New Diagnostic Criterion of Ankle Brachial Index for Peripheral Arterial Disease

Jin Doo Kang; Chang Woo Yeo; Hye Won Lee; Sung Woon Yoon; A Ra Jo; Byung Soo Kim; Kwang Jae Lee

doi:10.12997/jla.2015.4.2.109

Journal List > J Lipid Atheroscler > v.4(2) > 1059551

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Kang, Yeo, Lee, Yoon, Jo, Kim, and Lee: New Diagnostic Criterion of Ankle Brachial Index for Peripheral Arterial Disease

Original Article

Journal of Lipid and Atherosclerosis 2015; 4(2): 109-114.

Published online: 31 December 2015

DOI: https://doi.org/10.12997/jla.2015.4.2.109

New Diagnostic Criterion of Ankle Brachial Index for Peripheral Arterial Disease

Jin Doo Kang, Chang Woo Yeo, Hye Won Lee, Sung Woon Yoon, A Ra Jo, Byung Soo Kim, Kwang Jae Lee

Department of Internal Medicine, Dae Dong Hospital, Busan, Korea.

Corresponding Author: Kwang Jae Lee. Department of Internal Medicine, Daedong Hospital, 187, Chungnyeol-daero, Dongnae-gu, Busan 47737, Korea. Tel: +82-51-550-9963, Fax: +82-51-553-7575, luxrex@unitel.co.kr

Received 15 May 2015 Revised 29 July 2015 Accepted 29 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The ankle brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral arterial disease (PAD). However the diagnostic criterion of 0.9 has shown variable accuracy for identification of stenosis. We investigated more specific and sensitive diagnostic criterion of ABI for the diagnosis of PAD.

Methods

Among 5,379 patients who performed ABI test, 398 patients with abnormal ABI results or PAD symptoms underwent computed tomography angiography to confirm PAD. Each ABI results were compared with its sensitivity, specificity, positive and negative predictive values. ROC analysis and cross-tabulation analysis were performed to yield proper ABI criterion.

Results

ABI of 0.9 showed very high level of sensitivity (92.2%) and very low specificity(59.3%). ABI of 0.84 showed high level of specificity (81.4%), sensitivity (82.2%) and diagnostic correspondent rate (0.607).

Conclusion

The ABI of 0.84 could be more accurate and useful diagnostic Criterion for identifying PAD.

Keywords: Ankle brachial index, Peripheral arterial disease, Sensitivity, Specificity, CT angiography

Figures and Tables

Fig. 1

Receiver Operating Characteristic (ROC) curves for ABI for diagnosing peripheral vascular disease. The cutoff value of ABI was 0.84

Table 1

Characteristics of the patients

Mean±Standard deviation.

^*p<0.001 PAD versus Non PAD

PAD; peripheral arterial disease, BMI (kg/m²); body mass index

Table 2

Sensitivity, Specificity, Positive predictive value, Negative predictive value, Diagnostic Correspondent Rate of ABI 0.8 to 0.9

References

1. Attinger CE, Beckman J, Criqui M, Froelich JB, Giurini JM, Hamdan A, et al. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003; 26:3333–3341.

2. Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, et al. 1999-2000 national health and nutrition examination survey. Prevalence of lower- extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care. 2004; 27:1591–1597.

3. Peach G, Griffin M, Jones KG, Thompson MM, Hinchliffe RJ. Diagnosis and management of peripheral arterial disease. BMJ. 2012; aug. 14. 345:e5208.

4. Heijenbrok-Kal MH, Kock MC, Hunink MG. Lower extremity arterial disease: multidetector CT angiography meta-analysis. Radiology. 2007; 245:433–439.

5. Met R, Bipat S, Legemate DA, Reekers JA, Koelemay MJ. Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis. JAMA. 2009; 301:415–424.

6. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation. 2006; 113:1474–1547.

7. Khan TH, Farooqui FA, Niazi K. Critical review of the ankle brachial index. Curr Cardiol Rev. 2008; 4:101–106.

8. Dachun Xu, Jue Li, Liling Zou, Yawei Xu, Dayi Hu, Pagoto SL, et al. Sensitivity and specificity of the ankle--brachial index to diagnose peripheral artery disease: a structured review. Vasc Med. 2010; 15:361–369.

9. Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001; 344:1608–1621.

10. Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2012; 28:Suppl 1. 218–224.

11. Criqui MH. Peripheral arterial disease--epidemiological aspects. Vasc Med. 2001; 6:Suppl. 3–7.

12. Feigelson HS, Criqui MH, Fronek A, Langer RD, Molgaard CA. Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population. Am J Epidemiol. 1994; 140:526–534.

13. Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001; 286:1317–1324.

14. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004; 110:738–743.

15. Taylor-Piliae RE, Fair JM, Varady AN, Hlatky MA, Norton LC, Iribarren C, et al. Ankle brachial index screening in asymptomatic older adults. Am Heart J. 2011; 161:979–985.

16. Ouriel K, McDonnell AE, Metz CE, Zarins CK. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery. 1982; 91:686–693.

17. Guo X, Li J, Pang W, Zhao M, Luo Y, Sun Y, et al. Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J. 2008; 72:605–610.

18. Kock MC, Adriaensen ME, Pattynama PM, van Sambeek MR, van Urk H, Stijnen T, et al. DSA versus multi-detector row CT angiography in peripheral arterial disease: randomized controlled trial. Radiology. 2005; 237:727–737.

19. Schernthaner R, Stadler A, Lomoschitz F, Weber M, Fleischmann D, Lammer J, et al. Multidetector CT angiography in the assessment of peripheral arterial occlusive disease: accuracy in detecting the severity, number, and length of stenoses. Eur Radiol. 2008; 18:665–671.

20. Ouwendijk R, de Vries M, Pattynama PM, van Sambeek MR, de Haan MW, Stijnen T, et al. Imaging peripheral arterial disease: a randomized controlled trial comparing contrast-enhanced MR angiography and multi-detector row CT angiography. Radiology. 2005; 236:1094–1103.

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