Exercise-Ankle Brachial Pressure Index with One-Minute Treadmill Walking in Patients on Maintenance Hemodialysis

Tsuyuki, Kazuo; Kohno, Kenji; Ebine, Kunio; Tatsunori, Obara; Aoki, Toshiyuki; Muto, Atsushi; Ninomiya, Kenji; Kumagai, Kenta; Yokouchi, Itaru; Yazaki, Yoshio; Watanabe, Shinichi

doi:10.3400/avd.oa.12.00070

Cited by 14 publications

(16 citation statements)

References 8 publications

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“…When clinical decisions are made, the possibility of falsely elevated ABI, especially in patients with diabetes and operator dependent variation of the results should be taken in to consideration. ABI immediately after treadmill exercise has shown to be more sensitive than resting ABI, especially useful in patients who are on maintenance haemodialysis (17,18) and it could be a worthy experiment to replicate this finding using palpation method.…”

Section: No2 August 2015mentioning

confidence: 99%

Reliability of ankle-brachial pressure index measured by pulse palpation method in diagnosing peripheral arterial disease among patients with diabetes mellitus

Ranasinghe

Somasundaram

Wickramasinghe

et al. 2015

Sri Lanka J. Diabetes Endocrinol. Metab.

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Section: No2 August 2015mentioning

confidence: 99%

Reliability of ankle-brachial pressure index measured by pulse palpation method in diagnosing peripheral arterial disease among patients with diabetes mellitus

Ranasinghe

Somasundaram

Wickramasinghe

et al. 2015

Sri Lanka J. Diabetes Endocrinol. Metab.

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“…9) Walking was discontinued when one of the following conditions appeared: 1) horizontal or downsloping ST depression of 0.1 mV compared with the resting ST at 80 msec after the J point, 2) abnormal blood pressure responses (systolic pressure ≥250 mmHg and diastolic pressure ≥120 mmHg), 3) dangerous or potentially dangerous arrhythmias, 4) the maximum heart rate obtained using the equation "220 -age," 5) difficulty in walking due to lower limb pain, and 6) symptoms of the cardiopulmonary or neurological system. 9) The definition of PAD required a decrease more than 15% of the Ex-ABI. 3) CTA CTA was performed in all subjects within 1 week before or after the Ex-ABI measurements to confirm the stenotic lesion.…”

Section: Ex-abimentioning

confidence: 99%

“…However, the walking speed was reduced to 2.0 km/h when the patient was more than 70 years old or was a low left ventricular function case. 9) Walking was discontinued when one of the following conditions appeared: 1) horizontal or downsloping ST depression of 0.1 mV compared with the resting ST at 80 msec after the J point, 2) abnormal blood pressure responses (systolic pressure ≥250 mmHg and diastolic pressure ≥120 mmHg), 3) dangerous or potentially dangerous arrhythmias, 4) the maximum heart rate obtained using the equation "220 -age," 5) difficulty in walking due to lower limb pain, and 6) symptoms of the cardiopulmonary or neurological system. 9)…”

mentioning

confidence: 99%

Comparison of Diagnostic Accuracy between Pulse Volume Recording Parameters and Exercise-Ankle-Brachial Pressure Index in Patients with Ankle-Brachial Pressure Index above 0.91

Tsuyuki

Kohno

Asaoka

et al. 2016

Annals of Vascular Diseases

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Objective: The objective of this study was to clarify whether or not pulse volume recoding (PVR) parameters have screening capability equivalent to ankle-brachial pressure index after walking (Ex-ABI) for patients with 0.91 or higher ABI. Patients and Methods:The subjects were 87 patients (147 limbs) with symptoms of lower extremities with 0.91 or higher ABI. In all patients, upstroke time (UT), percentage of mean artery pressure (%MAP) of PVR and Ex-ABI were measured, and computed tomographic angiography (CTA) was concomitantly performed. Results: Area under the curve (AUC) of receiver operating characteristics (ROC) curves of Ex-ABI, %MAP, and UT were 0.90, 0.70, and 0.81, respectively. A significant difference was noted in AUC between Ex-ABI and %MAP (p <0.001). When the cut-off values were set at %MAP ≥45% and UT ≥180 msec, the accuracies of %MAP and UT were markedly lower than that of Ex-ABI. When the cut-off values were corrected to the values determined from the ROC curves (%MAP ≥41, UT ≥164 msec), the diagnostic accuracy of UT increased markedly. Conclusion: In patients with 0.91 or higher ABI, screening capability of PVR parameters was markedly lower than that of Ex-ABI, but UT has screening capability close to that of Ex-ABI when the cut-off value is corrected downward.Keywords: peripheral arterial disease, ankle-brachial pressure index, pulse volume recording IntroductionThe standard value of ankle-brachial pressure index (ABI) to detect peripheral artery disease (PAD) is 0.9 or lower, 1) but sticking to this value increases the probability of overlooking PAD showing boundary (0.91-1.0) and normal (1.1 or higher) values. 2) To prevent this overlooking, measurement of ABI immediately after walking (Ex-ABI) is recommended for patients with 0.91 or higher ABI. 3) However, although Ex-ABI is a superior method to detect the above PAD, it is not readily introduced into busy clinical sites because it requires an expensive exercise device, multiple manpower, and testing time. Solving these problems was tried by concomitant use of pulse volume recoding (PVR) for measurement of ABI in some studies. [4][5][6] Using oscillometric methods, PVR parameters can be measured simultaneously with ABI, being easy to introduce it into clinical sites. However, it is unclear whether or not these PVR parameters have screening capability equivalent to Ex-ABI. The objective of this study was to clarify whether or not these PVR parameters have screening capability equivalent to Ex-ABI for patients with 0.91 or higher ABI. The scanning range was planned with a scout view and included the entire vascular tree from the abdominal aorta to ankles. A total of 60-90 mL of contrast media (Proscope 300, Tokyo, Japan) was administered with an automated injector (KCA00226, Nemoto, Tokyo, Japan) at a flow rate of 2-3 mL/sec through a 20-G needle that was placed in a superficial vein. PAD is defined as the presence of stenosis of more than 75% in the case of lesion from an iliac artery to knee on CTA. Patients and Methods Patients Statistica...

