Ambulatory arterial stiffness index in diabetic patients / Índice de rigidez arterial ambulatorio en pacientes diabéticos

ABSTRACT Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.

Antecedentes El índice de rigidez arterial ambulatorio (AASI), derivado del monitoreo ambulatorio de presión arterial de 24 h (MAPA), puede ser un buen indicador de rigidez arterial. Objetivo Evaluar la correlación entre el AASI y la velocidad de onda de pulso braquial (VOP), el índice tobillo-brazo (ITB) y el índice vascular cardio-tobillo (CAVI) en pacientes con diabetes mellitus tipo 2 sin hipertensión arterial. Material y Métodos Estudio transversal en 28 pacientes con diabetes de 49 ± 7 años (40% mujeres). El AASI se calculó como 1 menos la pendiente de regresión de la presión arterial diastólica sobre la sistólica, usando datos del MAPA de 24 h, el cual se midió en el brazo, usando un dispositivo oscilométrico. El ITB se calculó como la razón entre la presión arterial sistólica del tobillo sobre la del brazo. El CAVI se derivó de la velocidad de onda de pulso medida con el dispositivo Vasera VS-1000. Para el análisis estadístico se utilizó el coeficiente de correlación bivariada de Spearman. Resultados Los valores de AASI, VOP, ITB y CAVI fueron 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s y 7.60 ± 1.90, respectivamente. Hubo una correlación negativa significativa entre AASI e ITB (r = -0.491, p < 0.01). Conclusiones Hay una asociación entre AASI, un marcador de rigidez arterial e ITB, un indicador de aterosclerosis, en estos pacientes con diabetes mellitus tipo 2.

Estructuras neurovasculares en riesgo durante abordajes artroscópicos en tobillo: un estudio cadavérico / Neurovascular structures at risk during arthroscopic approaches to the ankle: a cadaveric study

La artroscopía de tobillo ha tenido un aumento en su utilización en las últimas tres décadas para la corrección quirúrgica de afecciones del tobillo. Se prefiere a la cirugía abierta por sus múltiples ventajas, destacando la disminución de las complicaciones, con una prevalencia de 7,3 % para la artroscopia y 15,9 % para la cirugía abierta. Estudios previos de artroscopia de tobillo reportan complicaciones generales entre el 0,9 a 17 %, de las cuales el 33 a 50 % envuelven los nervios cutáneos, principalmente el nervio fibular superficial o alguna de sus ramas. El objetivo del presente estudio fue determinar estructuras neurovasculares en riesgo próximas a los portales artroscópicos del tobillo descritos en la literatura. Se llevó a cabo un estudio anatómico observacional, transversal y descriptivo. La muestra consistió en 10 tobillos de población mexicana en los cuales se introdujeron cánulas artroscópicas en algunos portales de tobillo descritos en la literatura y se realizó una disección superficial de los pies, posteriormente se determinó la distancia entre las estructuras neurovasculares próximas a los portales y se realizó un análisis estadístico con los resultados. Los resultados del estudio anatómico evidenció que portal antero-medial es el portal más seguro debido a que la distancia de dicho portal a una estructura neurovascular fue la más elevada, obteniendo una media de 11,30 mm±11,25, la menor distancia encontrada fue la del portal postero-medial con una media de 2,84 mm±1,28. El 10 % de los portales laterales resultaron con lesión de estructuras venosas tributarias de la vena safena menor. El portal antero-medial es el portal más seguro pero con mayor variabilidad respecto a las distancias de las estructuras neurovasculares al portal y el portal postero-medial es el de mayor riesgo debido a la mayor presencia de estructuras neurovasculares.

