Published online Dec 31, 2015.
https://doi.org/10.12997/jla.2015.4.2.109
New Diagnostic Criterion of Ankle Brachial Index for Peripheral Arterial Disease
Abstract
Background
The ankle brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral arterial disease (PAD). However the diagnostic criterion of 0.9 has shown variable accuracy for identification of stenosis. We investigated more specific and sensitive diagnostic criterion of ABI for the diagnosis of PAD.
Methods
Among 5,379 patients who performed ABI test, 398 patients with abnormal ABI results or PAD symptoms underwent computed tomography angiography to confirm PAD. Each ABI results were compared with its sensitivity, specificity, positive and negative predictive values. ROC analysis and cross-tabulation analysis were performed to yield proper ABI criterion.
Results
ABI of 0.9 showed very high level of sensitivity (92.2%) and very low specificity(59.3%). ABI of 0.84 showed high level of specificity (81.4%), sensitivity (82.2%) and diagnostic correspondent rate (0.607).
Conclusion
The ABI of 0.84 could be more accurate and useful diagnostic Criterion for identifying PAD.
Fig. 1
Receiver Operating Characteristic (ROC) curves for ABI for diagnosing peripheral vascular disease. The cutoff value of ABI was 0.84
Table 1
Characteristics of the patients
Table 2
Sensitivity, Specificity, Positive predictive value, Negative predictive value, Diagnostic Correspondent Rate of ABI 0.8 to 0.9
References
-
Attinger CE, Beckman J, Criqui M, Froelich JB, Giurini JM, Hamdan A, et al. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003;26:3333–3341.
-
-
Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, et al. 1999-2000 national health and nutrition examination survey. Prevalence of lower- extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care 2004;27:1591–1597.
-
-
Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation 2006;113:1474–1547.
-
-
Xu Dachun;Li Jue;Zou Liling;Xu Yawei;Hu Dayi;SL. Pagoto,et al. Sensitivity and specificity of the ankle--brachial index to diagnose peripheral artery disease: a structured review. Vasc Med 2010;15:361–369.
-
-
Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, et al. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2012;28 Suppl 1:218–224.
-
-
Criqui MH. Peripheral arterial disease--epidemiological aspects. Vasc Med 2001;6 Suppl:3–7.
-
-
Feigelson HS, Criqui MH, Fronek A, Langer RD, Molgaard CA. Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population. Am J Epidemiol 1994;140:526–534.
-
-
Ouriel K, McDonnell AE, Metz CE, Zarins CK. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery 1982;91:686–693.
-