Ankle brachial index < 0.9 underestimates the prevalence of peripheral artery occlusive disease assessed with whole-body magnetic resonance angiography in the elderly

Department of Radiology and Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Acta Radiologica (Impact Factor: 1.6). 04/2008; 49(2):143-9. DOI: 10.1080/02841850701732957
Source: PubMed


Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies.
To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly.
WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side.
There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one > or =50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a > or =50% stenosis in the pelvic or leg arteries.
An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population.

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    • "In a study comparing CIMT with ABI as an indicator for atherosclerotic vessel wall abnormalities of the arteries of the lower extremity, it was found that an increase in CIMT was related to a decrease in ABI (Bots et al., 1994). However, recently ABI has been established to underestimate the prevalence of significant stenoses and occlusions in the leg (Wikstrom et al., 2008). "
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    ABSTRACT: The aim of this study was to investigate the relationship between (i) carotid intima-media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (ΔCIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA). In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ΔCIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306). Carotid intima-media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ΔCIMT and TAS (P = 0·41). In the present study, CIMT, but not ΔCIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis.
    Clinical Physiology and Functional Imaging 01/2014; 34(6). DOI:10.1111/cpf.12116 · 1.44 Impact Factor
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    • "Sensitivity of ABI for detecting PAD is especially low for elderly and diabetic patients [13, 14]. More calcified arteries may not be compressible and reveal a higher ABI value and underestimate severity of PAD [15]. In addition, the elevated ABI values in spite of stenosis could be due to collateral circulation, which maintains blood flow to the lower limb beyond the obstruction [12]. "
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    ABSTRACT: Peripheral artery disease (PAD) is a marker of systemic atherosclerosis and most patients with PAD also have concomitant coronary artery disease (CAD). There are no published data investigating the relationship between PAD and CAD complexity assessed by a well-accepted classification system such as the SYNTAX score (SS) or Trans-Atlantic Inter-Society Consensus II (TASC II). The study population consisted of 72 patients who underwent coronary angiography for the assessment of CAD. At the same session, peripheral angiography was performed in cases of suspected PAD. A coronary lesion was defined as significant if it caused a 50% reduction of the luminal diameter by visual estimation in vessels ≥ 1.5 mm. The SYNTAX score was computed by dedicated software. Patients with peripheral artery disease were divided into four groups according to the Trans-Atlantic Inter-Society Consensus II classification. Numbers of patients with peripheral artery disease classified as A, B, C, and D by the Trans-Atlantic Inter-Society Consensus II classification were 27, 16, 18 and 11, respectively. SYNTAX scores for each group from A to D were 10 ±9, 11 ±10, 24 ±13 and 27 ±12, respectively; p for trend < 0.001. Higher Trans-Atlantic Inter-Society Consensus II classification is associated with higher SYNTAX score in patients who underwent coronary and peripheral diagnostic angiography. It may suggest that arterial atherosclerotic disease complexity is a systemic panvascular phenomenon.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 11/2013; 9(4):344-7. DOI:10.5114/pwki.2013.38863 · 0.15 Impact Factor
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    • "Males and females aged ≥40 years that had their ABI measurements were included in the analysis. Exclusion criteria were individuals with missing data and an ABI >1.5, usually seen in people with noncompressible arteries due to medial arterial calcification [10] [11]. Predictor variable PAD was measured by hand-held Doppler probe method as established previously [12] [13] and defined as present when ABI <0.9 and absent when ABI ≥0.9, a cut-off value validated by Xu et al. [10]. "
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    ABSTRACT: Background. Peripheral arterial disease (PAD) often coexists with congestive heart failure (CHF) and can be masked by symptoms of CHF such as functional limitation (FL), a common manifestation for both. Therefore, we sought to estimate the prevalence of PAD and its independent association with FL in CHF. Methods. We conducted a cross-sectional study on National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 to quantify weighted prevalence of CHF and PAD. Study cohort consisted of 7513, with ankle brachial index (ABI) measurements at baseline. Independent association of PAD (ABI ≤ 0.9) with FL in CHF was determined with multivariate logistic regression (MVLR). Results. Overall weighted PAD prevalence was 5.2%. CHF was present in 305 participants, and the weighted prevalence of PAD in this subgroup was 19.2%. When compared, participants with CHF and PAD were more likely to be older (P < 0.001), hypertensive (P = 0.005) and hypercholesterolemic (P = 0.013) than participants with CHF alone. MVLR showed that PAD (adjusted OR = 5.15; 95% CI: 2.2, 12.05: P < 0.05) and arthritis (adjusted OR = 2.36; 95% CI: 1.10, 5.06: P < 0.05) were independently associated with FL in CHF. Conclusion. Independent association of PAD with FL suggests the need for reinforced screening for PAD in individuals with CHF.
    12/2012; 2012(2012):306852. DOI:10.1155/2012/306852
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