The Effect of Post-Exercise Ankle-Brachial Index on Lower Extremity Revascularization

Hammad, Tarek A.; Strefling, Jason; Zellers, Paul; Reed, Grant W.; Venkatachalam, Sridhar; Lowry, Ashley M.; Gornik, Heather L.; Bartholomew, John R.; Blackstone, Eugene H.; Shishehbor, Mehdi H.

doi:10.1016/j.jcin.2015.04.021

Cited by 31 publications

(31 citation statements)

References 19 publications

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“…Recent studies highlight the clinical import of an abnormal exercise ABI with additive prognostic value for future limb revascularization and death compared with the resting ABI alone. 37, 38 Inadequate perfusion with exercise, which patients studied in the REACH registry, the incidence of the composite outcome (cardiovascular death/myocardial infarction/stroke/hospitalization) was highest in patients with PAD, and the presence of PAD in patients with cerebrovascular disease was associated with a doubling of the 1-year rate of stroke and myocardial infarction. 18 Thus, PAD is a key atherosclerotic marker, and its diagnosis and treatment may afford an opportunity to reduce the risk of a cardiovascular event.…”

Section: Reduced Limb Perfusion Caused By Arterial Obstructive Lesionsmentioning

confidence: 99%

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Hamburg

Creager

2017

Circ J

157

124

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estimates a more than 30% increase in deaths and disability attributable to PAD between 2005 and 2015, which is largely determined by population aging. 3,12 PAD prevalence escalates with advancing age, affecting 1 in 10 adults older than 70 years. In addition to age, smoking and diabetes are the strongest risk factors for PAD across the world. A comprehensive global evaluation of PAD found that its prevalence and risk factors are similar in high-income countries to low-and middle-income countries. 2,13 Lower socioeconomic status is a newly recognized risk factor for PAD. 14 Importantly, there has been a greater increase in PAD prevalence in low-and middle-income countries, rising by 28.7% from 2000 to 2010 as compared with 13.1% in high-income countries. 2, 15 The changing burden of PAD is also greater in women as compared with men.The health implications of PAD derive from both its limb and cardiovascular manifestations. Consistent with the systemic nature of atherosclerosis, polyvascular disease is common in patients with PAD. 16 In the REACH registry, 61% of PAD patients had concomitant coronary artery disease (CAD) and/or cerebrovascular disease. 16 Thus, the presence of PAD portends a high risk for subsequent cardiovascular events. A meta-analysis of over 48,000 participants in population-based cohort studies demonstrated that a low ankle-brachial index (ABI) predicted a 2-fold risk of death, cardiovascular death, and major coronary events at all ranges of the Framingham Risk Score. 4 Further, the elevated risk of cardiovascular events is present in both symptomatic and asymptomatic patients. 17 Patients with atherosclerotic disease in more than 1 vascular territory have particularly poor outcomes. 6 In the over 5,000 Japanese T here is growing recognition of the effect of peripheral artery disease (PAD) on cardiovascular health. 1 Recent studies indicate that, globally, over 200 million adults have PAD, 2,3 which is an expression of systemic atherosclerosis and well-established as heightening the risk for cardiovascular events. 4-6 The limb manifestations of PAD induce considerable suffering. Patients with PAD experience intermittent claudication, characterized as exertional leg pain that limits walking ability, and often times, disability. 7-9 Current medical therapies to reduce the burden of lower extremity symptoms in patients with PAD are limited. Revascularization by endovascular intervention or surgical reconstruction is used to treat lifestyle-limiting claudication if patients do not respond adequately to medical therapy including exercise training. Indeed, lower extremity revascularization with endovascular approaches has undergone a dramatic increase in use. 10 Though endovascular therapy improves blood flow and function, there are significant associated risks, and durability may be limited, especially in infrainguinal disease. Abundant evidence demonstrates the benefits of exercise therapy in claudication, yet the mechanisms underlying the beneficial effects remain incompletely defined. 11 Thus, ...