In the last three decades the procedure of ankle arthroscopy has increased in ankle surgery. It is preferred to open surgery for multiple reasons, the most important is that it has fewer complications, with a prevalence of 7.3 % for arthroscopy and 15.9 % for open surgery. Previous studies of ankle arthroscopy reported general complications between 0.9 to 17 % which involved cutaneous nerves at a rate of 33 to 50 %, mainly the superficial peroneal nerve. The principal objective of this study was to determine the neurovascular structures near the arthroscopic portals of the ankle. We carried out anatomical, observational, transversal and descriptive studies. This study was performed with 10 ankles of Mexican population. A 4 mm trocar was introduced in some of the portals described in the literature and superficial dissection of the feet was made. Subsequently, the distance between the nearest neurovascular structures was measured, and statistical analysis of the results was realized. The results of the anatomic study was that the anterior-medial portal was considered the safest portal because it has the highest distance between the portal and the neurovascular structure, with an average of 11.30 mm±11.25, the posterior-medial portal has the smallest average with 2.84 mm±1.28. A lesion of the small saphenous vein was reported in 10 % of the lateral portals. The antero-medial portal is the safest but with highest variability regarding the distances of the neurovascular structures to the portal and the postero-medial portal has the highest risk due to the increased presence of neurovascular structures.

The Effects of Short-duration Exercise on Arterial Stiffness in Patients with Stable Coronary Artery Disease

Arterial stiffness is an important contributor to the development of cardiovascular disease. We investigated the effect of short duration exercise using the treadmill test on arterial stiffness in the presence of coronary artery disease. We enrolled patients with and without coronary artery diseases (CAD and control group, 50 patients each) referred for treadmill testing. Brachial-ankle pulse wave velocity (baPWV) were measured before and after treadmill testing. Values of baPWV were significantly reduced at 10 min after exercise in both groups, more in the CAD group than in the control group (baseline baPWV and post-exercise change [cm/sec]: 1,527+/-245 and -132+/-155 in the CAD group, 1,439+/-202 and -77+/-93 in the control group, respectively, P for change in each group <0.001, P for difference in changes between the two groups <0.001). These findings persisted after adjusting for age, body mass index, systolic blood pressure, mean arterial pressure (MAP), MAP decreases, and baseline baPWV. Significant post-exercise baPWV reductions were observed in both groups, and more prominently in the CAD group. This finding suggests that short-duration exercise may effectively improve arterial stiffness even in patients with stable coronary artery disease.

The Relationship between Brachial Ankle Pulse Wave Velocity and Complement 1 Inhibitor

Complement 1 (C1) inhibitor is an acute phase protein with anti-inflammatory properties. The aim of the present study was to elucidate the relationship between brachial ankle pulse wave velocity (baPWV), the parameter of arterial stiffness, and C1 inhibitor. One hundred subjects were randomly enrolled in this study. Data about baPWV, age, gender, hypertension, smoking, and body mass index (BMI) were measured. Blood tests for total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, hemoglobin A1c, erythrocyte sedimentation rate, C-reactive protein, complement 3, and C1 inhibitor were performed. Based on the Pearson correlation, the C1 inhibitor showed a positive relation to the baPWV (P<0.001). Multiple regression analysis revealed the significant predictors of baPWV were not only the conventional risk factors of arteriosclerosis and/or atherosclerosis, such as age (P<0.001), gender (P<0.001), hypertension (P<0.001), and BMI (P=0.006), but also the acute phase protein, C1 inhibitor (P=0.025). In conclusion, C1 inhibitor is associated with arterial stiffness through its association with increased inflammation.

Atorvastatin improves arterial stiffness in normotensive normolipidaemic persons with type 2 diabetes.

Increased arterial stiffness is an independent predictor of cardiovascular disease and mortality in middle-aged and olderadults. We measured arterial stiffness by pulse wave velocity (PWV)in brachial-ankle segments by automated oscillometry in 71 normotensive and normolipidaemic subjects with type 2 diabetes (40 males and 31 females). 57 patients (whose baPWV was more than 1400 cm/second) were randomised into two groups, group A (n=29) were given 10 mg atorvastatin daily for 6 months and group B (n=28) were given placebo. After 6 months, atorvastatin group had significant improvement in brachial-ankle pulse wave velocity (baPWV) (1712.03 +/- 349.9 cm/second versus 1558.81 +/- 303.26 cm/ second, p< 0.05). Though the placebo group showed some improvement (1692.03 +/- 425.15 cm/second versus 1636.78 +/- 425.1 cm/second) it was not statistically significant. Despite correlation was noted between baPWV and systolic blood pressure (SBP), there was no significant correlation between the mean baPWV and duration of diabetes, body mass index (BMI), waist circumference, waist-hip ratio (WHR), waist to height ratio (WHtR), glycated haemoglobin (HbA1c), LDL, HDL cholesterol and spot urine albumin creatinine ratio (ACR) at the baseline. The decrement of LDL-cholesterol is correlated with the decrement of the baPWV in the atorvastatin group only (p<0.01).

