Ankle brachial index as a surrogate to vascular imaging in evaluation of peripheral artery disease in patients with type 2 diabetes

Ugwu, Ejiofor; Anyanwu, Anthony; Olamoyegun, Michael Adeyemi

doi:10.1186/s12872-020-01821-6

Cited by 15 publications

(20 citation statements)

References 22 publications

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“…In most studies an ABI <0·90 was defined as abnormal, followed by four studies that considered an ABI of <0·90 and >1·3–1·4 as PAD. Two studies investigated an ABI threshold of 0·9 and excluded patients with an ABI >1·3, 32 , 35 which is in line with current guidelines 2 , 50 in which patients with an ABI >1·3–1·4 should undergo alternative tests. In these two studies, 32 , 35 the ABI could accurately rule in PAD with a PLR of 8·72–17, but it failed to rule out PAD (NLR 0·24–0·84).…”

Section: Discussionmentioning

confidence: 86%

“…The diagnosis of DM was specifically noted in 3693 patients. Duration of DM was mentioned in 12 studies, 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 and ranged from 2 to 24 years. Eleven of the included studies described the application of multiple bedside tests per patient population, while twelve studies explored the diagnostic value of a singular bedside test, as shown in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

“… Ugwu et al. 35 2021 Nigeria Single-center cross-sectional cohort study N = 163 patients with diabetes (319 legs) with clinical suspicion of lower extremity PAD Mean age: 56 years Gender: 47% male Mean duration of DM was 8·6 years ABI < 0·9 DUS (PAD was defined as >50%) The severity of stenosis was graded as follows: (1) 50–75% = mild stenosis (2) 76–99% = moderate stenosis (3) complete occlusion = severe stenosis ABI (overall): Sens: 78·46% Spec: 91% PLR: 8·72 NLR: 0·24 ABI (moderate stenosis): Sens: 93% Spec: 91% PLR: 10·33 NLR: 0·08 ABI (mild stenosis): Sens: 54% Spec: 91% PLR: 6 NLR: 0·51 ABI (severe stenosis): Sens: 100% Spec: 91% PLR: 11·11 NLR: 0 Seven patients with ABI >1·3 were excluded. Unclear if study was prospective or retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies evaluated the ABI to diagnose PAD in patients prone to MAC. 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 In these studies, 10 different variables were investigated ( Table 4 shows an overview). In studies including patients with an ABI >1·3, the PLR ranged between 1·22 and 17, and the NLR ranged between 0 and 0·69 for an ABI with a threshold of <0·90.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

et al. 2022

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Section: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

et al. 2022

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“…It is the result of structural and functional vessel wall aberrations, resulting in limb ischemia and changes in pulse wave propagation, ultimately impacting the myocardium as well[ 85 ]. PAD is an independent risk factor for stroke, myocardial infarction and cardiovascular death, and the risk is even more apparent in diabetic patients[ 86 ]. In a study by Li et al [ 87 ] that was performed on 1647 patients with type 2 DM, low ABI (≤ 0.9) was independently associated with a high risk of all-cause and cardiovascular mortality.…”

Section: Ankle-brachial Indexmentioning

confidence: 99%

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

Piko¹,

Bevc²,

Ekart³

et al. 2021

WJD

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The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc. ) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

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Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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Ankle brachial index as a surrogate to vascular imaging in evaluation of peripheral artery disease in patients with type 2 diabetes

Cited by 15 publications

References 22 publications

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

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