Ankle-Brachial Index Testing at the Time of Stress Testing in Patients Without Known Atherosclerosis

作者：Narula Amar; Benenstein Ricardo J; Duan Daisy; Zagha David; Li Lilun; Choy Shan Alana; Konig**erg Matthew W; Lau Ginger; Phillips Lawrence M; Saric Muhamed; Vreeland Lisa; Reynolds Harmony R^*

来源：Clinical Cardiology, 2016, 39(1): 24-29.

DOI：10.1002/clc.22487

Background: Individuals referred for stress testing to identify coronary artery disease may have nonobstructive atherosclerosis, which is not detected by stress tests. Identification of increased risk despite a negative stress test could inform prevention efforts. Abnormal ankle-brachial index (ABI) is associated with increased cardiovascular risk.
Hypothesis: Routine ABI testing in the stress laboratory will identify unrecognized peripheral arterial disease in some patients.
Methods: Participants referred for stress testing without known history of atherosclerotic disease underwent ABI testing (n=451). Ankle-brachial index was assessed via simultaneous arm and leg pressure using standard measurement, automated blood-pressure cuffs at rest. Ankle-brachial index was measured after exercise in 296 patients and 30 healthy controls. Abnormal postexercise ABI was defined as a >20% drop in ABI or fall in ankle pressure by >30mm Hg.
Results: Overall, 2.0% of participants had resting ABI <= 0.90, 3.1% had ABI >= 1.40, and 5.5% had borderline ABI. No patient with abnormal or borderline ABI had an abnormal stress test. Participants who met peripheral arterial disease screening criteria (age >= 65 or 50-64 with diabetes or smoking) tended toward greater frequency of low ABI (2.9% vs 1.0%; P =0.06) and were more likely to have borderline ABI (0.91 to 0.99; 7.8% vs 2.9%; P = 0.006). Postexercise ABI was abnormal in 29.4% of patients and 30.0% of controls (P not significant).
Conclusions: Ankle-brachial index screening at rest just before stress testing detected low ABI in 2.0% of participants, all of whom had negative stress tests.

• 出版日期2016-1