Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients

Homza, Miroslav; Machaczka, Ondřej; Porzer, Martin; Kozák, Milan; Plášek, Jiří; Šipula, David

doi:10.5507/bp.2018.046

Cited by 17 publications

(25 citation statements)

References 30 publications

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“…Fourteen studies were retrospective [10][11][12][14][15][16][17]22,29,[33][34][35][36][37] and 19 were prospective. 13,[18][19][20][21][23][24][25][26][27][28][30][31][32][38][39][40][41][42]…”

Section: Resultsmentioning

confidence: 99%

“…For studies using CDUS, 15 of the 21 identified studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] reported the requisite data to perform the bivariate meta-analysis (sensitivity, specificity, number of participants with and without PAD) (Table S4). Mean sensitivity and specificity, DOR, ROC curve and AUC were calculated.…”

Section: What's New?mentioning

confidence: 99%

“…The way ABI was measured varied. Only 12 studies described the preparation for ABI assessment, 12,16,17,21,22,24,29,30,33,35,36,38 but this varied markedly and did not include all aspects recommended by guidelines, including pre-test rest time, abstinence from caffeine, exercise and smoking, and use of a temperature-controlled room (Tables 1 and 2). 44 Test reproducibility was reported in only two studies.…”

Section: Assessment Of the Abimentioning

confidence: 99%

“…12,[16][17][18][19]23,24,[29][30][31]33,34,41 The method used to calculate ABI varied. Some studies used the highest ankle pressure divided by the highest brachial pressure, 10,12,22,24,[28][29][30]41 whereas others reported multiple methods of calculating the ABI using: the lowest, highest and/or average of both ankle pressures; 14,17,34 the lowest ankle pressure; 11,18 an average of two ankle pressures 19,21,26 or did not specify which ankle pressures were used; 13,35,42 the highest ankle pressure divided by the brachial pressure from the same side or a single brachial pressure; 16,27,31,38 or single ankle pressure. 25 There was insufficient reporting to determine the method used to calculate the ABI in nine studies 15,20,23,25,33,36,37,39,…”

Section: Assessment Of the Abimentioning

confidence: 99%

“…Almost half (15) of the studies diagnosed PAD as one or more stenosis ≥ 50% of any lower limb artery. 11,13,14,16,17,[21][22][23]26,[29][30][31]33,35,36 Three studies diagnosed PAD as a stenosis of ≥ 70%, 12,18,25 and two as a stenosis > 75% 10,16 of any lower limb artery. The other studies used alternative methods such as velocity ratio 19 and a previously established artery stenosis score 28,45 to diagnose PAD or did not provide details of the method used (Tables 1 and 2).…”

Section: Imaging Comparatormentioning

confidence: 99%

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Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

et al. 2020

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Aim To systematically evaluate research investigating the accuracy of the ankle–brachial index (ABI) for diagnosing peripheral artery disease (PAD) in people with diabetes, as the accuracy is thought to be reduced in this cohort. Methods A database search of EBSCO Megafile Premier, Embase and The Cochrane Library was conducted to 28 February 2019. Prospective and retrospective investigations of the diagnostic accuracy of the ABI for PAD in people with diabetes using an imaging reference standard were eligible. Sensitivity and specify of the ABI and bivariate meta‐analysis against reference tests, or a standard summary receiver operating curve analysis (SROC) was performed. Results Thirty‐three studies met the inclusion criteria. ABI was compared with angiography in 12 studies and with colour duplex ultrasound (CDUS) in 21 studies. A SROC analysis of studies using angiography as the reference standard found a diagnostic odds ratio (DOR) of 9.06 [95% confidence interval (CI) 3.61 to 22.69], and area under the curve (AUC) of 0.76 (95% CI 0.66 to 0.86). Bivariate analysis of studies using CDUS demonstrated mean sensitivity of 0.60 (95% CI 0.48 to 0.71; P = 0.097) and mean specificity of 0.87 (95% CI 0.78 to 0.92; P < 0.001) with a DOR of 9.76 (95% CI 5.24 to 18.20; P < 0.0001) and AUC 0.72. Conclusions These results suggest the ABI has a high specificity but lower sensitivity in detecting imaging diagnosed PAD in people with diabetes. The low probability of the testing being able to rule diagnosis in or out suggest that the ABI has limited effectiveness for early detection of PAD in this cohort.

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Section: Resultsmentioning

confidence: 99%

Section: What's New?mentioning

confidence: 99%

Section: Assessment Of the Abimentioning

confidence: 99%

Section: Assessment Of the Abimentioning

confidence: 99%

Section: Imaging Comparatormentioning

confidence: 99%

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Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

et al. 2020

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Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

et al. 2020

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Comparison of different methods of ABI acquisition for detection of peripheral artery disease in diabetic patients

Cited by 17 publications

References 30 publications

Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

Estimating the diagnostic accuracy of the ankle–brachial pressure index for detecting peripheral arterial disease in people with diabetes: A systematic review and meta‐analysis

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

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