New Approach to Measuring the Ankle and Toe Brachial Indices as New Markers for Early Detection of Lower Extremity Peripheral Artery Disease

Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.

Lower Extremity Arterial Disease in Patients with Type 2 Diabetes: Prevalence and Associated Factors at the Libreville University Hospital Center

Introduction: Lower extremity arterial disease in diabetic patients has distinct characteristics. Objectives: To study the hospital frequency of lower extremity arterial disease and identify associated factors in diabetic patients at the Libreville University Hospital Center (CHUL). Materials and Methods: This was a cross-sectional study conducted from July 1, 2023, to January 31, 2024, in the endocrinology department of the CHUL. All patients with type 2 diabetes over the age of 18 admitted to this department, regardless of the reason for hospitalization, who provided informed consent, were included. Socio-demographic data and cardiovascular risk factors were recorded. Personal and family cardiovascular history and functional symptoms were investigated. The physical examination included measuring blood pressure, heart rate, and the ankle-brachial index in all patients. Results: A total of 219 patients were included, of whom 75 had lower extremity arterial disease, representing a prevalence of 34.24%. It was compensated in 28 cases (37.33%) and decompensated in 39 patients (52%). In eight cases (10.67%), there was critical chronic ischemia. Cardiovascular risk factors associated with diabetes were physical inactivity (89.5%), hypertension (55.25%), overweight (49.77%), obesity (22.84%), and smoking (10.04%). In multivariate analysis, only hypertension (OR = 2.09;95% CI: 1.05 - 4.17;p = 0.035) and LDL cholesterol (OR = 2.75;95% CI: 1.10 - 6.85;p = 0.03) were significantly associated with lower extremity arterial disease in diabetics at the University Hospital of Libreville. Conclusion: Lower extremity arterial disease is common in diabetic patients at the University Hospital of Libreville. It is often asymptomatic, thus requiring systematic screening.[-rId11-]

Ankle-brachial index as a predictor of all-cause and cardio- vascular disease mortality in 3733 Chinese patients with high cardiovascular risk

目的将在在高 CVD 风险的中国病人估计在所有原因和心血管的疾病(CVD ) 死亡和脚关节臂的索引(ABI ) 的 1 年风险之间的协会。完全，有高 CV 的 3733 个病人冒险的方法在基线有双边的 ABI 大小并且被跟随在上面为 1-1.5 年。病人们被划分到四个组：1 ) 冠的心疾病(CHD ) ；2 ) ischemic 击() ；3 ) 糖尿病 mellitus (DM ) ；4 ) 很高的风险组(VHR ) ，低 ABI 是被定义 < 0.9。3179 个病人全部的结果 A 被分析。低 ABI 的流行是 28.1% 。在 1 年，所有原因死亡是 8.7% ，和 27.6% 对 CVD 可归因；死亡由于 CV 事件是 4.8% 和 1.5% 。在调整另外的风险因素以后，低 ABI 的危险比率为所有原因死亡是 1.623 并且 2.304 为 CVD 死亡。在有或没有低 ABI 的病人类似，分别地在四 groups.Conclusion ABI 被发现是死亡的一个强壮、独立的预言者。有低 ABI 的病人有所有原因死亡和 CVD 死亡的实质地增加的风险。

Screening of Peripheral Artery Disease by Systematic Measurement of Ankle-Brachial Index among Diabetic Patients in Dakar

Introduction: The peripheral artery disease (PAD) is one of the chronic and frightening vascular complications of the diabetes whose tracking can be done by the Ankle-Brachial Index (ABI) measurement. We conducted in this context a study which consisted in measuring the ABI among hospitalized diabetic patients at Teaching Hospital of Pikine in Dakar, over 18 months’ duration. The aim was to determine the prevalence and evaluate factors correlated to the presence of the PAD. Patients and Method: This cross-sectional descriptive study interested the whole of diabetic patients hospitalized in Internal Medicine/Endocrinology Department, from January 2013 to June 2014. We carried out a complete clinical examination associated with ABI measurement by a Doppler probe for each included patient after having collected the clinical and paraclinical data. Results: Our population of study comprised 209 diabetic patients with a female predominance (126, 60.3%). The sex-ratio man/woman was 0.6. The median age of the population of study was 54 ± 2 years. In our series, 157 (75.1%) patients discovered their diabetes with the waning of an affection while the 52 (24.9%) other patients discovered their diabetes at the time of a systematic assessment. The PAD appeared by an intermittent claudication among 38 patients (18.2%). The ABI was normal for 126 patients (60.3%). The ABI was low for 51 patients (24.4%), unilateral in 3.8% of cases and bilateral in 20.6% of cases. The ABI was high among 32 patients (15.3%), unilateral in 7.2% of cases and bilateral in 8.1% of cases. The ABI extremes values were 0.11 and 2. In the population of study, 46 patients (22%) had a well-compensated PAD. The PAD was low compensated for 3 patients (1.4%) and severe for 2 patients (1%). The ABI was more frequent and significantly among women than men, with 32 cases (25.4%) against 19 (22.9%) cases (p = 0.021). The proportion of low ABI was more important among patients whose diabetes had evolved for more than 5 years (42.3% of cases) with a peak of frequency in the duration of 6 - 10 years (47.7% of cases). Conclusion: The PAD global prevalence among hospitalized diabetic patients appeared high with 24.4% patients presenting low ABI. Its early diagnosis among subjects at risk as for our study population allowed identifying asymptomatic subjects having another cardiovascular damage. Thus, the screening of obstructive arteriopathy of lower limb PAD by the measurement of ABI should be applied to all diabetic patients for a better assessment of atherosclerotic complication.