Índice Tornozelo-Braquial (ITB) determinado por esfigmomanômetros oscilométricos automáticos / Assessing Ankle-Brachial Index (ABI) by using automated oscillometric devices

FUNDAMENTO: Índice Tornozelo-Braquial (ITB) é essencial na prática clínica, mas dificuldades técnicas na sua execução pelo padrão de referência Doppler vascular (DV) tornam-no ainda pouco utilizado. OBJETIVO: Avaliar aplicabilidade da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos (EOA) e sugerir a utilização dos índices delta-Bráquio-Braquial (delta-BB) e delta-ITB como marcadores de risco cardiovascular. MÉTODOS: Estudo descritivo e observacional de 247 pacientes ambulatoriais (56,2 por cento feminino, média 62,0 anos) submetidos à determinação do ITB com aferição simultânea da pressão arterial (PA) em membros superiores (MMSS) e inferiores (MMII) utilizando-se dois EOA (OMRON-HEM705CP). Nos casos em que não foi possível aferir PA em pelo menos um dos MMII utilizou-se DV. Os pacientes divididos em Grupo N (ITB normal: 0,91 a 1,30) e Grupo A (ITB alterado: <0,90 ou >1,30) tiveram comparados entre si os valores de delta-ITB (diferença absoluta ITB/MMII) e delta-BB (diferença absoluta PAS/MMSS). RESULTADOS: Utilizando-se EOA foi possível determinar ITB em 90,7 por cento. Com dados do Grupo N determinaram-se valores de referência (VR) no percentil 95 de delta-ITB (0-0,13) e delta-BB (0-8 mmHg). Quando comparado com o Grupo N, o Grupo A apresentou prevalência mais elevada tanto de delta-ITB (30/52 contra 10/195; Razão de Chances: 25,23; p<0,0001) como de delta-BB (13/52 contra 7/195; Razão de Chances: 8,95; p<0,0001) acima dos VR. CONCLUSÃO: O ITB pode ser determinado na maioria das vezes com EOA. Delta-ITB e delta-BB acima dos VR estiveram significativamente mais prevalentes nos portadores de ITB alterado e podem ser sugeridos como marcadores de risco cardiovascular em futuros estudos epidemiológicos.

BACKGROUND: Assessing Ankle-Brachial Index is an essential procedure in clinical settings, but since its measurement by the gold standard Doppler Ultrasonic (DU) technique is impaired by technical difficulties, it is underperformed. OBJECTIVE: The aim of this study was to assess the efficacy of an automated oscillometric device (AOD) by performing Ankle-Brachial Index (ABI) assessments and to suggest delta brachial-brachial (delta-BB) and delta-ABI as markers of cardiovascular risk. METHODS: In this observational and descriptive study, 247 patients (56.2 percent females, mean age 62.0 years) had their arterial blood pressure (ABP) measured for ABI calculation. Two AOD (OMRON-HEM705CP) devices were used for simultaneous measurements of the ABP, first of the two arms and then of the arm with higher systolic ABP and a leg, first the left and then the right one. When leg ABP measurements were not possible, ABI determination was performed by using the standard Doppler Ultrasonic (DU) technique. Patients were designated to Group N (normal ABI: 0.91 to 1.30) or Group A (abnormal ABI: <0.90 or >1.30). Other indexes were also calculated: delta-BB (absolute difference in mmHg of systolic ABP between arms) and delta-ABI (absolute difference of ABI between legs) and the results were compared. RESULTS: In most patients (90.7 percent), it was possible to determine the ABI. Group N data allowed calculation of the 95th percentile reference values (RV) of delta-BB (0 to 8 mmHg) and delta-ABI (0 to 0.13). When compared to Group N, Group A had a significantly higher prevalence of high values greater than the RVs of delta-ABI (30 of 52 and 10 of 195, respectively; Odds Ratio = 25.23; p<0.0001) and delta-BB (13 of 52 and 7 of 195, respectively; Odds Ratio = 8.95; p<0.0001). CONCLUSION: In most patients, the ABI could be measured by AOD. Both indexes, delta-BB and delta-ABI greater than the RVs, were significantly more prevalent in patients with abnormal ABI ...

Escore para rastrear idosos (> 75 anos) de alto risco para doença arterial periférica / A risk score for predicting peripheral arterial disease in individuals 75 years or older

FUNDAMENTO: A prevalência de doença arterial periférica (DAP) é elevada entre os idosos. A maioria é assintomática e o exame físico pouco sensível. No Brasil, os fatores associados à DAP em idosos são pouco conhecidos. OBEJETIVOS: Identificar os fatores associados à presença de doença arterial periférica (DAP) em idosos (> 75 anos) da comunidade e desenvolver um escore de predição da doença. MÉTODOS: Estudo transversal, aninhado em uma coorte prospectiva ("Epidoso"). Foram avaliados 176 idosos (> 75 anos) da comunidade. A presença de DAP foi definida por meio do índice tornozelo-braquial <0,90. Os fatores associados à DAP, na análise univariada, foram analisados em modelo de regressão logística múltipla e um escore foi formulado de acordo com a probabilidade da doença. Valores de p<0,05 foram considerados significantes. RESULTADOS: A prevalência de DAP foi de 36,4 por cento. Os preditores de DAP foram: anormalidades dos pulsos dos tornozelos, hipertensão arterial, tabagismo e dor/desconforto na(s) perna(s) durante a caminhada. Essas variáveis obtiveram escores de 13, 9, 5 e 5, respectivamente. O ponto de corte (cutoff) para definir "alto risco de DAP" ficou acima dos 18 pontos e resultou em sensibilidade de 85,9 por cento, especificidade de 71,4 por cento, valor preditivo (VP) positivo de 63,2 por cento e VP negativo de 89,9 por cento. O poder discriminatório e a calibração foram excelentes (área sob a curva ROC=85 por cento e teste goodness-of-fit=p=0,639). CONCLUSÃO: Em razão do bom desempenho, o escore proposto pode tornar-se uma ferramenta simples e útil para identificar os idosos (> 75 anos) da comunidade com alto risco para DAP e que mereceriam investigação mais detalhada.

BACKGROUND: The prevalence of peripheral arterial disease (PAD) in the elderly is high. Most are asymptomatic and the sensitivity of the physical exam is low. In Brazil, little is known in regard to PAD risk factors in the elderly. OBJECTIVES: To identify risk factors for PAD among elderly individuals (> 75 years) in the community and to develop a prediction score. METHODS: Cross-sectional, prospective, community-based study nested within a cohort study ("Epidoso"). A total of 176 individuals were assessed. PAD was defined as an ankle-brachial index <0.9. Risk factors associated with PAD were entered into a multivariate logistic regression model. Statistical modeling was used to formulate a score according to the likelihood of PAD. A p value <0.05 was significant. RESULTS: PAD was present in 36.4 percent of participants. Abnormal pedal pulses, hypertension, cigarette smoking, and complain of leg pain/discomfort in either leg on walking were predictors of PAD. Based on the coefficients of the logistic regression, these variables were given scores of 13, 9, 5 and 5, respectively. A cutoff point >18 points defined the "high risk" individuals and yielded sensitivity, specificity, positive predictive value and negative predictive value of 85.9 percent, 71.4 percent, 63.2 percent and 89.9 percent, respectively. Receiver-operator characteristic analysis yielded area under curve of 85 percent, indicating excellent discrimination and goodness-of-fit statistics indicated excellent calibration (p=0.639). CONCLUSION: Because of its good performance, the proposed score can become a simple and useful tool to identify elderly community residents at higher risk of PAD who should be considered for further investigation.

