Ankle brachial index is equally predictive of exercise-induced limb ischemia in diabetic and non-diabetic patients with walking limitation

作者：Henni Samir; Ammi Myriam; Gourdier Anne Sophie; Besnier Louis; Signolet Isabelle; Colas Ribas Christophe; Picquet Jean; Abraham Pierre^*

来源：Journal of Diabetes and Its Complications, 2018, 32(7): 702-707.

DOI：10.1016/j.jdiacomp.2018.03.011

• Exercise
• Peripheral vascular disease
• Pain
• Transcutaneous oxygen pressure
• Ankle to brachial pressure index
• Diabetes mellitus

Background: In diabetic patients, arterial stiffness may impair compressibility of vessels and result in higher ankle to brachial index (ABI) than in non-diabetic subjects.
Methods: We studied 1972 non-diabetic and 601 diabetic patients, with suspected peripheral artery disease, Exercise transcutaneous oxygen pressure (Ex-tcpO2), expressed in DROP index (limb tcpO2 change minus chest tcpO2 change), is insensitive to arterial stiffness and can estimate exercise-induced regional blood flow impairment (RBFI). A minimal DROP <-15 mm Hg indicates the presence of RBFI (positive test). ABI was simplified to a category variable (ABIc) by rounding ABI to the closest first decimal.
Results: In the ABIc range 0.4 to 1.1 linear regression for mean DROP values were: y = 34 x - 53; (R-2 = 0.211) and y = 33 x - 52; (R-2 = 0.186) in diabetic and Non-diabetic patients, respectively. Both Db and non-D patients showed a high proportion of positive Ex-tcpO2 tests for ABIc in the normal range (ABIc: 1.0 and over) from 27.1 to up to 58%. More than half of patients with borderline ABI (ABIc = 0.9) had RBFI during exercise, it was 65.6% in diabetic and 58.5% non-diabetic patients.
Conclusions: Resting ABI was not a better predictor of exercise-induced RBFI in non-Db than in Diabetic patients. Our results highlights the interest of still measuring resting-ABI in diabetic patients to argue for the vascular origin of exertional limb pain, but also of performing exercise tests in patients with walking impairment.

• 出版日期2018-7