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
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.
Available from: Graeme J Houston
- "To the best of the authors knowledge, this is the first time that sequential WB-MRA has been used to quantify the progression rates of stenotic arterial disease. This adds to the current literature which shows that WB-MRA can detect significant arterial pathology outwith the lower limbs, more accurately quantifies stenotic disease in the lower limbsBMI body mass index, BP blood pressure, SAS standardised atheroma score, CIMT carotid intima media thickness, ABPI ankle-brachial pressure index Int J Cardiovasc Imaging than ABPI, and can effect management changes in this population[3,14,15]. Additionally, the extra cost of extending standard lower limb MRA to include whole body imaging in combination with a cardiac MRI has been shown to be cost-effective due to a reduction in the requirement for down stream extra tests. "
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ABSTRACT: Assess the feasibility of whole body magnetic resonance angiography (WB-MRA) for monitoring global atheroma burden in a population with peripheral arterial disease (PAD). 50 consecutive patients with symptomatic PAD referred for clinically indicated MRA were recruited. Whole body MRA (WB-MRA) was performed at baseline, 6 months and 3 years. The vasculature was split into 31 anatomical arterial segments. Each segment was scored according to degree of luminal narrowing: 0 = normal, 1 = <50 %, 2 = 50–70 %, 3 = 71–99 %, 4 = vessel occlusion. The score from all assessable segments was summed, and then normalised to the number of assessable vessels. This normalised score was divided by four (the maximum vessel score) and multiplied by 100 to give a final standardised atheroma score (SAS) with a score of 0–100. Progression was assessed with repeat measure ANOVA. 36 patients were scanned at 0 and 6 months, with 26 patients scanned at the 3 years follow up. Only those who completed all three visits were included in the final analysis. Baseline atherosclerotic burden was high with a mean SAS of 15.7 ± 10.3. No significant progression was present at 6 months (mean SAS 16.4 ± 10.5, p = 0.67), however there was significant disease progression at 3 years (mean SAS 17.7 ± 11.5, p = 0.01). Those with atheroma progression at follow-up were less likely to be on statin therapy (79 vs 100 %, p = 0.04), and had significantly higher baseline SAS (17.6 ± 11.2 vs 10.7 ± 5.1, p = 0.043). Follow up of atheroma burden is possible with WB-MRA, which can successfully quantify and monitor atherosclerosis progression at 3 years follow-up.
Available from: Johan Wikström
- "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.
Available from: Mustafa Tarik Agaç
- "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 . 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 . "
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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.
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