Predictors of an abnormal postexercise ankle brachial index: Importance of the lowest ankle pressure in calculating the resting ankle brachial index

Abstract

Background The postexercise ankle‐brachial index (ABI) is useful in patients with suspected peripheral arterial disease (PAD) and a normal resting ABI. Our objective was to determine the independent predictors of an abnormal postexercise ABI. Hypothesis We hypothesized that the lowest ankle systolic pressure to calculate the resting ABI would be associated with an abnormal post‐exercise ABI. Methods Among 619 consecutive patients referred for suspected PAD, we calculated the postexercise ABI in patients with a normal resting ABI. An ABI <0.90 at rest was considered abnormal. We investigated 3 definitions of an abnormal postexercise ABI, defined as either <0.90, or >5% or >20% reduction compared with rest. Results Using multivariate analysis, the lowest ABI (calculated using the lowest and not the highest ankle systolic pressure) was consistently the most powerful independent predictor of an abnormal postexercise ABI. Patients with an abnormal lowest resting ABI were significantly more likely to have an abnormal postexercise ABI, as well as a significantly greater reduction in the ABI compared with rest. The lowest ABI had a high specificity (95%) but low sensitivity (82%) for a postexercise ABI <0.90. Conclusions An abnormal lowest ABI (calculated with the lowest ankle systolic pressure) is the most important independent predictor of an abnormal ABI response to exercise in patients with a conventionally normal ABI. All such patients should be exercised and their ABI measured postexercise.

Ankle-Brachial Index as the Best Predictor of First Acute Coronary Syndrome in Patients with Treated Systemic Hypertension

“…This is due to the fact that the symptomatic course of the disease is observed in patients with very advanced atherosclerotic lesions due to the development of collateral circulation. Postexercise drops in systolic blood pressure values as observed in exercise tests are even better for identification of disturbed supply of blood to the lower limbs [23]. Perhaps postexercise ABI values would be the strongest predictor of ACS in our study group.…”

The Ability of the Toe-Brachial Index to Predict the Outcome of Treadmill Exercise Testing in Patients with a Normal Resting Ankle-Brachial Index

“…9 The lower the resting ABI, the higher the probability of obtaining an abnormal test result, as was also indicated by this study. 10 Since limbs with a low TBI have a lower ABI in average than limbs with a normal TBI, there is a logical increase in the probability of an abnormal test result in that group. Accordingly, we did not detect a significant difference between patients with a normal TBI and low TBI within most of the ABI subgroups.…”

Rapid and automated risk stratification by determination of the aortic stiffness in healthy subjects and subjects with cardiovascular disease

“…ABI measurements were obtained using a Doppler probe on the posterior tibial and anterior tibial artery locations, as previously described [22,24]. According to current guidelines, the highest value was used for the calculations and divided by the highest systolic brachial Doppler pressure [16].…”