Importance of Ankle/Brachial Pressure Index in Saudi Patients with Coronary Artery Disease

Background: The ankle/brachial pressure index (ABPI) has been shown to be a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the importance of measuring ABPI in Saudi patients with coronary artery disease (CAD). METHODS: This is a hospital based cross-sectional study which was conducted on all Saudi patients who underwent coronary angiography without symptoms of peripheral arterial disease at King Fahd Hospital of the University, Al-Khobar Saudi Arabia. All patients underwent measurement of their ABPI. The study was carried out between December 2010 and November 2011. RESULTS: During the study period, two hundred and five patients were included. Fifty-nine (28.8%) patients were Group II (ABPI ≤ 0.90) and the rest was Group I (ABPI > 0.90). Significant correlation was also found between low ABPI and the extent of CAD (mean number of arteries involved in Group I was 1.78 ± 0.83 compared to 2.10 ± 0.736 in Group II p = 0.011). Nevertheless, the correlation between low ABPI, and the severity of presentation of CAD were also significant (Incidence of myocardial infarction with congestive heart failure was 0.5% in Group I compared to 12% in Group II p CONCLUSION: The ABPI is an important prognostic indicator for Saudi patients with CAD.

Risk factors and ankle brachial indexes in cerebral infarction combined with peripheral arterial disease

BACKGROUND: Ankle brachial index (ABI) is widely involved in researches and clinical application of peripheral vascular injury of patients with diabetes mellitus (DM); however, the application in cerebral infarction (CI) is rare. OBJECTIVE: To investigate the possible risk factor of cerebral infarction plus peripheral arterial disease (PAD), compare metabolic characteristics of patients who having CI plus PAD or only having CI, and understand the significance of ABI on screening and diagnosing CI plus PAD of lower limb. DESIGN: Contrast observation based on CI patients. SETTING: Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 124 CI patients were selected from Department of Neurology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region from July 2005 to April 2006, including 72 males and 52 females aged from 45 to 88 years. All patients met the diagnostic criteria of cerebrovascular disease established by National Academic Conference of Cerebrovascular Diseases in 1995 and determined as cerebral infarction with MRI or CT examination. All patients provided informed consent. There were 46 cases (37.2%) with CI plus PAD and 78 cases (62.8%) only with CI. METHODS: Blood pressure of bilateral ankles and upper extremities was measured at plain clinostatism with DINAMAP blood pressure monitor (GE Company). The ratio between average systolic pressure of lateral ankle and average systolic pressure of both upper extremities was regarded as ABI. The normal ABI was equal to or more than 0.9. If ABI < 0.9 occurred at one side, patients were diagnosed as PAD. On the second morning after hospitalization, blood was collected to measure fasting blood glucose (FBG), 2-hour postprandial blood glucose (PBG2h), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Among them, blood glucose, lipid and other biochemical markers were measured with enzyme chemistry assay and HbA1c was measured with HbA1c meter based on high liquid phase. Measurement data and enumeration data were compared with t test and Chi-square test, and multiple factors were dealt with Logistic regression analysis and multivariate linear regression analysis. MAIN OUTCOME MEASURES: Results of correlation between ABI and metabolic markers with multivariate linear regression analysis; risk factors of CI plus PAD with Logistic regression analysis; comparisons of metabolic markers between PAD and non-PAD patients. RESULTS: All 124 patients with acute CI were involved in the final analysis. ① Comparisons of metabolic markers: Levels of serum LDL-C and uric acid (UA) were higher of PAD patients than those of non-PAD patients (t =2.051 9, 3.339 1, P < 0.05); however, there were no significant differences among other metabolic markers (P > 0.05). ② Results of multivariate linear regression analysis: PBG2h, LDL-C and UA were obvious correlation with ABI of posterior tibial artery of lower limb and dorsal pedis artery (partial regression coefficient = -0.231 to -1.010, P < 0.05). ③ Risk factors of CI plus PAD with Logistic regression analysis: Age, smoking history, sum of CI focus (≥3) and LDL-C were independent risk factor of CI plus PAD (OR =1.524-5.422, P < 0.05-0.01). CONCLUSION: ① Levels of serum LDL-C and UA of patients with CI plus PAD are high. ② ABI of lower limbs is correlation with PBG2h, LDL-C and UA. In addition, measuring ABI is beneficial for early diagnosing PAD of lower limbs of patients who have poorly controlled blood glucose, abnormal lipid and poor renal function. ③ Age, LDL-C and sum of CI focus (≥3) are independent risk factors of CI plus PAD. It is of significance for screening non-PAD patients to evaluate risk degrees and prognosis and select therapeutic methods based on ABI measurement.

Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease

Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years;81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.

Effect of applying selenium fertilizer to improve soil and increase selenium level in food for prevention and treatment of Kaschin-Beck disease

For prevention and treatment of Kaschin-Beck disease by applying Se fertilizer to soil to increase Se up to normal level for the wheat grains is introduced in this paper. After use this measure the intake of Se by the residents in the exemplary area increased from 10.4μg to 33.6 μg per day in average. After supplementing Se to human body one year, there is no new patient found among 300 healthy children in the exemplary area but 4 patients found among 264 healthy children in the control area. It is shown that by applying Se fertilizer to KBD area is a effective way for preventing and cure this disease.

Study on correlation between humic acid and selenium in Kaschin-Beck disease areas

The relationship between humic acid and selenium content was studied in this research. The results of calculation showed that there is more humic acid and less selenium in Kaschin-Beck disease areas in China. Fulvic acid in soil could increase selenium level in plants. The chemical bonding between humic acid and selenium was observed with an I.R. spectroscope. It was remarkable for the changes of absorption peak and frequency in 1100-1000 cm-1, 900-700 cm-1.

Perturbations in Amino Acid Metabolism in Children with Kaschin-Beck Disease: A Study of Urinary Target Metabolomics

Kaschin-Beck disease (KBD) is an endemic and chronic osteoarthropathy characterized by pathological aspects including chondrocyte degeneration, necrosis, progressive loss of articular cartilage, and secondary degenerative osteoarthrosis of epiphyseal cartilage, epiphyseal plate cartilage, and articular cartilage, during puberty[1]. The main clinical symptoms are limb joint pain, thickening, deformation, limited movement, muscle atrophy, and in case of more severely affected patients, short fingers (toes), short limbs, and even short stature[1].

The roles of organic degradation products andselenium in the pathogenesis ofKaschin-Beck disease

An investigation on the organic degradation products and selenium in the pathogenesis of Kaschin-Beck disease was carried out. The results demonstrated that the organic degradation products existed in food and drinking water were the pathogens of the KBD; their leading pathological process of cells would be 'membrane injury' due to peroxide. As GSH-Px is a selenium contained enzyme, therefore insufficient selenium would be one of the most important conditions to cause KBD.

The epidemic characteristics of Kaschin-Beck disease (KBD) in different eco-environments

Epidemiological survey of 573 families, clinical examination of 2593 persons, and X-ray examination of 1136 persons (in 16 typical endemic villages) were conducted, based on the classification of endemiology for KBD disease areas, i.e, mountain type, loess plateau type, plateau type, and flatlands type. It was revealed that the KBD disease areas exhibited the regular pattern of corming-into-being, development and passing-away and the characteristics of growth and decline. Further, it was found clinically that the disease areas may be divided into 4 types, i.e., recent onset, developing, stable, and historical. This division is simple and easy, practical, scientific, and reliable and can be applied by medical personnel at different levels.

Redox potential E_H [Se(VI)/Se(IV)] of aqueous extractof soils from Yongshou Kaschin-Beck diseaseregion and the influence by humic acid

The relation between EH [Se(VI)/Se(IV)] and pH of soil aqueous extract in Kaschin-Beck disease region and the effects of natural redox agents, namely humic substances, MnO2 and Fe2+, on the redox property of the system were studied. The results indicated that both humic acid and Fe2+ could enhance the reducibility of Se(VI) and MnO2, a limited oxidizability for Se(IV). Fe2+ showed a weak reducibility only at low pH value. The reducibilities of three sulfur-containing compounds for Se(VI) were in following order:thioglycollic acid > L-cysteine > sulfide

Role of interaction between selenium and organic matters on causes of Kaschin-Beck disease

Influences of organic matters of soil and water on speciation and biological utilization of selenium are discussed. Humic acid is found to be the main pool of selenium in soil and affects the bio-availability of the element in soil-plant system. Fulvic acid from drinking water inhibits the absorption of selenium taken from diet. The relationship between high content of organic matters of water and selenium deficiency on the causes of KBD could be reflected in the limited synthesis of glutathione peroxidase, which is generally stimulated by fulvic acid from drinking water.

