Arterial Stiffness and Ankle-Brachial Index - Cross-Sectional Study of 259 Primary Care Patients ≥50 Year-Old.

BACKGROUND Lower-extremity arterial disease (LEAD) is the most common form of peripheral artery disease (PAD), and diagnosis relies on the ankle-brachial index (ABI). The objective of our study was to evaluate the correlation between ABI and arterial stiffness parameters, specifically focusing on PWV. Additionally, we aimed to assess the correlation between PWV and established LEAD risk factors. MATERIAL AND METHODS The study included primary care patients aged ≥50 years. Pulse wave velocity was measured with a Mobil-o-Graph Pulse Wave Analyzer (I.E.M. Germany). Two criteria defined abnormal PWV: 1) universal PWV threshold exceeding 10 m/s (uPWVt) and 2) surpassing an individualized threshold calculated by the device, accounting for sex, age, and blood pressure (iPWVt). RESULTS We assessed PWV in 266 individuals and both PWV and ABI in 259. Overall, 6/259 (2.3%) had a diagnosis of LEAD, 44/259(16.9%) had ABI <0.9, and 97/259 (37.5%) had PWV values above iPWVt. Among patients with Doppler ABI <0.9, 25/44 (56.8%) exhibited elevated iPWVt versus 72/215 (33.5%) in those with ABI ≥0.9 (P=0.003, r=0.18 Spearman's correlation). Among patients with ABI <0.9 19/44 (43.2%) had PWV >iPWVt (P=0.003, r=0.18). We observed significant correlation between elevated PWV (both cutoffs) and hypertension (in both P=0.009, r=0.16) and PWV >uPWVt correlated with the presence of diabetes (P=0.004, r=0.18). CONCLUSIONS Elevated PWV correlates with abnormal ABI and some cardiovascular risk factors in primary care patients aged 50 and above. Use of individualized PWV thresholds, factoring in age, appears to be a preferable approach for assessment of arterial stiffness and early diagnosis of LEAD.

Assessing Automatic Plethysmographic Ankle-Brachial Index Devices in Peripheral Artery Disease Detection: A Comparative Study with Doppler Ankle-Brachial Index Measurements.

BACKGROUND The ankle-brachial index (ABI) is a critical diagnostic test for peripheral artery disease (PAD), albeit requiring technical expertise and dedicated resources. The advent of automatic ABI devices proposes a more accessible approach, necessitating fewer resources and less expertise. This study was conducted to gather data on PAD prevalence and to evaluate the correlation and efficacy of automatic ABI measurements vs traditional Doppler ABI measurements to understand their potential role in primary care settings. MATERIAL AND METHODS ABI measurements were obtained using both the Doppler method and an automatic plethysmographic device (Dopplex ABility, Huntleigh Healthcare). RESULTS Of the 290 participants (mean age 67.6±7.4 years), Doppler ABI method identified 16.8% with abnormal results (<0.9), while the automatic method identified only 5.9%. The mean Doppler ABI was 1.05±0.15, and the mean automatic ABI was 1.12±0.13. The sensitivity of the automatic ABI measurements was 22.2%, and the specificity was 96.8%, with a positive predictive value of 57.1%, and a negative predictive value of 86.9%. Adjustments in the automatic assessment and inclusion of pulse wave velocity enhanced the diagnostic capabilities of the automatic ABI device. CONCLUSIONS While the automatic plethysmographic ABI device may lack the necessary diagnostic capabilities to replace the traditional Doppler ABI device as a standalone test in PAD diagnosis, it could still offer significant value in primary care settings if integrated with adjusted cut-off points and pulse wave velocity analysis.

Diagnosis and Treatment of Lower Extremity Arterial Disease-A Survey among Family Medicine Trainees in Poland.

Guidelines point to the ankle-brachial index (ABI) as a non-invasive tool for the initial diagnosis of lower extremity artery disease (LEAD). Questions have been raised whether primary practices should perform ABI. An online questionnaire was distributed among family medicine trainees in two academic centers in Poland. The questionnaire aimed to establish their knowledge about LEAD management and their opinion on the usefulness of ABI measurement and other LEAD diagnostic methods in primary care. ABI measurement was found either very or moderately useful in LEAD diagnosis by 94.5% of the respondents. Among the three most important elements of LEAD management, lifestyle changes, secondary prevention of atherosclerosis and exercise treatment were chosen, respectively, by 98.6%, 83.6% and 72.6% of them. ABI was seen as a useful diagnostic method at the primary care by 74% of the participants; however, 82.2% of them do not have access to ABI measurement in their workplace. The residents have good knowledge of the diagnostic methods of LEAD and consider ABI measurement as useful in LEAD diagnosis. However, most of them do not have access to ABI measurements in their clinical practices. Future discussion and potential financial changes will be needed for the introduction of ABI measurements into Polish primary care.

Automated Measurements of Ankle-Brachial Index: A Narrative Review.

Peripheral artery disease (PAD) is an atherosclerotic disease that causes obstruction in lower limb arteries. It increases cardiovascular risk even in asymptomatic patients. Accurate diagnostic tools for identification of affected individuals are needed. Recently, there have been attempts to establish a reliable method of automated ankle-brachial index (ABI) identification. A search of PubMed database to identify studies assessing automatic ABI measurements in agreement with standard PAD diagnosis methods was conducted in December 2020. A total of 57 studies were analyzed in the review. The majority of analyzed studies found ABI measured by automatic oscillometric devices to be potentially feasible for use. Some note that, even though the Doppler and oscillometric methods are not fully interchangeable, the oscillometric devices could be used in screening. Significantly fewer publications are available on automatic plethysmographic devices. For photoplethysmography, most studies reported either good or moderate agreement with reference standards. For air plethysmography, poorer agreement with Doppler ABI is suggested. It is noted that pulse volume recording (PVR) function may improve the diagnostic accuracy of the devices.