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Section: Reduced Limb Perfusion Caused By Arterial Obstructive Lesionsmentioning

confidence: 99%

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Hamburg

Creager

2017

Circ J

157

124

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“…The significance of ABI is well-documented in the literatures. [2][3][4][5][6] It is obtained by the higher value of either DP or PT pressure divided by the higher brachial pressure. 2 Using a similar concept, the PBI mea-…”

Section: Pbi and Abimentioning

confidence: 99%

“…It has been reviewed in multiple studies and correlated well with obstructive lesions and subsequent cardiovascular events. [2][3][4][5][6] The most recent American College of Cardiology and the American Heart Association guideline recommends resting or exercise ABI as a reproducible way to diagnose obstructive PAD. 5 A 2008 meta-analysis from 16 cohorts showed a reverse J-shaped association between ABI and cardiovascular mortality.…”

Section: Introductionmentioning

confidence: 99%

Functional hemodynamics assessment during endovascular Tibio‐pedal retrograde intervention of peripheral arterial disease

Kwan

Parikh

Patel

et al. 2019

Cathet Cardio Intervent

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Objective We sought to use a novel technique to measure the functional hemodynamics of peripheral arterial lesions during endovascular interventions. Background Functional hemodynamics has not been thoroughly evaluated during endovascular interventions. The aim of our study is to evaluate the feasibility and the potential benefits of pedal pressures measurements from tibio‐pedal access. Methods We retrospectively reviewed 100 consecutive patients who underwent endovascular interventions via tibio‐pedal artery access between October 3, 2018 and December 15, 2018. Baseline and postintervention pedal pressures from the pedal sheaths were measured. We also evaluated the pedal‐brachial index (PBI) which is defined as the pedal sheath pressure divided by the simultaneously brachial cuff pressure. We compared baseline pedal pressures, postintervention pedal pressures, baseline PBI, postintervention PBI, % change of PBI ([postintervention PBI minus baseline PBI]/baseline PBI), and resting ankle‐brachial index (ABI) versus baseline PBI in this cohort of patients. Results All 100 patients had successful tibio‐pedal artery access. Baseline pedal pressure was 70 + 30 mmHg with post intervention pedal pressure of 133 + 27 mmHg (p < .001). Baseline PBI was 0.75 + 0.24 with post intervention PBI of 1.09 + 0.19 (p < .001). The correlation coefficient of resting ABI vs. baseline PBI was 0.55. The % change of PBI was 63.2 + 52.4%. There was significant improvement of postintervention PBI when compared to baseline PBI in the majority of patients. Conclusions Obtaining pedal pressures and PBI from tibio‐pedal access can be a feasible tool for endovascular interventions. This simple technique can provide us important functional hemodynamics information before and after peripheral revascularization.

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“…The present observational study demonstrates that in a population referred to an outpatient cardiology facility with a normal resting ABI, the lowest resting ABI (calculated using the lowest ankle systolic pressure) was the most powerful predictor of an abnormal postexercise ABI. An abnormal lowest ABI was also associated with a greater reduction in the postexercise ABI, which previously has been shown to be an independent predictor of lower‐limb revascularization and adverse outcomes and provides additional prognostic information in patients referred for stress testing with suspected coronary disease …”

Section: Discussionmentioning

confidence: 75%

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

Armstrong

Tobin

Matangi

2017

Clinical Cardiology

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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.

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The Effect of Post-Exercise Ankle-Brachial Index on Lower Extremity Revascularization

Abstract: Post-exercise ABI appears to offer both clinical (lower extremity revascularization) and prognostic information in those with normal and abnormal resting ABI.

Cited by 31 publications

References 19 publications

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Pathophysiology of Intermittent Claudication in Peripheral Artery Disease

Functional hemodynamics assessment during endovascular Tibio‐pedal retrograde intervention of peripheral arterial disease

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

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