Dataset Information

Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

ABSTRACT: BACKGROUND:The association between measures of arterial compliance and peripheral arterial disease (PAD) is unclear. Early changes in arterial wall compliance could be a useful marker of patients at high risk for developing lower extremity atherosclerosis. METHODS:We used linear and logistic regression models on baseline data from 2,803 female and 2,558 male participants in the Multi-Ethnic Study of Atherosclerosis (MESA) to study associations between tonometry-derived baseline measures of arterial compliance (large artery compliance (C1) and small artery compliance (C2)) and the baseline ankle-brachial index (ABI), as well as change in the ABI over ~3 years of follow-up. RESULTS:In cross-sectional analyses, lower C1 and C2 values, indicating poorer arterial compliance, were associated with lower ABI. There were significant linear trends across strata of ABI, especially in C2 which ranged from 3.7 ml/mm Hg × 100 (95% confidence interval (CI) 3.3-4.2) in women with an ABI < 0.90 to 4.2 ml/mm Hg × 100 (95% CI 4.1-4.3 P < 0.001) in women with ABI 1.10 - <1.40. Similar significant trends (P < 0.001) were seen in men. In prospective analyses, those with the lowest tertile of C2 values at baseline had a greater multivariable-adjusted odds for decline in ABI of ? 0.15 over 3 years compared to those with the highest C2 values at baseline (odds ratio (OR) 1.80, 95% CI 1.23-2.64). CONCLUSIONS:We observed that less compliant arteries were significantly associated with low ABI in cross-sectional analysis and with greater decline in odds of ABI over time.

SUBMITTER: Wilkins JT

PROVIDER: S-EPMC3748962 | biostudies-literature | 2012 May

REPOSITORIES: biostudies-literature

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Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

Wilkins John T JT McDermott Mary M MM Liu Kiang K Chan Cheeling C Criqui Michael H MH Lloyd-Jones Donald M DM

American journal of hypertension 20120223 5

<h4>Background</h4>The association between measures of arterial compliance and peripheral arterial disease (PAD) is unclear. Early changes in arterial wall compliance could be a useful marker of patients at high risk for developing lower extremity atherosclerosis.<h4>Methods</h4>We used linear and logistic regression models on baseline data from 2,803 female and 2,558 male participants in the Multi-Ethnic Study of Atherosclerosis (MESA) to study associations between tonometry-derived baseline me ...[more]

PMID: 22357412

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Project description:Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and calcification in the cutaneous, ophthalmologic, and vascular tissues. Cardiovascular manifestations such as peripheral arterial disease (PAD) are frequent in PXE. Because of the changes in the elastic properties and medial calcification of the arterial wall in PXE, the impact of the arterial remodeling on the ankle brachial index (ABI), a well-established diagnostic method for the detection and follow-up of PAD, remains to be determined in this disease.This was a cross-sectional, comparative, open study, which took place at the PXE Consultation Center, University Hospital of Angers. The subjects were 53 patients (mean age, 49 ± 14 years; 35 females) with PXE clinically proven on the basis of established criteria (skin changes, angioid streaks, and skin biopsy). The ABI at rest, symptoms of intermittent claudication (IC), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (c-f PWV), compliance (CC), and ? stiffness index were measured in a single-center cohort.Forty-five percent of the PXE patients had an ABI ?0.90, but only one patient had an ABI >1.40. IC was found in 23% of the patients with an ABI ?0.90. There were no significant differences between the patients with a low and normal ABI in terms of IMT (P = .566) or ? stiffness index (P = .194), but differences were significant for c-f PWV (P = .010) and CC (P = .011). Adjusted multivariate linear regression for the Framingham-Laurier score showed that patients with a low ABI had less compliant carotid arteries (B = 0.318, P = .039).PAD detected by a low ABI is very frequent in PXE, although with limited prevalence of symptomatic claudication. Unexpectedly, ABI was low in such calcifying PAD and associated with lower CC, independently of atherosclerosis risk factors. These findings demonstrate that PXE represents a unique monogenic model of PAD in which the specific arterial wall remodeling could change the diagnostic value of the ABI to detect PAD.

Project description:BackgroundNon-invasive clinic-based tools for assessing PAD are not without limitations. Therefore, costly tests like Doppler study, CT angiography and MR angiography are often required to make a diagnosis. Ankle brachial index (ABI), commonly used for assessment of PAD, has high false positivity rates in sclerosed, calcified arteries which render them non-compressible. Toe brachial index (TBI) can be an alternative, as digital arteries are relatively unaffected by these changes.AimTo compare the reliability of ABI and TBI in diagnosing PAD in type 2 diabetes using CT angiography (CTA) as the reference.Methods175 adults with T2D were selected. ABI &TBI were measured with an automated vascular Doppler XT 6 ports bilaterally for all subjects. For any subject, the limb with lower ABI and TBI was included for analysis. ABI < 0.9 & TBI < 0.6 were taken as evidence of PAD. CTA showing > 50% narrowing was taken as evidence of PAD.Results24% of our study subjects had CTA confirmed PAD. ABI has low sensitivity of 35.29% (95% CI 0.21-0.52) compared to TBI being 82.35% (95% CI 0.66-0.92). The specificity however was similar. ABI < 0.9 was able to detect CTA confirmed PAD, but ABI > 0.9, including the so-called normal ABI (0.9-1.3) was unable to detect PAD. ROC showed ABI at 1.005 has sensitivity 64.71% (95% CI 0.48- 0.79) and specificity 61.7% (95% CI 0.53-0.69) and TBI at 0.6 has sensitivity 82.35% (95% CI 0.66-0.92) & specificity 92% (95% CI 0.87-0.96). Utilizing Cohen's Kappa, the reliability of ABI with respect to CTA showed fair agreement (K = 0.225, p = 0.001), whereas the reliability of TBI with respect to CTA showed substantial agreement (K = 0.759, p < 0.0001).ConclusionABI < 0.9 detects PAD reliably, but presence of PAD in patients with ABI > 9.0 including the normal of ABI (0.9-1.3) can be confirmed with TBI, which correlated strongly with CTA. TBI is also non-inferior for PAD detection, when ABI < 0.9. TBI and not ABI can be utilized for initial assessment of PAD in subjects with T2D.

Dataset Information

Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

Publications

Associations of noninvasive measures of arterial compliance and ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis (MESA).

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