What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Diabetes with and without calcified lower limb arteries (n=76). Intervention: Diastolic ankle-brachial pressure index (ABI-d) vs. Systolic ankle-brachial pressure index (ABI-s). Primary outcome: Difference between ABI-s and ABI-d in patients with calcified leg arteries (Group A) (p=<0.001).

October 26, 2016Open Access

Diastolic versus systolic ankle-brachial pressure index using ultrasound imaging & automated oscillometric measurement in diabetic patients with calcified and non-calcified lower limb arteries

Q: What are the key findings of this study?

In diabetic patients with calcified lower limb arteries, the diastolic ankle-brachial index (1.07) was significantly lower than the falsely elevated systolic index (1.30, P<0.001).

Key Result

In diabetic patients with calcified lower limb arteries, the diastolic ankle-brachial index (1.07) was significantly lower than the falsely elevated systolic index (1.30, P<0.001).

Study Design

Type

Cross-Sectional (n=76)

Multicenter

Structured PICO

Does diastolic ABI provide a more reliable measure than systolic ABI in diabetic patients with calcified lower limb arteries?

Population

76 participants, including 51 asymptomatic diabetic patients with and without calcified lower limb arteries and 25 healthy volunteers, evaluated for the feasibility of using diastolic ankle-brachial index.

Exposure

Diastolic ankle-brachial pressure index (ABI-d) measurement using an automated oscillometric device

Comparator

Systolic ankle-brachial pressure index (ABI-s) measurement using the same automated oscillometric device

Outcome

Difference between ABI-s and ABI-d across the three groupssurrogate

Diastolic ABI may serve as a useful complementary measure to systolic ABI in diabetic patients with calcified lower limb arteries where systolic ABI is falsely elevated.

Main Result

Absolute Event Rate: 1.07% vs 1.3%

p-value: p=<0.001

Limitations

Lack of patients with supra-normal ABI or non-compressible vessels
Did not compare the automated boso ABI machine measurement to a mercury sphygmomanometer and continuous Doppler device
Relatively small sample size
Patients were chosen on the basis that none had any signs or symptoms of flow-limiting arterial disease

Abstract

BACKGROUND: Ankle-brachial pressure index-systolic (ABI-s) can be falsely elevated in the presence of calcified lower limb arteries in some diabetic patients and therefore loses its value in this cohort of patients. We aim at investigating the feasibility of using the diastolic (ABI-d) instead of ABI-s to calculate the ABI in diabetic patients with calcified limb arteries. METHODS: A total of 51 patients were chosen from the diabetic foot clinic. Twenty six of these patients had calcified leg arteries by Duplex scan (Group A) and 25 patients did not have calcifications in their leg arteries (Group B). Twenty five healthy volunteers were enrolled in the study for group C and they were matched with other participants from group B and A in age and sex. ABI measurement was performed using "boso ABI-system 100 machine". Systolic ABI (ABI-s) and diastolic ABI (ABI-d) were calculated based on bilateral brachial and ankle oscillometric pressures. ABI is considered normal when it is ≥0.9. Repeated measures ANOVA test was used to test for comparing mean scores for ABI-s and ABI-d across the three groups. Statistical significance is considered when P 0.05). CONCLUSIONS: ABI-d may be helpful and can be used as a complementary measure instead of ABI-s in falsely elevated ABI caused by partial incompressible vessel.

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