title: Prognostic value of low and high ankle-brachial index in hospitalized medical patients.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is frequently underdiagnosed in the clinical practice, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular (CV) death. The ankle-brachial pressure index (ABI) represents a noninvasive, objective tool to diagnose PAD and to predict adverse outcome.
  
  
  METHODS
  ABI was determined by means of Doppler velocimetry, in 707 patients, aged 50 years or older, consecutively hospitalized in an internal medicine ward, who were followed-up for at least 12 months in order to assess all-cause and CV mortality.
  
  
  RESULTS
  Symptomatic PAD affected 8% of the population while the prevalence of PAD, defined as ABI <0.90, was 29%; high ABI (>1.40) was found in 8% of the patients. After a mean follow-up period of 1.6 years, both low and high ABI were independently associated with CV mortality with a hazard ratio of 1.99 (p=0.016) for low and 2.13 (p=0.04) for high ABI, compared with normal ABI (0.90-1.40). High ABI also independently predicted all-cause mortality with a hazard ratio of 1.77 (p=0.04).
  
  
  CONCLUSIONS
  ABI measurement reveals a large number of individuals with asymptomatic PAD among those hospitalized in an internal medicine department. An increased mortality was observed in patients with both low and high ABI. Hospital admission for any reason may serve as an opportunity to detect PAD and start appropriate preventive actions.
authors.affiliation: Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy. lpasqua@unipg.it
authors.forename: Leonella
authors.initials: L
authors.lastname: Pasqualini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Matteo
authors.initials: M
authors.lastname: Pirro
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vaudo
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.forename: Renato
authors.initials: R
authors.lastname: Colella
authors.forename: Salvatore
authors.initials: S
authors.lastname: Innocente
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ciuffetti
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014463:Ultrasonography