The ankle-brachial index in normal neonates and infants is significantly lower than in older children and adults

Katz, Schmuel; Globerman, Anat; Avitzour, Malka; Dolfin, Tzipora

doi:10.1016/s0022-3468(97)90192-5

Cited by 29 publications

(14 citation statements)

References 7 publications

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“…20,21 The changes in wall thickness resulting from increased hydrostatic pressure in the lower extremities with walking (vertical position) occur during the second year of life and plausibly explain why the ABI is Ͻ1.00 in the newborn and increases to adult values at 2 to 3 years of age. 22 Therefore, both reflected waves and changes in vessel wall thickness and consequently stiffness contribute to SBP amplification.…”

Section: Physiology Of the Abi Why Is Sbp Higher In The Ankles Than Imentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,376

827

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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Section: Physiology Of the Abi Why Is Sbp Higher In The Ankles Than Imentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,376

827

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“…TBI was analyzed in 474 toes of 237 subjects (117 men and 120 women, Table 1B). The subjects were 20-25 years old, and their median age was 21 (Q1-Q3: 20-21) years for men and 20 (20)(21) years for women. The heights and brachial blood pressures were significantly higher in men than in women.…”

Section: Resultsmentioning

confidence: 99%

“…The mechanism underlying ABI ≥1.0 is not yet fully clarified; 2) however, not only the difference in the distance from the heart to the brachium and ankle, but also some differences in arterial characteristics between the arm and the leg including vascular resistance and arterial stiffness possibly play certain roles. Some studies have shown that ABI is higher in men than in women 2,20) and suggested that ABI may increase with age in childhood, 20,21) likely similar to PWV which increases with age and the increase is more rapid in men than in women. 18,22) However, data regarding age-related ABI characteristics of young people are limited.…”

Section: Introductionmentioning

confidence: 99%

Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

Watanabe

Hara

Yunoki

et al. 2015

Annals of Vascular Diseases

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Objective: To clarify the characteristics of ankle-brachial index (ABI), toe-brachial index (TBI), and pulse volume recording (PVR) of the ankle with brachial-ankle pulse wave velocity (baPWV) in healthy young adults. Material and Methods: We analyzed ABI, TBI, baPWV, and PVR in the ankle of healthy adults aged 20 to 25 years (median, 20 years) using an automatic oscillometric device between 2002 and 2013. The ABI, baPWV, and PVR in 1282 legs of 641 subjects (301 men and 340 women) and the TBI in 474 toes of 237 subjects (117 men and 120 women) were evaluated. Results:The measured values showed no bilateral differences. ABI and baPWV were higher in men than in women, but TBI was similar in both sexes. ABI <1.0 was observed in 18.1% of the legs in men and in 25.6% in women. TBI <0.7 was observed in 16.2% of the toes in men and 19.1% in women. For ankle PVR, the % mean arterial pressure was higher in women than in men. The upstroke time was <180 ms in most subjects. Conclusions: For young people, ABI <1.0 or TBI <0.7 may not always indicate vascular abnormalities. When evaluating circulatory indexes, age and sex should be considered.Keywords: ABI, TBI, baPWV, PVR, healthy young adults indications of ABI. The cut-off value of ABI for detecting PAD has been confirmed as 0.9 with high sensitivity and specificity. 2) Moreover, ABI is a strong predictor of cardiovascular events: the normal ABI range was revised as 1.00 to 1.40, because patients with ABI ranging from 0.91 to 0.99 have been shown to be at the borderline of cardiovascular risk. 2) On the other hand, TBI measurements are more cumbersome and are limited to special institutions (e.g., vascular laboratories) using different techniques including laser Doppler flowmetry, photoplethysmography, oscillometric plethysmography, and mercury strain gauge plethysmography. Thus, basic data on a uniform technique for a large population remain limited. Although the cut-off value of TBI for detecting PAD is set at 0.6 or 0.7, there has been no global consensus. 1,[3][4][5] Although the normal standard ranges of ABI and TBI are based on data obtained mostly from middle and senior adults, [3][4][5][6] young patients with lower limb complaints such as coldness, pain, or claudication are also primarily examined by ABI and TBI measurements because PAD including Buerger disease, Raynaud disease, Takayasu arteritis, and even arteriosclerotic diseases can occur in young patients, as the prevalence of PAD is estimated to be 1.2% to 4% of people in their late 20s. 7) However, they occasionally show ABI <1.0 or TBI <0.7 despite their normal physical findings, making the diagnosis confusing.The gold standard method for ABI measurement has been the Doppler method since the 1980s, 2) but on the other hand, automated oscillometric sphygmomanometers have come into use recently. Moreover, full-automated ABI/TBI measuring devices have been developed since the late 1990s. 8,9) We have used the automated ABI/TBI measuring devices in our clinical work. The form PWV/ABI ® (Colin Co., Aichi, Jap...

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“…Alternatively, decreased conduit artery stiffness around birth might have an opposite effect, exaggerating arterial blood pooling during systole, increasing the inertial component of cardiac load and, finally, causing CV death (Nichols & O’Rourke 2006). Thus, around birth, either a pronounced increase or decrease in wall‐material stiffness might have an impact on CV risk (Safar & Boudier 2005), and even alter coronary perfusion around birth and even in adulthood (Katz et al. 1997).…”

Section: Basis Of Vascular Development: Macrocirculation and The Recimentioning

confidence: 99%

Cross‐talk between macro‐ and microcirculation

Safar

Struijker‐Boudier

2010

Acta Physiologica

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Physiologically, macro- and microcirculation differ markedly as macrocirculation deals with pulsatile pressure and flow and microcirculation with steady pressure and flow. Various such haemodynamic aspects correspond to a large heterogeneity in the structure and function of the vascular tree. In the past, diseases such as hypertension and diabetes mellitus were classified on the basis of the structure and function of small and large arteries. The purpose of this paper is to review the cross-talk between the micro- and macrocirculation. We shall discuss this cross-talk from the perspective of the development, physiology and pathology of the entire arterial tree.

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The ankle-brachial index in normal neonates and infants is significantly lower than in older children and adults

Cited by 29 publications

References 7 publications

Measurement and Interpretation of the Ankle-Brachial Index

Measurement and Interpretation of the Ankle-Brachial Index

Ankle-Brachial Index, Toe-Brachial Index, and Pulse Volume Recording in Healthy Young Adults

Cross‐talk between macro‐ and microcirculation

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