title: Post-exercise ankle-brachial index is not an indispensable tool for the detection of peripheral arterial disease in an epidemiological survey. A post-hoc analysis of the Athens Study.
abstract: OBJECTIVE
  Previous studies have estimated the sensitivity, specificity and predictive value of non-invasive methods for the detection of peripheral arterial disease (PAD). The aim of our study was to evaluate the performance of non-invasive diagnostic tools and more specifically ankle-brachial index (ABI) at rest and after exercise for the detection of PAD in an epidemiological survey conducted in Greece.
  
  
  METHODS
  Overall, a representative sample of 2089 adults (911 men and 1178 women), 18-90 years old (mean age 46.88+14.98 years) living in the greater Athens area, participated in the study. For the detection of intermittent claudication, the Rose questionnaire (RQ) was used. Moreover, physical examination (PE) of the lower extremities was performed, ABI both at rest and after exercise was measured.
  
  
  RESULTS
  Thirty subjects were diagnosed with PAD, corresponding to a prevalence of 1.43%. Sensitivity and specificity of RQ, PE, ABI at rest and one minute after stress test were 53.33%, 66.67%, 100%, 64.71% and 98.79%, 97.77%, 99.81%, 94.94%, respectively. The combination of RQ with PE and ABI at rest yielded a 41.18% sensitivity, but a very high specificity (100%) and positive predictive value (100%).
  
  
  CONCLUSIONS
  ABI at rest detected PAD in the epidemiological setting, and its combination with RQ and PE attained a very high specificity. Intermittent claudication and physical examination, while easier to evaluate, were considerably less sensitive. Finally, inclusion of postexercise ABI did not increase sensitivity which leads to the conclusion that this diagnostic tool is not needed for the detection of PAD in large epidemiological surveys.
authors.affiliation: Fourth Department of Internal Medicine and Unit of Vascular Medicine, Evangelismos State General Hospital, Athens, Greece. vangouv@yahoo.gr
authors.forename: E
authors.initials: E
authors.lastname: Gouveri
authors.forename: N
authors.initials: N
authors.lastname: Papanas
authors.forename: G
authors.initials: G
authors.lastname: Marakomichelakis
authors.forename: C
authors.initials: C
authors.lastname: Tzavara
authors.forename: F
authors.initials: F
authors.lastname: Drakopanagiotakis
authors.forename: E
authors.initials: E
authors.lastname: Maltezos
authors.forename: E J
authors.initials: EJ
authors.lastname: Diamantopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D005080:Exercise Test; D005260:Female; D006115:Greece / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D010808:Physical Examination; D011237:Predictive Value of Tests; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult