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Exercise testing in patients with a normal ABI and an abnormal lowest ABI.

EuroPRevent 2014  
Doctor Murray Matangi (EUD ID : 32405)
Kingston Heart Clinic
Cardiology Dept.
460 Princess Street
K7L 1C2 - Kingston Canada
Phone : +1 6135443242 - Fax : +1 6135464487
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
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Title : Exercise testing in patients with a normal ABI and an abnormal lowest ABI.
Topic : 01.11 - Vascular disease (Prevention & Epidemiology)
Category : Not Member of EACPR
Option : No Options
D. Armstrong1, D. Brouillard1, U. Jurt1, C. Tobin1, M. Matangi1 - (1) Kingston Heart Clinic, Kingston, Canada
Purpose. Of our PAD testing, 2,184 have normal ABIs bilaterally (0.90-1.30). In 246 (11.3%) of these normals the other "lowest ABI" is abnormal (<0.90). This occurs in 1 ankle (8.8%) or both ankles (2.5%). The "lowest ABI" is the ratio of the lowest ankle systolic pressure divided by the highest brachial systolic pressure. Post-exercise ABI measurements may be a method of detecting abnormal lower limb perfusion in this group. The purpose of this study is to compare 4 groups, see Table 1 for group definitions.
Methods. Our database was searched for patients who had undergone post-exercise measurement of ABI and fitted into one of the 4 groups. Patients were exercised for 5 minutes at 10 degrees and a speed of 2mph. The test was stopped for symptoms or when the 5 minutes was completed. The ankle pressures and highest brachial pressure were measured at rest and post-exercise. Five post-exercise measurements were recorded as quickly as possible. An abnormal ABI response to exercise was any fall to <0.90 in the first or second post-exercise measurement. ANOVA and Chi-squared analysis were used where appropriate.
Results. Group 1 comprised 120 patients and 11 had an abnormal response (9.2%). Group 2 comprised 172 patients and 75 had an abnormal response (43.6%). Group 3 comprised 12 patients and 9 had an abnormal response (75%), Group 4 comprised 61 patients and 50 had an abnormal response (82%), P<0.0001 using Chi-squared analysis.
Conclusions. Post-exercise ABIs should be performed in all patients with normal resting ABIs (0.90-1.30) in both legs and either leg symptoms, femoral bruits or an abnormal lowest ABI, and in the case of the abnormal lowest ABI groups, even in the absence of leg symptoms or femoral bruits.
Table 1.
 

AbN/N (%)

Rest ABI

Ex1 ABI

Ex2 ABI

Ex3 ABI

Ex4 ABI

Ex5 ABI

P value

Gp1

11/109 (9.2%)

1.14±0.07

1.09±0.12

1.11±0.12

1.12±0.13

1.14±0.13

1.13±0.12

<0.0001

Gp2

75/97 (43.6%)

1.09±0.09

0.95±0.16

1.00±0.14

1.02±0.13

1.03±0.12

1.05±0.12

<0.0001

Gp3

9/3 (75%)

1.02±0.09

0.90±0.13

0.95±0.12

0.96±0.10

0.96±0.08

0.97±0.10

<0.0001

Gp4

50/11 (82%)

1.00±0.08

0.83±0.18

0.90±0.14

0.92±0.12

0.93±0.11

0.95±0.12

<0.0001

P value

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

<0.0001

 
Gp1= All 4 ABIs normal, no leg symptoms, no femoral bruits. Gp2 All 4 ABIs normal ± leg symptoms ± femoral bruits. Gp3 Normal ABI, abnormal lowest ABI, no symptoms, no femoral bruits. Gp4 Normal ABI abnormal lowest ABI ± symptoms ± femoral bruits.