The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

Herráiz-Adillo, Ángel; Cavero‐Redondo, Iván; Álvarez‐Bueno, Celia; Pozuelo‐Carrascosa, Diana P.; Solera-Martínez, Montserrat

doi:10.1016/j.atherosclerosis.2020.09.026

Cited by 60 publications

(49 citation statements)

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“…The review points out that in a subgroup analysis of automated and Doppler ABI, similar diagnostic accuracy was found. In the meta-analysis, automatic ABI sensitivity and specificity against reference standard tests were 62% and 92%, respectively [ 50 ]. Another systematic review on general ABI reliability was published in 2019, and it reported three studies that used automatic measurements: one with a plethysmographic device, one with an oscillometric device, and one with ABI measured with Doppler probe and TBI measured by means of plethysmography.…”

Section: Discussionmentioning

confidence: 99%

Automated Measurements of Ankle-Brachial Index: A Narrative Review

Danieluk

Chlabicz

2021

JCM

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Peripheral artery disease (PAD) is an atherosclerotic disease that causes obstruction in lower limb arteries. It increases cardiovascular risk even in asymptomatic patients. Accurate diagnostic tools for identification of affected individuals are needed. Recently, there have been attempts to establish a reliable method of automated ankle-brachial index (ABI) identification. A search of PubMed database to identify studies assessing automatic ABI measurements in agreement with standard PAD diagnosis methods was conducted in December 2020. A total of 57 studies were analyzed in the review. The majority of analyzed studies found ABI measured by automatic oscillometric devices to be potentially feasible for use. Some note that, even though the Doppler and oscillometric methods are not fully interchangeable, the oscillometric devices could be used in screening. Significantly fewer publications are available on automatic plethysmographic devices. For photoplethysmography, most studies reported either good or moderate agreement with reference standards. For air plethysmography, poorer agreement with Doppler ABI is suggested. It is noted that pulse volume recording (PVR) function may improve the diagnostic accuracy of the devices.

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Section: Discussionmentioning

confidence: 99%

Automated Measurements of Ankle-Brachial Index: A Narrative Review

Danieluk

Chlabicz

2021

JCM

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“…Compared with ABI, TBI may be a better marker of atherosclerosis (24). In contrast to ABI, TBI is independent of medial artery calcification and has a linear correlation with PAD severity and poor prognosis (25,26). In this regard, TBI measurements presumably have more information than ABI for predicting poor prognosis (26).…”

Section: Discussionmentioning

confidence: 99%

Low Toe–Brachial Index Is Associated With Stroke Outcome Despite Normal Ankle–Brachial Index

Han

Lee

et al. 2021

Front. Neurol.

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Introduction: We investigated whether the toe–brachial index (TBI) is associated with stroke prognosis and evaluated this association in patients with normal ankle–brachial index (ABI).Methods: Acute ischemic stroke patients who underwent TBI measurements were enrolled. Poor functional outcome was defined as modified Rankin Scale score ≥3. Major adverse cardiovascular event (MACE) was defined as stroke recurrence, myocardial infarction, or death. Normal ABI was defined as 0.9 ≤ ABI ≤ 1.4.Results: A total of 1,697 patients were enrolled and followed up for a median 39.7 (interquartile range, 25.7–54.6) months. During the period, 305 patients suffered MACE (18.0%), including 171 (10.1%) stroke recurrences. TBI was associated with hypertension, diabetes, atrial fibrillation, aortic plaque score, ABI, and brachial–ankle pulse wave velocity (all p < 0.05). In multivariable logistic regression, TBI was inversely associated with poor functional outcome in all patients [odds ratio (OR) 0.294, 95% confidence interval (CI) 0.114–0.759], even in patients with normal ABI (OR 0.293, 95% CI 0.095–0.906). In multivariable Cox regression, TBI < 0.6 was associated with stroke recurrence [hazard ratio (HR) 1.651, 95% CI 1.135–2.400], all-cause mortality (HR 2.105, 95% CI 1.343–3.298), and MACE (HR 1.838, 95% CI 1.396–2.419) in all patients. TBI < 0.6 was also associated with stroke recurrence (HR 1.681, 95% CI 1.080–2.618), all-cause mortality (HR 2.075, 95% CI 1.180–3.651), and MACE (HR 1.619, 95% CI 1.149–2.281) in patients with normal ABI.Conclusions: Low TBI is independently associated with poor short- and long-term outcomes in acute ischemic stroke patients despite normal ABI.

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“…In summary, the findings by Herraiz-Adillo et al [1] suggest that TBI assessment is equally beneficial as ABI assessment. Unfortunately, TBI measurements are rarely reimbursed by the national health care systems at the level of general practitioner/family physicians.…”

mentioning

confidence: 89%

“…In this issue of Atherosclerosis [1], Herraiz-Adillo and colleagues revisit the diagnosis of PAD, investigating the accuracy of toe brachial index (TBI) and ankle brachial index (ABI) in the diagnosis by a systematic review and meta-analysis.…”

mentioning

confidence: 99%

“…TBI is helpful in patients were ABI measurements are imprecise (Mönckeberg's sclerosis), but in those patients the presence of LEAD is mostly overt or highly expected. In the publication of Herraiz-Adillo et al [1], the use of TBI would increase the sensitivity of LEAD diagnosis. Early detection of overt atherosclerosis would change the treatment algorithm for these peoplenow patients -including the use of platelet inhibition, angiotensin converting enzyme inhibitors and statins [2,3].…”

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confidence: 99%

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