Variation in measurement of ankle-brachial pressure index in routine clinical practice

Fisher, Charles; Burnett, Alison; Makeham, Virginia; Kidd, Jenifer; Glasson, Madeleine; Harris, John P.

doi:10.1016/s0741-5214(96)70025-3

Cited by 44 publications

(35 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, the difference between the 2 measures was similar to that seen when obtaining repeat ambulatory blood pressure 10 or performing the ABI. 11 Not surprisingly, Doppler ultrasound determination of the ABI and oscillometric-based ABI were quite similar, showing a strong association between the 2 methods. Other studies have evaluated oscillometry in the determination of the ABI.…”

Section: Discussionmentioning

confidence: 86%

Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

2006

View full text Add to dashboard Cite

Abstract-Peripheral arterial disease (PAD) remains underdiagnosed by primary care and cardiovascular physicians. The office-based assessment of PAD is limited by the need for specialized equipment and the time required for performance of the ankle-brachial index (ABI). We explored whether the accuracy of automated ABI measurement by oscillometry compared favorably with the gold-standard method using continuous-wave Doppler ultrasound. Consecutive patients referred to our university hospital noninvasive vascular laboratory for ABI measurement were invited for participation. Of 205 patients, 201 participated, including 55 with PAD. The ABI was measured by automated oscillometry and Doppler ultrasound. The test of trends revealed a correlation coefficient of 0.78 in the left leg and 0.78 in the right leg (PϽ0.01 for both). The mean ABI difference between methods was 0.04Ϯ0.01 and 0.06Ϯ0.01, respectively, in the left and right legs. The differences between the methods followed a normal distribution. Key Words: vascular diseases Ⅲ atherosclerosis P eripheral arterial disease (PAD) remains the least recognized and treated form of atherosclerosis. It is present in 5 to 12 million Americans 1,2 but is diagnosed in less than half of these patients. 3 The diagnosis of PAD has important prognostic implications and requires institution of therapeutic lifestyle changes and medical therapy to reduce cardiovascular morbidity and mortality. One important reason that the diagnosis of PAD is made infrequently is the lack of an easy-to-perform diagnostic test.The ankle-brachial index (ABI) is the ratio of the systolic pressure at the ankle compared with the brachial artery pressure. When the ABI is Յ0.9, a diagnosis of PAD is made with up to a 90% accuracy. 4 Measurement of the systolic pressure in both brachial arteries and pedal pulses is performed with a continuous-wave Doppler ultrasound. The greatest barrier to office-based ABI measurement is the time required for testing. 5 A test that is automated, easy to perform, and less reliant on specialized skills may facilitate measurement of the ABI, increasing the diagnosis of PAD in susceptible populations. Oscillometric (automated) determination of blood pressure is approved for blood pressure measurement and is commonly available, reliable, and simple to use. 6 Oscillometers measure the magnitude of the pressure vacillation in the limb as the cuff is deflated from suprasystolic pressures. As the pressure in the cuff decreases and approaches systolic blood pressure, oscillation rapidly increases and eventually reaches a peak after which decrease of the cuff pressure causes the oscillation to decrease. Systolic blood pressure is calculated when the oscillation increases rapidly and the diastolic pressure when the oscillation decreases rapidly. Accordingly, we compared the automated, oscillometric measurement of the ABI to the Doppler ultrasound measurement of the ABI to determine whether there is a simple, fast, and accurate method suitable for common use in the office. Methods Pa...

show abstract

Section: Discussionmentioning

confidence: 86%

Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

2006

View full text Add to dashboard Cite

show abstract

“…Second, there is no ABI cutpoint that is universally accepted as being the best predictor of cardiovascular events, although for screening purposes, it may be hypothesized that an ABI Յ0.9 is likely to be more sensitive in identifying asymptomatic atherosclerosis than a lower cutpoint. Finally, although change in ABI has been related to worsening peripheral arterial disease 7 or outcome after vascular operation, 8 its predictive value for subsequent vascular events has not been investigated in any detail.…”

