Étude comparative tensiomètre automatique versus doppler à ultrasons dans la mesure de l’index de pression systolique à la cheville (Ipsc)

Performance of systolic pressure index for lower limb peripheral arterial disease in a group of elderly in sub-Saharan Africa

BACKGROUND

The automatic measurement of the ankle-brachial index (ABI) constitutes a reliable, simple, safe, rapid, and inexpensive alternative diagnostic screening test compared with the Doppler method for peripheral arterial disease (PAD). We aimed to compare the diagnostic performance of automatic ABI measurement tests to Doppler ultrasound for PAD in a group of patients aged 65 years and above, in Sub-Saharan Africa.

METHODS

This was an experimental comparative study of the performance of Doppler ultrasound to the automated ABI test in the diagnosis of PAD in patients aged ≥ 65 years followed-up at the Yaoundé Central Hospital, Cameroon between January to June 2018. An ABI threshold < 0.90 is defined as a PAD. We compare the sensitivity, and specificity of the high ankle-brachial index (ABI-HIGH), low ankle-brachial index (ABI-LOW), and the mean ankle-brachial index (ABI-MEAN) for both tests.

RESULTS

We included 137 subjects with an average age of 71.7 ± 6.8 years. In the ABI-HIGH mode, the automatic device had a sensitivity of 55% and a specificity of 98.35% with a difference between the two techniques of d = 0.024 (p = 0.016). In the ABI-MEAN mode, it had a sensitivity of 40.63% and a specificity of 99.15%; d = 0.071 (p < 0.0001). In the ABI-LOW mode, it had a sensitivity of 30.95% and a specificity of 99.11%; d = 0.119 (p < 0.0001).

CONCLUSION

The Automatic measurement of systolic pressure index has a better diagnostic performance in the detection of Peripheral Arterial Disease compared to the reference method by continuous Doppler in sub-Saharan African subjects aged ≥ 65 years.

Frequency and factors associated with arterial remodeling in persons living with human immunodeficiency virus in Parakou in 2019

BACKGROUND

The side effects of antiretroviral drugs and the chronic inflammation induced by human immunodeficiency virus (HIV) infection contribute to the development of atherosclerotic arterial remodeling in people living with HIV (PLWH).

OBJECTIVES

To determine the frequency and factors associated with arterial remodeling in PLWH treated at the university hospital of Parakou.

METHODS

It was a cross-sectional, descriptive, and analytic study. Data were collected from March to August 2019 at the university hospital of Parakou in Benin. PLWH aged at least 18years and consenting were included. The diagnosis of arterial remodeling was retained in the presence of at least one of the following criteria: carotid intima-media thickness≥1mm, anteroposterior diameter of the abdominal aorta≥25mm, ankle brachial index<0.9, presence of atheromatous plaque. Data were recorded and analyzed with R 3.5.1 software, and the threshold of significance was 5%.

RESULTS

A total of 114 patients have undergone arterial Doppler ultrasound. The majority were women (71.9%). The patients' mean age was 43.2±10.2years with extremes of 18 and 67years. The frequency of arterial remodeling was 24.6%. The most common atherosclerotic lesion found was atheromatous overload (IMT≥1mm). Age≥50y (p=0.003; ORa=4.9[1.5-15.6]), male sex (p=0.037; ORa=4.1[1.3-13.4]), and a family history of hypertension and/or diabetes (p=0.027; ORa=3.6[1.1-12.8]) were significantly associated with atherosclerosis in PLWH.

CONCLUSION

Arterial remodeling was frequent among PLWH in Parakou in 2019. The associated factors were the classic cardiovascular risk factors that should be systematically taken into account in the follow-up of these patients.