title: Discordant Diagnosis of Lower Extremity Peripheral Artery Disease Using American Heart Association Postexercise Guidelines.
abstract: To determine whether postexercise criteria for peripheral artery disease (PAD) diagnosis recommended by the American Heart Association (AHA) identifies the same group of PAD patients.Diagnosis of PAD is performed using ankle-brachial index at rest (resting-ABI). When resting-ABI is not contributive, an AHA scientific statement recommend to use 1 of 2 following criteria: a postexercise ABI decrease of greater than 20% or a postexercise ankle pressure decrease of greater than 30 mm Hg.Between 1996 and 2012, 31,663 consecutive patients underwent lower-extremity arterial study at Mayo Clinic. Among them, only unique patients who had exercise treadmill testing were analyzed. In this retrospective analysis, resting-ABI, postexercise ABI, and postexercise decrease of ankle pressure measured at 1-minute were measured in each patient. We conducted an analysis of agreement between postexercise criteria expressing the agreement separately for the positive and the negative ratings. Twelve thousand three hundred twelve consecutive patients were studied with a mean age of 67 ± 12 years, 61% male. According to resting-ABI, 4317 (35%) patients had PAD. In the whole population, if a clinician diagnoses "PAD" with 1 postexercise criterion, the probability that other clinicians would also diagnose "PAD" is 74.3%. If a clinician diagnoses "no PAD", the probability that other clinicians would also diagnose "no PAD" is 82.4%. In the patients to be of potential benefit from treadmill test when the resting-ABI > 0.90, if a clinician diagnoses "PAD" with 1 postexercise criterion, the probability that other clinicians would also diagnose "PAD" is 58.4% whereas if a clinician diagnoses "no PAD," the probability that other clinicians would also diagnose "no PAD" is 87.5%.Postexercise criteria do not identify the same group of PAD patients. In our opinion, postexercise criteria to define PAD deserve additional study.
authors.affiliation: From the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA (GM, AWP, DAL, KPC, CMC, TWR, PWW); and LUNAM University, Inserm 1083/CNRS 6214, Faculty of Medicine, Angers, France (GM); and INSERM Clinical Investigation Center CIC 1414, F-35043 Rennes, France (GM).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Mahe
authors.forename: Amy W
authors.initials: AW
authors.lastname: Pollak
authors.forename: David A
authors.initials: DA
authors.lastname: Liedl
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Cohoon
authors.forename: Charlene
authors.initials: C
authors.lastname: Mc Carter
authors.forename: Thom W
authors.initials: TW
authors.lastname: Rooke
authors.forename: Paul W
authors.initials: PW
authors.lastname: Wennberg
mesh_terms: D000368:Aged; D000572:American Heart Association; D055109:Ankle Brachial Index; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012146:Rest / Q000502:physiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States