AUTHOR=Métairie Antoine , Tollenaere Quentin , Lanéelle Damien , Le Faucheur Alexis , Le Pabic Estelle , Omarjee Loukman , Mahé Guillaume 

TITLE=Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.941600

DOI=10.3389/fcvm.2022.941600

ISSN=2297-055X

ABSTRACT=Objectives: Ankle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesize to simplify ABI measurement by measuring only the pressure where the best arterial flow is recorded. The aim of this study is to evaluate the concordance between ABI performed according to American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI). Design: Monocentric cross-sectional study. Methods: We included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial flow was classified using the Saint-Bonnet classification. Concordances were analysed with the kappa coefficient (Confidence Interval 95%). Exercise PAD study was registered n° NCT03186391. Results: One hundred and eighty-eight patients (62+/-12 years and 26.8+/-4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI has an excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity. Conclusion: There is an almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into 5 pressure measurements instead of 7 in patient suspected of PAD with exertional limb symptoms. The question remains in chronic limb ischemia patients.