Doença arterial obstrutiva periférica e índice tornozelo-braço em pacientes submetidos à angiografia coronariana / Peripheral arterial occlusive disease and ankle-brachial index in patients who had coronary angiography

OBJETIVO: Avaliar a prevalência de doença arterial obstrutiva periférica (DAOP) em coronariopatas. Avaliar a relação entre índice Tornozelo-Braço (ITB) e doença coronariana, e sua correlação com fatores de risco cardiovascular. MÉTODO: ITB investigado com ultra-sonografia Doppler. Características clínicas pesquisadas: idade, sexo, diabetes mellitus, hipertensão arterial sistêmica, etilismo, tabagismo e obesidade. População: 113 pacientes submetidos à angiografia coronariana. Primeira análise: 2 grupos - ausência e presença de coronariopatia. Segunda análise: 3 grupos - Grupo 1 - ausência de lesão coronariana; Grupo 2 - estenose < 70 por cento; e Grupo 3 - estenose > 70 por cento. Terceira análise: 2 grupos - ausência e presença de DAOP. RESULTADOS: 90,76 por cento dos coronariopatas apresentaram DAOP. Houve diferença significante quanto à faixa etária (p<0,001), hipertensão (p<0,001), tabagismo (p<0,001), IMC (p<0,001), pressão sistólica (p<0,001), diastólica (p<0,001) e de pulso (p<0,001) e ITB (p<0,001) entre indivíduos com e sem lesão coronariana. Houve diferença significante quanto à faixa etária (p<0,001), diabetes (p=0,030), hipertensão (p<0,001), tabagismo (p<0,001), IMC (p<0,001), pressão sistólica (p<0,001), diastólica (p<0,001) e de pulso (p<0,001) e ITB (p<0,001) entre os pacientes divididos quanto ao grau da coronariopatia. Houve diferença significante quanto à faixa etária (p<0,001), hipertensão (p<0,001), tabagismo (p<0,001), IMC (p<0,001), pressão sistólica (p<0,001), diastólica (p<0,001) e de pulso (p<0,001) entre pacientes com e sem DAOP. Pela Análise de Regressão Logística, pacientes idosos, obesos e com ITB < 0,90 apresentam probabilidade de lesão coronariana de 98,93 por cento. CONCLUSÃO: ITB < 0,90 constitui um possível marcador de doença arterial coronariana em pacientes com risco de doenças cardiovasculares.

OBJECTIVE: To evaluate the prevalence of peripheral arterial disease (PAD) in patients with coronary arterial disease. To evaluate the relation between ankle-brachial index (ABI) and coronary arterial disease, and its correlation with cardiovascular risk factors. METHOD: ABI investigated with Doppler ultrasonic device. Clinical characteristics researched: age, gender, diabetes, hypertension, alcoholism, smoking and obesity. Population: 113 patients who had coronary angiography. First analyses: 2 groups - absence and presence of coronary arterial disease. Second analyses: 3 groups - Group 1 - absence of coronary lesion; Group 2 - stenosis <70 percent; and Group 3 - stenosis >70 percent. Third analyses: 2 groups - absence and presence of PAD. RESULTS: 90.76 percent of patients with coronary arterial disease presented PAD. There were significant difference including age (p<0.001), hypertension (p<0.001). smoking (p<0.001), body mass index (BMI) (p<0.001), systolic blood pressure (SBP) (p<0.001), diastolic blood pressure (DBP) (p<0.001) and pulse pressure (PP) (p<0.001) and ABI (p<0.001) between patients with and without coronary lesion. There were significant difference including age (p<0.001), diabetes (p=0.030), hypertension (p<0.001), smoking (p<0.001), BMI (p<0.001), SBP (p<0.001), DBP (p<0.001) and PP (p<0.001) and ABI (p<0.001) between patients divided as severity of coronary arterial disease. There were significant difference including age (p<0.001), hypertension (p<0.001), smoking (p<0.001), BMI (p<0.001), SBP (p<0.001), DBP (p<0.001) and PP (p<0.001) between patients with and without PAD. By Logistic Regression Analysis, old obese patients with ABI<0.90 have a risk of coronary lesion of 98.93 percent. CONCLUSION: ITB<0.90 might be a marker of coronary arterial disease in patients at risk of cardiovascular diseases.

Buerger's disease: clinical and histomorphological study.

There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.

