Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: an observational study

Abstract

Background Peripheral artery disease (PAD) in the lower extremities is a common complication of type 2 diabetes and has been shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but this method has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) in combination with the ABI would improve the prediction of mortality. Methods We retrospectively collected data from patients with type 2 diabetes who had undergone ABI and %MAP measurements at our hospital. We separated the cohort into four groups according to their ABI and %MAP values, and we examined whether these indices were associated with mortality. Results A total of 5569 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of the enrolled patients died. The combination of ABI and %MAP was significantly more effective than ABI alone for predicting mortality (C index of 0.62, 95% confidence interval [CI] of 0.57 to 0.65 vs. C index of 0.57, 95% CI of 0.53 to 0.62; P = 0.038). In multivariate analysis (with a reference group defined by ABI > 0.90 and %MAP ≤ 45%), the highest risk of mortality was seen in patients with ABI ≤ 0.90 and %MAP > 45% (hazard ratio = 2.045 [95% CI 1.420, 2.945], P < 0.001). Conclusions The use of %MAP alongside ABI appears to significantly improve the prediction of all-cause mortality in patients with type 2 diabetes.

Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

“…ROC results revealed that the combination of ABI and baPWV may improve risk classification in predicting all-cause and expanded CVD mortality in patients with T2DM. ABI and baPWV are simple, non-invasive, economical, and realistic measures that have become increasingly important in predicting mortality [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] . Most studies exploring the associations of ABI and/or baPWV with mortality in T2DM population [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] only considered ABI alone [28][29][30][31][32][33][34][35][36][37]…”

“…Only two works considered baPWV alone 43,44 , and another two simultaneously considered ABI and baPWV 45,46 . As a consequence, the findings on the association between ABI and mortality were inconsistent [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] . Significant associations were observed in some studies [28][29][30][31][32][33][34][35][36][37][38][39][40] but not in others 41,42 .…”

“…As a consequence, the findings on the association between ABI and mortality were inconsistent [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] . Significant associations were observed in some studies [28][29][30][31][32][33][34][35][36][37][38][39][40] but not in others 41,42 . Two prior studies conducted in patients with DM did not detect the predictive capacity of abnormal ABI for mortality, and these non-significant findings can be explained by their small sample sizes 41,42 .…”

A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study

“…Diabetic retinopathy was reported to be associated with eGFR variability and predictive of all-cause mortality in patients with type 2 DM [40,41]. Peripheral artery disease (PAD) was also reported to be associated with CKD [42], and a high-risk PAD is predictive of all-cause mortality in patients with type 2 DM [43]. Moreover, Zhang et al [44] verified that CKD was associated with a reduction in left ventricular function and strain based on cardiac magnetic resonance imaging in patients with type 2 DM.…”

Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

“… 29 There is a lack of investigation to assess the relationship between %MAP and glucose variability. Since a combination of low ABI and high %MAP carries a high mortality risk in patients with DM, 30 we hypothesized that glucose variability is associated with ABI and %MAP in patients with DM. Therefore, this screening study investigated whether glucose variability, as estimated by the standard deviation (SD) of annual fasting plasma glucose, is significantly associated with PAD, reflected by either high %MAP or low ABI, in patients with DM.…”