Cut-Off Value of the Ankle-Brachial Pressure Index at Which the Accuracy of Brachial-Ankle Pulse Wave Velocity Measurement is Diminished

Abstract

ulse wave velocity (PWV) is used in the management of atherosclerotic cardiovascular disease as a validated marker of disease severity and a predictor of future events. [1][2][3][4] Recently, the use of brachial -ankle PWV, which can be obtained by simply wrapping the 4 extremities with blood pressure cuffs, was validated 5-7 and the technique is quite simple it is thus useful for screening the general population; in addition, the ankle -brachial blood pressure index (ABI) can also be simultaneously obtained. [5][6][7] For accurate PWV measurement, a clear recording of the pulse waves is very important, but in cases of severe atherosclerosis, the stenosis of the arteries affects the recording and it is not sufficiently clear. 8,9 ABI is a simple marker of peripheral arterial stenosis 10-15 and can provide information about the prevalence of arterial stenosis in subjects who are undergoing a brachial -ankle PWV recording. However, the cut-off value for ABI at which the accuracy of brachial -ankle PWV measurements is diminished because of arterial stenosis has not been established. Therefore, we proposed and evaluated the following hypothesis. At the site of arterial stenosis, the serial changes in the waveform obscure the foot of the waveform and delay the calculated PWV. 9 The discrepancy in brachial -ankle PWV (abnormal difference) between the 2 sides of the Circulation Journal Vol.69, January 2005body reflects the lack of accuracy of the brachial -ankle PWV measurement on the delayed side because of arterial stenosis. Therefore, we examined the ABI on the side of the delayed brachial -ankle PWV as a marker of the lack of brachial -ankle PWV accuracy in patients with a discrepancy in their brachial -ankle PWV values (abnormal difference). Methods SubjectsOf the patients who visited the outpatient clinic of the Second Department of Internal Medicine of Tokyo Medical University Hospital or were admitted to the department for the diagnosis or treatment of cardiovascular disease between April 2001 and August 2003, patients who underwent a brachial -ankle PWV recording and gave their informed consent were enrolled in the study. Subjects with a plasma creatinine concentration of greater than 176.8 mol/L, with an aortic graft, and those with atrial fibrillation, were excluded. The total number of subjects was 1,361 (60±12 years old). Atherosclerotic cardiovascular diseases were classified according to the criteria of the International Classification of Diseases (10th version) for coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Hypertension, dyslipidemia and diabetes mellitus were diagnosed according to the guidelines of the Japanese Society of Hypertension, 16 the Japan Atherosclerosis Society 17 and the Japan Diabetes Society. 18 The study's protocol was approved by the ethical committee of Tokyo Medical University. Background The present study was conducted to establish the cutoff value of the ankle -brachial pressure index (ABI) at which the accuracy of brachial -ankle pulse wave v...

Brachial-ankle Pulse Wave Velocity as an Index of Central Arterial Stiffness

“…In particular, care should be taken in the interpretation of baP-WV among subjects with reduced ABI. In such subjects, baPWV is decreased and does not accurately reflect central arterial stiffness 12,26) . In conclusion, this study provides further information showing that baPWV correlated best with aortic PWV among the five PWV measurements.…”

Brachial-Ankle PWV: Current Status and Future Directions as a Useful Marker in the Management of Cardiovascular Disease and/or Cardiovascular Risk Factors

“…It has been demonstrated that the reliability of the brachial-ankle PWV measurement is diminished in subjects with atrial fibrillation, frequent arrhythmias, or inaccurate pulse wave recordings because of arterial stenosis (e.g., ankle brachial pressure index 0.95) 8,13,14) .…”

Renal and Vascular Protective Effects of Telmisartan in Patients with Essential Hypertension

“…The brachial-ankle pulse wave velocity (baPWV) was measured bilaterally using a volume-plethysmographic apparatus PWV/ABI device (Colin Medical Technology Company, Komaki, Japan) in accordance with a methodology described elsewhere (5), and the mean value was calculated as a parameter of arteriosclerosis. Values are expressed as the mean±SEM.…”