title: Relationship between ankle brachial index and arterial remodeling in pseudoxanthoma elasticum.
abstract: OBJECTIVE
  Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and calcification in the cutaneous, ophthalmologic, and vascular tissues. Cardiovascular manifestations such as peripheral arterial disease (PAD) are frequent in PXE. Because of the changes in the elastic properties and medial calcification of the arterial wall in PXE, the impact of the arterial remodeling on the ankle brachial index (ABI), a well-established diagnostic method for the detection and follow-up of PAD, remains to be determined in this disease.
  
  
  METHODS
  This was a cross-sectional, comparative, open study, which took place at the PXE Consultation Center, University Hospital of Angers. The subjects were 53 patients (mean age, 49 ± 14 years; 35 females) with PXE clinically proven on the basis of established criteria (skin changes, angioid streaks, and skin biopsy). The ABI at rest, symptoms of intermittent claudication (IC), carotid intima-media thickness (IMT), carotid-femoral pulse wave velocity (c-f PWV), compliance (CC), and β stiffness index were measured in a single-center cohort.
  
  
  RESULTS
  Forty-five percent of the PXE patients had an ABI ≤0.90, but only one patient had an ABI >1.40. IC was found in 23% of the patients with an ABI ≤0.90. There were no significant differences between the patients with a low and normal ABI in terms of IMT (P = .566) or β stiffness index (P = .194), but differences were significant for c-f PWV (P = .010) and CC (P = .011). Adjusted multivariate linear regression for the Framingham-Laurier score showed that patients with a low ABI had less compliant carotid arteries (B = 0.318, P = .039).
  
  
  CONCLUSIONS
  PAD detected by a low ABI is very frequent in PXE, although with limited prevalence of symptomatic claudication. Unexpectedly, ABI was low in such calcifying PAD and associated with lower CC, independently of atherosclerosis risk factors. These findings demonstrate that PXE represents a unique monogenic model of PAD in which the specific arterial wall remodeling could change the diagnostic value of the ABI to detect PAD.
authors: University Hospital of Angers, PXE Consultation Centre, Angers, France. geleftheriotis@chu-angers.fr
authors: Georges
authors: G
authors: Lefthériotis
authors: Pierre
authors: P
authors: Abraham
authors: Yannick
authors: Y
authors: Le Corre
authors: Olivier
authors: O
authors: Le Saux
authors: Daniel
authors: D
authors: Henrion
authors: Pierre Henri
authors: PH
authors: Ducluzeau
authors: Fabrice
authors: F
authors: Prunier
authors: Ludovic
authors: L
authors: Martin
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D016009:Chi-Square Distribution; D003187:Compliance; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011561:Pseudoxanthoma Elasticum / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography