Ankle pressure as an indicator of risk for systemic atherosclerosis

Contemporary methods of assessment of possible cardiovascular disease based on traditional risk factors are not perfect. Therefore new ways are sought. Simple and cheap methods include assessment of the blood pressure on the lower extremities above the ankles. The finding of a reduced index of ankle pressure (ratio of blood pressure above the ankles and pressure on the arm) indicates affection of the arteries of the lower extremities and a significantly increased risk of cardiovascular diseases (in particular myocardial infarction and stroke), independently on other risk factors. Therefore this simple examination should be made in middle aged and elderly subjects with a medium and high cardiovascular risk in order to define more accurately the health status, and in case of a reduced ankle pressure similar provisions should be made as in patients with secondary preventive care.     

Relationships of coronary artery atherosclerosis severity with blood pressure variability and ankle-brachial index in hypertensive patients

Background Numerous trials showed that blood pressure variability(BPV) plays an important role in triggering acute cardiovascular and cerebrovascular events. However, few studies have clarified the relationship between the coronary artery atherosclerosis severity with BVP and ankle-brachial index(ABI). There are few studies in which have investigated BPV, ankle-brachial index(ABI), brachial ankle pulse wave velelocity(ba PWV)and severity of coronary angiography( CAG) at the same time. Methods Totally 188 hypertensive patients from January 2012 to March 2015 were enrolled in this study. All the cases underwent 24 h ambulatory blood pressure monitoring(ABPM), CAG and ABI. The extent of coronary artery disease was assessed by the Gensini score system. The subjects were divided into four groups: A( Gensini score=0), B(Gensini score≤20), C( 20Gensini score 50), D(Gensini score≥50). Pearson correlation and stepwise multiple regression were used for analyses. Results Compared with the A and B group, most of blood pressure standard deviation and average ABI of D group were higher(P 0.05). Correlation analysis indicated that Gensini score was positively correlated with24 h systolic blood pressure standard deviation(24hsbpsd),day systolic blood pressure standard deviation(dsbpsd)and night systolic blood pressure standard deviation(nsbpsd); But it was reversely correlated with ABI. ABI was reversely correlated with 24 hsbpsd and nsbpsd. Gensini score was positively correlated with 24hsbpsd(P=0.02)and dsbpsd(P0.05),while reversely correlated with ABI(P0.05) by multiple linear stepwise regression analysis.Conclusion BPV and ABI are closely related to severity of coronary artery atherosclerosis. They are predictors in patients with coronary artery disease with hypertension.     

成年人生活方式与踝肱血压指数的相关性分析

目的：探讨生活方式与踝肱血压的关系。方法：采用自主研发的KD-991型便携式踝肱血压同步测试仪对来自全国各地的2121名中国成年人进行踝肱血压测试,并分为吸烟组与不吸烟组、大量饮酒组与适量饮酒组、运动组与缺乏运动组,对相对应的组的踝肱血压指数（ABI）异常率进行组间对比。结果：ABI异常（ABI≤0．9或者≥1．3）率：吸烟组（15．3％）、大量饮酒组（13．6％）和缺乏运动组（10．5％）,均明显高于相对应的不吸烟组（7．9％）、适量饮酒组（7．5％）和运动组（7．4％）,P均〈0．05。结论：不良生活方式与踝肱血压异常相关,用ABI指导人们改变不良生活方式,对于预防动脉粥样硬化的发生、早发现和有效控制其发展大有裨益。     

Admission blood pressure response as an indicator of hypertensive risk

In this retrospective study we aimed to identify from 50 outpatient (OP) mild hypertensives without clinical evidence of target organ damage (TOD), a group with unsustained hypertension in order to see whether they had less echocardiographic TOD than patients with sustained hypertension. Following OP assessment, patients were admitted to a hospital ward and BP was measured after 30 minutes' rest. In 21 patients (fallers) BP fell after admission and in 29 (non-fallers) BP either rose or remained the same (fallers = 164/102 OP v 152/93 mmHg hospital, non-fallers = 165/102 OP v 168/105 mmHg hospital, P less than 0.001 for SBP/DBP differences between the groups on hospitalisation). During the whole day after admission, ambulatory intra-arterial pressure (IABP) was consistently lower in the fallers (137/88 v 148/93 mmHg, P less than 0.04 for SBP, P = NS for DBP) and systolic variability was slightly but significantly higher (18 v 16 mmHg P = 0.05). Echocardiographically-assessed left ventricular mass index (LVMI) was significantly higher in the non-fallers (117 v 101 g/m2 P = 0.03) and correlated positively with mean systolic IABP in both groups although this only reached significance in the non-fallers (n = 25, r = 0.53 P less than 0.01 nonfallers v n = 18 r = 0.42 P = NS fallers). We believe the less sustained pressure of the fallers was responsible for their lower LVMIs and that an exaggerated defence reaction was operating when they were outpatients which relaxed following 30 minutes' rest in hospital. The study demonstrates the importance of sustained hypertension in the development of hypertensive cardiac TOD.     

Ankle-arm blood pressure index as a correlate of preclinical carotid atherosclerosis in elderly Japanese men

Peripheral artery disease correlates with preclinical carotid atherosclerosis in Western populations. However, little is known about this correlation in Asian populations. In a cross-sectional population-based study, we examined the correlation between peripheral arterial disease and carotid intima-media thickness (IMT) among 726 Japanese men aged 60-79 years. None of them had a history of clinical peripheral arterial disease. The ankle-to-arm systolic blood pressure index (AAI) was used as a surrogate estimate of peripheral arterial disease. Compared to men with AAI> or =0.90, those with AAI<0.90 were 1-4 years older, and had lower mean body mass index and higher prevalence of current smokers. The mean AAI correlated inversely and linearly with maximum IMT in the common and internal carotid arteries (CCA and ICA), and men with AAI<0.90 had higher prevalence of maximum ICA IMT > or =1.5mm than did those with AAI> or =0.90. The multivariate odds ratio (95% confidence interval) of maximum ICA IMT > or =1.5mm was 2.9 (1.0-8.4), while that of maximum CCA IMT> or =1.1mm was 1.4 (0.5-3.8) for men with AAI<0.90 versus > or =1.30. The sensitivity was 65% and the specificity was 98% for low AAI to detect ICA IMT > or =1.5mm. Low AAI is a strong correlate for internal carotid atherosclerosis and the AAI measurement may be of use to screen for preclinical peripheral atherosclerosis among Japanese elderly men.     

Comparison of three measures of the ankle-brachial blood pressure index in a general population.

The ankle-brachial blood pressure index (ABI) predicts cardiovasular disease. To our knowledge, no study has compared manual ABI measurements with an automated electronic oscillometric method in a population sample. We enrolled 946 residents (50.8% women; mean age, 43.5 years) from 8 villages in JingNing County, Zhejiang Province, P.R. China. We computed ABI as the ratio of ankle-to-arm systolic blood pressures from consecutive auscultatory or Doppler measurements at the posterior tibial and brachial arteries. We also used an automated oscillometric technique with simultaneous ankle and arm measurements (Colin VP-1000). Mean ABI values were significantly higher on Doppler than auscultatory measurements (1.15 vs. 1.07; p<0.0001) with intermediate levels on oscillometric determination (1.12; p<0.0001 vs. Doppler). The differences among the three measurements were not homogeneously distributed across the range of ABI values. Doppler and oscillometric ABIs were similar below 1.0, whereas above 1.2 Doppler and auscultatory ABIs were comparable. In Bland and Altman plots, the correlation coefficient between differences in Doppler minus oscillometric ABI and ABI level was 0.21 (p<0.0001). The corresponding correlation coefficient for Doppler minus auscultatory ABI was -0.13 (p<0.0001). In conclusion, automated ABI measurements are feasible in large-scale population studies. However, the small differences in ABI values between manual and oscillometric measurements depend on ABI level and must be considered in the interpretation of study results.     

踝臂指数与冠状动脉狭窄程度的关系

目的探讨踝臂指数与冠状动脉狭窄程度的关系。方法入选在我院住院的837例患者,其中男553例,女284例,平均年龄59.31±9.85岁.行冠造动脉造影术,以Gensini评分评价患者冠状动脉狭窄程度,检测ABI,以ABI≤0.9作为诊断外周血管病的标准。结果 ABI的高低与冠脉狭窄程度显著相关,随着ABI值的降低,Gensini评分会增加,两者呈负相关关系。同时,ABI值与动脉粥样硬化累积的冠脉支数也相关,伴有PAD冠心病患者的较外周血管正常的患者,三支病变和左主干病变所占的比例高。结论 ABI可作为冠状动脉粥样硬化的生物标记,能够反映冠状动脉狭窄程度。     

踝臂指数与老年女性冠状动脉粥样硬化程度的相关性研究

目的探讨踝臂指数与老年女性冠状动脉粥样硬化程度的相关性。方法选择232例老年女性,根据冠状动脉造影检查结果分为对照组(38例)、单支病变组(46例)、2支病变组(65例)、3支或左主干病变组(3支病变组,83例),进行踝臂指数的测量、病史采集及血脂检查。结果与对照组和单支病变组比较,2支病变组和3支病变组患者踝臂指数明显降低(P0.01);单支病变组与对照组踝臂指数比较,差异无统计学意义(P=0.319);踝臂指数与Gensini评分呈显著负相关(r=-0.487,P=0.001)。结论踝臂指数与老年女性冠状动脉粥样硬化病变程度密切相关,有助于评估冠状动脉狭窄程度。     

Upstroke time as a marker of atherosclerosis in patients with diabetes mellitus who have a normal ankle-brachial index

We measured upstroke time in 509 patients with diabetes who had a normal ankle-brachial index (ABI) (1.00 ≤ ABI ≤ 1.40) (443 men and 66 women; mean age: 67.6 ± 10.8 years). The prevalence of cardiovascular disease was significantly higher in patients with prolonged upstroke time at the ankle than in patients with normal upstroke time. The association between prolonged upstroke time and a higher risk of cardiovascular disease remained significant after adjusting for confounders.     

踝肱指数高值糖尿病患者下肢动脉粥样硬化病变的超声特点

目的分析踝肱指数(ABI)高值糖尿病患者下肢动脉粥样硬化病变的超声特点。方法随机选取糖尿病患者92例,根据ABI值分为:ABI高值组(23例,ABI>1.3)、AB1正常组(39例,ABI 0.9～1.3)及ABI低值组(30例,ABI<0.9),根据下肢动脉超声结果,对下肢动脉粥样硬化病变进行分析。结果与ABI低值组比较,ABI高值组患者下肢动脉病变闭塞率明显降低(63.3%vs 4.3%,P<0.05);ABI高值组患者下肢动脉粥样硬化病变主要表现为弥漫性斑点状强回声及小斑块病变(82.6%),并且,病变主要分布于下肢远端(44.4%)。ABI正常组患者下肢动脉粥样硬化病变以近端为主(81.8%)。结论 ABI高值患者下肢动脉粥样硬化病变的临床特征与动脉内膜中层钙化的病变特征一致,表明ABI高值对糖尿病患者动脉内膜中层钙化具有较高的预测价值。     

踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

踝臂指数在下肢动脉粥样硬化疾病中的诊断价值

下肢动脉粥样硬化疾病(lower extremity atherosclerotic disease)是指下肢动脉粥样硬化导致动脉狭窄甚至闭塞,使下肢组织出现慢性或急性缺血症状的疾病,是冠心病的等危症.踝臂指数(ABI)是目前诊断下肢动脉硬化疾病最常用、最普遍的无创性辅助检查,低ABI值(＜0.9)对评估下肢动脉硬化疾病的病变程度、病程进展、预后判断均具有重要价值[1].     

Accuracy of ankle-brachial index obtained by automated blood pressure measuring devices in patients with diabetes mellitus

Background

Upper arm automated blood pressure devices are widely available and could be used to estimate the ankle-brachial index.

Methods

We conducted a trial to determine the equivalence of ankle-brachial index estimated by an upper arm blood pressure measuring device as index method compared to the handheld Doppler method as the reference standard. A total of 110 patients with diabetes mellitus were sequentially examined by two methods.

Results

The prevalence of peripheral arterial disease was 32%. The index method obtained valid measurements in 104 (95%) patients. Ankle-brachial index was lower with the index method compared to the reference standard (mean difference: −0.05; 95% confidence interval [CI]: −0.50 to 0.39). This confidence interval was above the boundaries clinically established as equivalence margins in our study. The kappa agreement between two methods was 0.45. The performance of the index method was: sensitivity: 67%; specificity: 87%; positive likelihood ratio: 5.25; negative likelihood ratio: 0.18; positive predictive value: 71%; negative predictive value: 85%; and the area under the receiving operating characteristic curve: 0.87 (95% CI: 0.78-0.93).

Conclusion

Upper arm automated blood pressure measuring devices cannot replace the handheld Doppler method to estimate the ankle-brachial index in patients with diabetes mellitus.     

Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in patients with diabetes mellitus

BACKGROUND:

Previous studies have reported a close correlation between low ankle-brachial pressure index (ABPI) and various cardiovascular risk factors. However, despite the well-established potential hazards of consequent coronary artery disease (CAD), no data exist on the relationship between ABPI and the severity of CAD, particularly in patients with diabetes mellitus (DM).

METHODS:

A total of 840 patients ranging from 35 to 87 years of age (mean [± SD] 63.9±10.2 years) with suspected CAD in a clinical practice were enrolled. All patients underwent ABPI measurements and coronary angiography. Patients were divided into four groups according to the results of ABPI measurements and the presence or absence of DM: group A had an ABPI value of at least 0.9 but no DM (A⁻/D⁻); group B had an ABPI value of at least 0.9 and DM (A⁻/D⁺); group C had an ABPI of less than 0.9 but no DM (A⁺/D⁻); and group D had an ABPI value of less than 0.9 and DM (A⁺/D⁺).

RESULTS:

Age was significantly higher in the A⁺ (groups C and D) than the A⁻ patients (groups A and B). Moreover, men predominated in all four groups. Comparisons of sex distribution among the four groups revealed that group D had the highest percentage of women, while group A had the lowest. Total cholesterol level did not differ among the four groups, although group D tended to have the highest result. Patients in group D had the highest percentages of hypertension, hypercholesterol, hypertriglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol among the four groups. Group D exhibited the highest triglyceride and uric acid levels, the lowest high-density lipoprotein cholesterol level, and the highest metabolic syndrome criteria number and percentage of metabolic syndrome. Furthermore, group D had the highest mean lesion numbers, mean numbers of target vessel involvement, stenoses with type C classification and complex morphology lesions (chronic total occlusion, diffuse or calcified lesions) among the four groups. There were still significant differences in lesion numbers (P<0.001) and numbers of target vessel involvement (P<0.001) for ABPI predicting CAD severity after controlling for the effects of DM and age. The sensitivity, specificity, positive predictive value and negative predictive value of using an ABPI of less than 0.9 to predict CAD differed significantly between patients with and without DM.

CONCLUSIONS:

ABPI is a useful noninvasive tool for predicting CAD severity, even in patients with DM.