Study on the action and mechanism of humic acids in Kaschin-Beck disease

Humic acids, especially FA in fractions, contain more oxygen functional groups. In this experiment, on the basis of confirming the action of humic acids on KBD, what was studied is the biological effects of one of main oxygen functional groups, hydroxy group (-OH). The results indicate that inducing pathologic process of KBD, obviously decrease the GSH-Px activity and induce peroxidation membrane injury of tissue. The SOD activity increase in the tissues caused by oxygen functional groups showed that enhancing of free radical reaction should not be neglected.

A retrospective survey on the effect of Kaschin-Beck disease prophylaxis by a change of water sources

In order to provide further references for studing on the causes of Kaschin-Beck discase (KBD) and measuring for its prevention and treatment from a macroscopic view, we analyzed the natural growth and declineof KBD and the effects of selenium and humic acid on its occurrence from an epidemiologic angle. In this article through a retrospective survey on the spots of disease areas by comparison between a change in water sources and that without. It was proved that a change in water sources was an effective measure for the prevention of KBD occurrence, and the pathogenic factor of KBD was one (or several kinds) of organic compounds or active radicals related to water.

Humic acid and free radical in environment of Kaschin-Beck disease areas

The humic acid contents in drinking water and soil in Kaschin-Beck disease areas were found more than that of non-disease areas in this research. Changes of free radical concentration in drinking water were agreed with that of humic acid contents in drinking water of Kaschin-Beck disease areas. A positive correlation of free radical concentration and humic acid content in drinking water has been shown (r=0.913) . The structure of I. R. spectra of humic acid under ultraviolet light has been changed. Thus it indicated that free radical was resulted from benzoqiunonyl groups of humic acid in environment.

Research on organic matters in the drinking water of Kaschin-Beck disease area

Organic matters in drinking water of Kaschin-Beck disease areas were extracted. Then analyses and characterization were performed by means of multiply chemical and physical methods. The results did not show the obvious difference in the frame structure of humic substances and the structure of rmcromolecular compounds in the drinking water of disease and non-disease areas, but the difference in the contents of some micromolecular compounds and radicals. The investigation also includes the preliminary research on the photoreaction of drinking water from disease and non-disease areas and the accumulation of natural organic matter in the bone of tested animals.

Need for surveillance of concomitant peripheral artery disease in patients with coronary disease: results of the AGATHA survey in Malaysia

Background For patients with cardiovascular disease (CVD), co-existence of peripheral artery disease (PAD) predicts increased mortality, and such patients are also more likely to benefit from aggressive therapy. Surveillance of PAD is often neglected at health clinics. Our aim is to highlight the importance and ease of surveillance of PAD in patients with CVD. Objective To determine the prevalence of symptomatic and asymptomatic PAD in a Malaysian patient population with documented CVD. Methods and Results A total of 393 subjects with established CVD were recruited from three centres (85 women and 308 men), as part of a larger international (AGATHA) survey. PAD, determined by presence of claudicant symptoms on interview and/or abnormal ankle-brachial index (ABI) score of less than 0.9, was present in 21.4% of patients-of whom 64% were asymptomatic. Abnormal ABI is associated with higher systolic blood pressure and number of arterial beds affected. Conclusions Concomitant PAD is prevalent among CVD patients in Malaysia. ABI screening is simple and yields a high proportion of patients with extensive atherosclerosis who may require more aggressive atherosclerotic risk management.(J Geriatr Cardiol 2007;4:195-199.)

Association of Race and Change in Ankle-Brachial Index: The Atherosclerosis Risk in Communities (ARIC) Cohort

Objective: This study evaluates the association of self-reported race with change in ankle-brachial index (ABI) over time and modification of this association by paraoxonase gene (PON1, PON2 and PON3) single nucleotide polymorphisms (SNPs). Methods: This longitudinal study included 11,992 (N = 2952 Black, N = 9040 White) participants from the Atherosclerosis Risk in Communities (ARIC) cohort with PON genotyping. Mixed-effects models examined whether race was associated with change in ABI over time after adjustment for known peripheral artery disease (PAD) risk factors. Results: Change in ABI over time differed between Whites and Blacks (race-time interaction, p < 0.0001). Stratified analyses showed that ABI values were better in both Blacks and Whites who completed high school or more education compared to those who completed less education. None of the PON SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons. Conclusions: ABI differences by race were small and although statistically significant, may not be clinically significant. Change in ABI over time varies by race and may be modified by education. Results suggest that higher education may influence the lifestyle and behavioral choices contributing to better ABI in both Blacks and Whites. Further studies are needed to confirm this observation.