Toe-brachial index and exercise test can improve the exploration of peripheral artery disease

Kovács, D; Csiszar, Beata; Biró, Katalin T.; Koltai, Katalin; Endrei, D.; Juricskay, I.; Sandor, Barbara; Praksch, Dora; Tóth, Kálmán; Késmárky, Gábor

doi:10.1016/j.atherosclerosis.2018.01.023

Cited by 10 publications

(8 citation statements)

References 34 publications

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“…The difference in directional change in TP between our present study and Kovacs et al (2018) may have been associated with methodological differences between the studies (e.g. laser Doppler versus photoplethysmography for TP measurements) [ 10 ]. However, given the relatively small magnitude of change in both studies, it is unlikely to be of clinical significance, particularly given the relatively wide 95% limits of agreement reported for TP in numerous studies previously [ 22 , 23 ].…”

Section: Discussioncontrasting

confidence: 61%

“…All these changes were statistically significant. Recent research investigating the effect of 5 min of treadmill walking, or a 6 min walk test, in people with diagnosed PAD and a healthy control group, demonstrated increases in both ankle and toe pressures in those without PAD but an overall reduction in both ABI and TBI (mean drop 0.05 for both) ratios [ 10 ]. The current study demonstrated a reduction in TP post exercise, contrary to Kovacs et al (2018) who demonstrated an increase in TP post exercise.…”

Section: Discussionmentioning

confidence: 99%

“…Research investigating the effect of exercise on the TBI is limited. A single study has investigated the effect of five minutes of graded treadmill exercise or a six minute walk test on TP and TBI measures [ 10 ] in 120 people with PAD and a control population ( N = 30). Using laser-Doppler fluxmetry to measure TP, the study demonstrated in the diseased population a significant reduction in TP and TBI measures post exercise.…”

Section: Introductionmentioning

confidence: 99%

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How does a short period of exercise effect toe pressures and toe‐brachial indices? A cross‐sectional exploratory study

Tehan

Sadler

Chuter

2018

Journal of Foot and Ankle Research

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BackgroundWhilst post exercise ankle-brachial indices (ABI) are commonly used to help identify peripheral arterial disease (PAD), the role of post exercise toe pressures (TP) or toe-brachial indices (TBI) is unclear. The aim of this study was to determine, in a population without clinical signs of PAD, the effect that 30 s of weight-bearing heel raises has on TP and TBI values. Additionally, the ability of resting TP and TBI values to predict change in post-exercise values using the heel raise method was investigated.MethodsParticipants over the age of 18 with a resting TBI of ≥0.60 and ABI between 0.90 and 1.40, without diabetes, history of cardiovascular disease and not currently smoking were included. Following ten minutes of supine rest, right TP and bilateral brachial pressures were performed in a randomized order using automated devices. Participants then performed 30 s of weight-bearing heel raises, immediately after which supine vascular measures were repeated. Data were assessed for normality using the Shapiro-Wilk test. For change in TP and TBI values the Wilcoxon Signed-Rank Test was performed. For correlations between resting and change in post exercise values, the Spearman Rank Order Correlations were performed, and where significant correlation identified, a linear regression undertaken.ResultsForty-eight participants were included. A statistically significant decrease was seen in the median TP from resting 103.00 mmHg (IQR: 89.00 to 124.75) to post exercise 98.50 mmHg (IQR: 82.00 to 119.50), z = − 2.03, p = 0.04. This difference of 4.50 mmHg represents a 4.37% change and is considered a small effect size (r = 0.21). The median TBI also demonstrated a statistically significant decrease from resting 0.79 (IQR: 0.68 to 0.94) to post exercise 0.72 (IQR: 0.60 to 0.87), z = − 2.86, p = < 0.01. This difference of 0.07 represents an 8.86% change and is considered a small effect size (r = 0.29). Linear regression demonstrated that resting TBI predicted 22.4% of the variance in post exercise TBI, p = < 0.01, coefficients beta − 0.49.ConclusionsThirty seconds of weight-bearing heel raises resulted in a similar decrease in TBI values seen in longer periods of exercise. TP values also showed a decrease post exercise; however this was contrary to previous studies.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How does a short period of exercise effect toe pressures and toe‐brachial indices? A cross‐sectional exploratory study

Tehan

Sadler

Chuter

2018

Journal of Foot and Ankle Research

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“…Many mechanisms have been used to detect PAD and lower limb ischemia [3, 4]. Kovacs et al [5] reported that toe pressure and transcutaneous oximetry (TcPO 2 ) with exercise were used to detect PAD in 120 patients. The results indicated that the toe brachial index (TBI) with exercise provides a reliable receiver-operating characteristic (ROC) curve for PAD.…”

Section: Introductionmentioning

confidence: 99%

Laser Doppler blood flowmeter as a useful instrument for the early detection of lower extremity peripheral arterial disease in hemodialysis patients: an observational study

Ishii

Takabe²,

Yanagawa³

et al. 2019

BMC Nephrol

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BackgroundA simpler method for detecting atherosclerosis obliterans is required in the clinical setting. Laser Doppler flowmetry (LDF) is easy to perform and can accurately detect deterioration in skin perfusion. We performed LDF for hemodialysis patients to determine the correlations between blood flow in the lower limbs and peripheral arterial disease (PAD).MethodsThis retrospective study included 128 hemodialysis patients. Patients were categorized into the non-PAD group (n = 106) and PAD group (n = 22), 14 early stage PAD patients were included in the PAD group. We conducted LDF for the plantar area and dorsal area of the foot and examined skin perfusion pressure (SPP) during dialysis.ResultsSPP-Dorsal Area values were 82.1 ± 22.0 mmHg in the non-PAD, and 59.1 ± 20.3 mmHg in PAD group, respectively (p < 0.05). The LDF-Plantar blood flow (Qb) values were 32.7 ± 15.5 mL/min in non-PAD group and 21.5 ± 11.3 mL/min in PAD group (p < 0.001). A total of 21 non-PAD patients underwent LDF before and during dialysis. The LDF-Plantar-Qb values were 36.5 ± 17.6 mL/min before dialysis and 29.6 ± 17.7 mL/min after dialysis (p < 0.05). We adjusted SPP and LDF for PAD using logistic regression, SPP-Dorsal-Area and LDF-P were significantly correlated with PAD (p < 0.05). The receiver-operating characteristic curve analysis indicated cut-off values of 20.0 mL/min for LDF-Plantar-Qb during dialysis.ConclusionLDF is a simple technique for sensitive detection of early-stage PAD. This assessment will help physicians identify early-stage PAD, including Fontaine stage II in clinical practice, thereby allowing prompt treatment.

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“…The third included study, by Kovacs et al [32], showed significantly lower values for PAD patients compared with healthy controls (42 ± 15 versus 55 ± 9; p < 0.005). The authors measured Doppler ultrasound, TcPO 2 , and toe pressure at rest and after exercise in 120 patients with PAD and 30 healthy controls.…”

Section: Application Within Padmentioning

confidence: 90%

A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease

Kirsten

Kleiss

Schuurmann

et al. 2019

Expert Review of Medical Devices

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Toe-brachial index and exercise test can improve the exploration of peripheral artery disease

Cited by 10 publications

References 34 publications

How does a short period of exercise effect toe pressures and toe‐brachial indices? A cross‐sectional exploratory study

How does a short period of exercise effect toe pressures and toe‐brachial indices? A cross‐sectional exploratory study

Laser Doppler blood flowmeter as a useful instrument for the early detection of lower extremity peripheral arterial disease in hemodialysis patients: an observational study

A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease

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