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“…3) The ABI and TBI were obtained by dividing the arterial pressures of the ankle and the great toe, respectively, by the systolic brachial artery pressure on the arm without an arteriovenous fistula. According to the Guidelines of the TASC II 4) and the Japanese Society of Dialysis Therapy, 5) an ABI <0.9 and TBI <0.6 were used as the positive criteria.…”

Section: Abi and Tbimentioning

confidence: 99%

“…However, in terms of safety, the walking speed was reduced to 2.0 km/h in patients aged ≥70 years or showing decreased left ventricular function or decreased walking ability. 3) During the exercise TBI measurement, 12-lead ECG records were monitored using a cardiac assessment system for exercise testing (CASE 8000, Marquette Electronics). Walking was discontinued when one of the following symptoms appeared: 1) horizontal or downsloping ST depression of 0.1 mV compared with the resting ST at 80 m/sec after the J point; 2) abnormal blood pressure responses (systolic pressure ≥250 mmHg, diastolic pressure ≥120 mmHg); 3) dangerous or potentially dangerous arrhythmias; 4) the maximum heart rate obtained using the equation "220 -age"; 5) difficulty in walking due to lower limb pain, and 6) symptoms of the cardiopulmonary or neurological system.…”

Section: Exercise Tbi Measurementmentioning

confidence: 99%

Utility of Exercise-Induced Zero TBI Sign in Patients on Maintenance Hemodialysis

Tsuyuki

Kohno

Ebine

et al. 2016

Annals of Vascular Diseases

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This is a translation of J Jpn Coll Angiol 2015; 55: 125-129. It is uncertain whether exercise-induced zero toe brachial index sign (e-ZETS) is beneficial to prevent advanced perfusion disturbance in maintenance hemodialysis (HD) patients. In HD patients, we compared the clinical findings and prognoses among 22 toes in a resting zero toe brachial index sign (r-ZETS) group, 22 toes in an e-ZETS group, and 63 toes in a non-e-ZETS group. The hemodynamics of the lower extremities in the e-ZETS group is intermediate between the r-ZETS and non-e-ZETS groups. As the result of a 36-month followup observation, the r-ZETS avoidance rate was significantly lower in the e-ZETS group (63.6%; P <0.001) than the none-ZETS group (98.4%), showing that it was difficult to avoid advanced perfusion disturbance. The e-ZETS in HD patients may appear before r-ZETS, being beneficial as a predictor for advanced perfusion disturbance. (This is a translation of J Jpn Coll Angiol 2015; 55: 125-129.)Keyword: peripheral arterial disease, critical limb ischemia, hemodialysis, toe brachial pressure index, exercise posture and producing a driving force in walking. However, patients on maintenance hemodialysis (HD patients) sometimes undergo great toe amputation due to critical limb ischemia (CLI), resulting in a marked decrease in the activity of daily life. 1) CLI is often treated by revascularization, when revascularization is not indicated, perfusion disorders should be diagnosed as early as possible, and efforts should be made to prevent CLI. Since CLI is closely associated with a poor prognosis, even earlier diagnosis is required.As a diagnostic method for perfusion disorders at the toe level, the ratio of the toe to brachial blood pressure (toe brachial pressure index: TBI) is widely used. Matsui et al. 2) called the state not allowing TBI measurement "the zero TBI sign," and reported that this sign is a good parameter indicating severe perfusion disorders of the toe. This zero TBI sign (resting zero TBI sign: r-ZETS) represents a state in which the toe pressure is below 40 mmHg as the measurement threshold of automatic devices for blood pressure measurement. Findings such as ischemic resting pain, ulceration, or gangrene in addition to such a hemodynamic state lead to CLI. Therefore, r-ZETS is an important factor for the diagnosis of CLI, and measurement for its detection is indispensable.However, in terms of early diagnosis and treatment, measurement for r-ZETS detection is not performed at an appropriate timing. In daily clinical practice, regular TBI measurements are important for the early diagnosis of "the condition as the gateway to severe perfusion disorders including CLI." However, there is no clear TBI cut-off value indicating this condition.In HD patients, the complication rate of severe perfusion disorders is high, and CLI sometimes suddenly develops in the absence of intermittent claudication. Therefore, it is necessary to detect objective signs indicating the gateway to severe perfusion disorders including CLI and take act...

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Exercise-Ankle Brachial Pressure Index with One-Minute Treadmill Walking in Patients on Maintenance Hemodialysis

Cited by 14 publications

References 8 publications

Reliability of ankle-brachial pressure index measured by pulse palpation method in diagnosing peripheral arterial disease among patients with diabetes mellitus

Reliability of ankle-brachial pressure index measured by pulse palpation method in diagnosing peripheral arterial disease among patients with diabetes mellitus

Comparison of Diagnostic Accuracy between Pulse Volume Recording Parameters and Exercise-Ankle-Brachial Pressure Index in Patients with Ankle-Brachial Pressure Index above 0.91

Utility of Exercise-Induced Zero TBI Sign in Patients on Maintenance Hemodialysis

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