Association of serum albumin and homocysteine levels and cardio-ankle vascular index in patients with continuous ambulatory peritoneal dialysis

BACKGROUND: The cardio-ankle vascular index (CAVI) is a newly developed arteriosclerotic measurement that has been proposed as an alternative to aortic pulse-wave velocity (PWV). The present study used the CAVI to identify the main factors associated with arteriosclerosis in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Fifteen CAPD patients were enrolled in the study. The CAVI is independent of the pressure and vascular reflection between the heart valve and the ankle. Serum albumin, uric acid, total calcium, phosphorus, lipid levels, high-sensitivity C-reactive protein and homocysteine concentrations in CAPD patients were measured using standard methods. Total body fat mass, truncal and non-truncal fat mass and lean body mass were measured using dual energy X-ray absorptiometry with a Lunar DPX-L scanner. RESULTS: CAPD patients had a mean CAVI of 9.37+/-3.16 m/sec, which was higher than the general population. The CAVI was negatively correlated with the serum albumin concentration (r=-0.548; p=0.034). Stepwise regression analysis showed that both the serum albumin concentration (beta=-0.643, p=0.013) and the serum homocysteine level (beta=0.486, p=0.004) were independently associated with the CAVI. CONCLUSIONS: An increase in CAVI was independently associated with both serum albumin and homocysteine level.

Distribution of the Ankle-Brachial Index and Associated Cardiovascular Risk Factors in a Population of Middle-Aged and Elderly Koreans

The Doppler ankle-brachial pressure index (ABI) is an objective and efficient tool that can be used to determine the presence and severity of peripheral arterial disease in the lower extremities. The ABI value is inversely associated with other cardiovascular risk factors. To date, there have been no studies of the distribution of ABI in Korea. We performed a cross-sectional study of 1,943 subjects (681 men and 1,262 women; 45-74 yr old) in Namwon, Korea. The prevalence of a low ABI (or=1.30) was prevalent in 3.1% of men and 0.8% of women. Age, smoking habits, waist circumference, hypertension, and blood pressure were associated with ABI values in both sexes. The presence of carotid plaques was associated with ABI values only in men, whereas pulse pressure was associated with ABI values only in women (p<0.05). Although the prevalence of a low ABI in the present study was lower than those reported previously for Western populations and Japanese men, our results suggest that the ABI might be used as an indicator of cardiovascular risk factors in adult Koreans.

Carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with and without coronary artery disease.

BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.

Ankle brachial index as a predictor of generalized atherosclerosis.

OBJECTIVE: To assess ankle brachial index (ABI) as a screening method to target subclinical atherosclerosis in middle aged individuals. MATERIAL AND METHODS: Total 160 patients over the age of 40 years were included in the study for a period of 16 months. Their ABI was determined either by colour Doppler method (30 patients) and/or sphygmomanometry (all 160 patients). A value of < 0.9 was taken as cutoff point for significant stenosis. RESULTS: Total 69 patients out of total of 160 had significantly low ABI value (43.12%) which shows that there is a very high incidence of low ABI in the community. Overall > 50% of the patients were largely asymptomatic and had presence of two or more risk factors. ABI < 0.9 was a good screening test to detect such individuals at an earlier stage (sub-clinical). CONCLUSION: A significantly low (< 0.9) ABI value can detect subclinical atherosclerotic vascular involvement and predict future occurrence of preventable major vascular event.

Predictive value of the ankle-brachial index in the evaluation of intermittent claudication

The purpose of this study was to determine whether the ankle-brachial index (ABI) could be used to predict the prognosis for a patient with intermittent claudication (IC). We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test

Comparative study of ankle brachial index [abi] digitial subtraction angiography [dsa] and doppler flowmetry in evaluation of diabetic foot

It is a prospective study carried out at Lahore General Hospital from April 1993 to April 1996 in 21 Diabetic Patients with ulceration in the foot. The purpose of this study was to find out the best method for assessment of Diabetic Foot Ulceration. For this purpose Clinical Method, Ankle Brachial Index, Doppler Ultrasound and Digital Subtraction Angiography were compared as individual parameters. The results show that DSA has got the best sensitivity [93%], followed by Doppler Sonograpy [86%] and Ankle Brachial Index [84%]. We conclude that Digital Subtraction Angiography should be carried out in all doubtful cases to decide the management and the level of amputation