Key result
Simultaneous post-exercise ABI and between-leg blood pressure differences identify EIAE in athletes with ~93% accuracy.
Why the study?
Rapid systemic pressure changes during recovery from exercise may affect the diagnostic performance of ABI in detecting exercise-induced arterial endofibrosis, and the benefit of simultaneous versus consecutive pressure measurements was unclear.
Does ABI calculated from simultaneous measurements improve diagnostic accuracy compared to consecutive measurements in detecting exercise-induced arterial endofibrosis in athletes?
Case-Control (n=84)
Does ABI calculated from simultaneous measurements improve diagnostic accuracy compared to consecutive measurements in detecting exercise-induced arterial endofibrosis in athletes?
Simultaneous pressure measurements for calculating ABI significantly improve diagnostic accuracy for detecting exercise-induced arterial endofibrosis in athletes compared to consecutive measurements.
Simultaneous postexercise ABI measurements may improve EIAE detection accuracy in athletes; leaves open need for prospective validation before changing practice.
PURPOSE: Exercise improves the diagnostic performance of ankle-to-brachial index (ABI) in the detection of exercise-induced arterial endofibrosis (EIAE). Pressure values for all four limbs are required to calculate ABI, but rapid systemic pressure changes occur during the recovery period from exercise. We checked whether after exercise, ABI calculated from simultaneous measurements was better than from consecutive measurements for differentiating athletes with EIAE from normal athletes. METHODS: We studied 42 normal athletes and 42 athletes suffering from unilateral pain caused by histologically proven EIAE. Bilateral brachial and ankle (ASBP) systolic blood pressure levels were simultaneously measured in the supine position at rest and every minute during the first 4 min of the recovery from incremental maximal exercise. Using receiver operating characteristics curves (ROC), we compared the diagnostic performance of single-leg ASBP and ABI values and between-leg ASBP (DeltaASBP) and ABI (DeltaABI) differences, calculated from simultaneous (simu) versus consecutive (cons) measurements, to discriminate athletes with EIAE from normal athletes. RESULTS: For single-leg postexercise values, ROC curve area was significantly higher for ABIsimu compared with ASBPsimu (P < 0.05, r = 0.91) and ASBPrand (P < 0.05, r = 0.68). Areas (+/- SE of area) of the ROC curves for postexercise Delta ASBPsimu and Delta ABIsimu were 0.97 +/- 0.01 and 0.97 +/- 0.02, respectively, and were higher than areas for postexercise Delta ASBP and Delta ABI calculated from consecutive and random measurements (P < 0.01). Accuracy for postexercise Delta ASBPsimu and Delta ABIsimu in discriminating EIAE from normal athletes was 93% [95% CI; 85-97], with a cutoff point of 22 mm Hg and 0.10, respectively. CONCLUSION: Delta ASBP and/or Delta ABI calculated from simultaneous pressure measurements should be recommended when searching for unilateral EIAE. Whether this result is applicable in the detection of early atherosclerotic lesions in sedentary subjects requires future investigation.
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Faucheur et al. (2006) conducted a case-control in Exercise-induced arterial endofibrosis (EIAE) (n=84). Simultaneous measurement of bilateral brachial and ankle systolic blood pressure and ABI vs. Consecutive measurements was evaluated on Discrimination of athletes with EIAE from normal athletes (Accuracy 93%, 95% CI 85-97, p=<0.01). Simultaneous measurement of postexercise between-leg systolic blood pressure and ABI differences accurately discriminated athletes with EIAE from normal athletes (accuracy 93%, 95% CI 85-97).
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