Section: Discussionmentioning

confidence: 99%

“…Although quick and easy to perform with a high patient acceptability, the ABI was originally used to identify lower-limb atherosclerosis. How-ever, it has subsequently been shown to be an accurate 7,8 and reliable 9 marker of generalized atherosclerosis. Cohort studies with between 5 and 10 years of follow-up have shown that people with a low ABI have an increased risk of both cardiovascular morbidity 10 and mortality.…”

mentioning

confidence: 99%

Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

et al. 2004

View full text Add to dashboard Cite

Background-Prediction of major cardiovascular and cerebrovascular events using conventional risk factor models is limited. Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) could improve risk prediction and provide more focused primary prevention strategies. We wished to determine the added value of a low ABI in the prediction of long-term risk of cardiovascular and cerebrovascular events and death. Methods and Results-In 1988, 1592 men and women 55 to 74 years of age were randomly selected from the age-sex registers of 11 general practices in Edinburgh, Scotland, and followed up over a period of 12 years for incident events. After adjustment for age and sex, an ABI Յ0.9 was predictive of an increased risk of fatal myocardial infarction (MI), cardiovascular death, all-cause death, combined fatal and nonfatal MI, and total cardiovascular events. After further adjustment for prevalent cardiovascular disease, diabetes, and conventional risk factors, a low ABI was independently predictive of the risk of fatal MI. Addition of the ABI significantly (PՅ0.01) increased the predictive value of the model for fatal MI compared with a model containing risk factors alone. Comparison of areas under receiver operator characteristic curves confirmed that a model including the ABI discriminated marginally better than one without. Conclusions-Addition of the ABI significantly improved prediction of fatal MI over and above that of conventional risk factors. We recommend that the ABI be incorporated into routine cardiovascular screening and that the potential of its inclusion into cardiovascular scoring systems (with a view to improving their accuracy) now be examined.

show abstract

“…7,10 Information has been published about the variability of ABI measurements. [10][11][12][13][14][15][16][17][18][19][20][21][22] In general, in these studies, the variability is expressed as a percentage of the average observed ABI values ranging from 8% to 16%, whereas in absolute values the standard deviation of the difference of repeated ABI measurements was between ±0.10 and ±0. 15.…”

Section: Introductionmentioning

confidence: 99%

Interobserver variability of ankle–brachial index measurements at rest and post exercise in patients with intermittent claudication

2009

View full text Add to dashboard Cite

The ankle-brachial index (ABI) post exercise is claimed to play a complementary role in the diagnosis or exclusion of intermittent claudication (IC). The interobserver variability of ABI measurements at rest and post exercise in patients with typical symptoms of IC is the subject of this study with emphasis on ABI post exercise. ABI at rest and post exercise were measured in both legs of 20 patients with typical symptoms of IC. After 15 minutes of rest these measurements were repeated by another observer. Analysis according to Bland-Altman was performed on 40 paired leg measurements at rest and 40 paired leg measurements post exercise. The average ABI at rest for the first observer was 0.84 (standard deviation ±0.18) and for the second was 0.84 (±0.17). Post-exercise averages were 0.73 (±0.25) and 0.74 (±0.27), respectively. The standard deviation of the ABI difference between observers was 0.08 at rest and 0.15 post exercise. The interobserver variability of the ABI was 10% at rest and 21% post exercise. The interobserver variability post exercise is an important given when rules are defined about how the ABI post exercise translates into a more reliable and objective diagnosis of IC.

show abstract

Variation in measurement of ankle-brachial pressure index in routine clinical practice

Cited by 44 publications

References 11 publications

Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

Automated Oscillometric Determination of the Ankle–Brachial Index Provides Accuracy Necessary for Office Practice

Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors

Interobserver variability of ankle–brachial index measurements at rest and post exercise in patients with intermittent claudication

Contact Info

Product

Resources

About