, Bagchi P, Meyghani Z, Tehrani B, Qian X, Garg PK, Ambale-Venkatesh B, Bhatia HS, Ohyama Y, Wu CO, Budoff M, Allison M, Criqui MH, Bluemke DA, Lima JAC, deFilippi CR. Association of coronary artery calcification and thoracic aortic calcification with incident peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab042. [PMID: 35005719 PMCID: PMC8717048 DOI: 10.1093/ehjopen/oeab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The association of subclinical atherosclerotic disease in the coronary arteries and thoracic aorta with incident peripheral arterial disease (PAD) is unknown. We investigated the association between coronary artery calcium score (CACs) and thoracic aortic calcium score (TACs) with incident clinical and subclinical PAD.
Methods and results
The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women aged 45–84 from four ethnic groups who were free of clinical cardiovascular disease at enrolment. Coronary artery calcium score and thoracic aortic calcium score were measured from computed tomography scans. Participants with a baseline ankle-brachial index (ABI) ≤0.90 or >1.4 were excluded. Abnormal ABI was defined as ABI ≤0.9 or >1.4 at follow-up exam. Multivariable logistic regression and Cox proportional hazards models were used to test the associations between baseline CACs and TACs with incident abnormal ABI and clinical PAD, respectively. A total of 6409 participants (female: 52.8%) with a mean age of 61 years were analysed. Over a median follow-up of 16.7 years, 91 participants developed clinical PAD. In multivariable analysis, each unit increase in log (CACS + 1) and log (TACs + 1) were associated with 23% and 13% (P < 0.01for both) higher risk of incident clinical PAD, respectively. In 5725 (female: 52.6%) participants with an available follow-up ABI over median 9.2 years, each 1-unit increase in log (CACs + 1) and log (TACs + 1) were independently associated with 1.15-fold and 1.07-fold (P < 0.01for both) higher odds of incident abnormal ABI, respectively.
Conclusion
Higher baseline CACs and TACs predict abnormal ABI and clinical PAD independent of traditional cardiovascular risk factors and baseline ABI.
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Affiliation(s)
- Hooman Bakhshi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Pramita Bagchi
- Department of Statistics, George Mason University , Fairfax, VA, USA
| | - Zahra Meyghani
- Department of Medicine, Inova Fairfax Medical Campus , Falls Church, VA, USA
| | - Behnam Tehrani
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Xiaoxiao Qian
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine , Los Angeles, CA, USA
| | | | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , La Jolla, CA, USA
| | - Yoshiaki Ohyama
- Clinical Investigation and Research Unit, Gunma University Hospital , Maebashi, Japan
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute , Bethesda, MD, USA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center , Torrance, CA, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, WI, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University , Baltimore, MD, USA
| | - Christopher R deFilippi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
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Unkart JT, Allison MA, Araneta MRG, Ix JH, Matsushita K, Criqui MH. Burden of Peripheral Artery Disease on Mortality and Incident Cardiovascular Events. Am J Epidemiol 2020; 189:951-962. [PMID: 32242233 DOI: 10.1093/aje/kwaa051] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
Using data from the Multi-Ethnic Study of Atherosclerosis (United States, 2000-2015), 6,527 racially/ethnically diverse adults (mean age, 62 (standard deviation, 10) years) free of known cardiovascular (CVD) had ankle brachial index (ABI) assessment of their bilateral dorsalis pedis/posterior tibial arteries (4 vessels total) and were followed for total mortality and incident CVD events/mortality. Individuals were classified into categories of 0-, 1-, 2-, 3- or 4-vessel peripheral artery disease (PAD) (ABI of ≤0.9). There were 1,202 deaths (18%), 656 incident CVD events (10%), and 282 CVD deaths (4.3%). Of the 6,527 individuals, 5,711 (87.5%) had 0-, 460 (7.0%) had 1-, 218 (3.3%) had 2-, 69 (1.1%) had 3-, and 69 (1.1%) had 4-vessel PAD, respectively. In multivariable Cox models, higher number of vessels with PAD was associated with higher risk of mortality (P for trend <0.001), CVD events (P for trend = 0.002), and CVD mortality (P for trend = 0.001). Compared with individuals who had 0-vessel disease, hazard ratios for mortality were 1.29 (95% confidence interval (CI): 1.06, 1.59) for 1-, 1.45 (95% CI: 1.14, 1.86) for 2-, 1.58 (95% CI: 1.13, 2.21) for 3-, and 2.15 (95% CI: 1.58, 2.94) for 4-vessel disease. A similar pattern was seen for CVD events/mortality. These results suggest the importance of accounting for ABI values of all 4 leg arteries in clinical practice and research.
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Wiltz-James LM, Foley J. Hospital Discharge Teaching for Patients with Peripheral Vascular Disease. Crit Care Nurs Clin North Am 2019; 31:91-95. [PMID: 30736938 DOI: 10.1016/j.cnc.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peripheral disease affects both arteries and veins and encompasses pathophysiologic conditions that affect arterial, venous, and lymphatic circulations. This article discusses disorders of peripheral vascular disease (PVD) that affect the lower extremity. PVD is an obstruction in the arteries known as arteriosclerosis obliterans, a condition that manifests from insufficient tissue perfusion that results in hardening of the arteries. Peripheral artery disease leads to an inflammatory condition called atherosclerosis. People at greatest risk include smokers, diabetics, those with high blood pressure, and those with elevated cholesterol levels.
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Affiliation(s)
- Lucretia M Wiltz-James
- Louisiana State University Health New Orleans, School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA.
| | - James Foley
- Louisiana State University Health New Orleans, School of Nursing, 1900 Gravier Street, New Orleans, LA 70112, USA
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Pasek J, Cieślar G, Sieroń A. Combined therapy in the treatment of mixed etiology leg ulcer - case report. Ther Clin Risk Manag 2018; 14:1915-1921. [PMID: 30349270 PMCID: PMC6183550 DOI: 10.2147/tcrm.s176321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The most frequent causes of leg ulcers are chronic venous disease (CVD) related mainly to venous hypertension and peripheral arterial disease (PAD) related to disseminated atheromatous lesions in lower limb arteries. In 15%-21% of patients, ulcers of mixed venous-arterial etiology occur, which are usually more resistant for conservative therapy (compression therapy, pharmacotherapy, wearing elastic stockings, leg elevation and massage, change of lifestyle, and regular physical exercises). The contemporary model of complex therapy of leg ulcers in the course of chronic venous and arterial insufficiency more often also comprises numerous physical therapy procedures as associated therapy. This paper presents beneficial results of treatment applied to a 58-year-old patient with 1-month lasting painful chronic ulcers of both shins of mixed venous-arterial etiology, resistant to conservative therapy, which was performed by using the device Laserobaria-S for local combined physical therapy including simultaneous action of hyperbaric oxygen, extremely low-frequency (ELF) variable magnetic field, and low-energy light radiation. As a result of a 9-week therapeutic cycle consisting of 30 daily procedures, a complete healing of ulcers in both shins with accompanying subsidence of pain and substantial reduction in the intensity of local inflammation around the ulcer was obtained. The patient reported no side effects, and no complications were observed during the therapy.
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Affiliation(s)
- Jarosław Pasek
- Institute of Physical Education Tourism and Physiotherapy, University of Jan Długosz in Częstochowa, Częstochowa, Poland,
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| | - Aleksander Sieroń
- Department of Internal Medicine, Angiology and Physical Medicine, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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