title: Ankle-Brachial Index Testing at the Time of Stress Testing in Patients Without Known Atherosclerosis.
abstract: BACKGROUND
  Individuals referred for stress testing to identify coronary artery disease may have nonobstructive atherosclerosis, which is not detected by stress tests. Identification of increased risk despite a negative stress test could inform prevention efforts. Abnormal ankle-brachial index (ABI) is associated with increased cardiovascular risk.
  
  
  OBJECTIVE
  Routine ABI testing in the stress laboratory will identify unrecognized peripheral arterial disease in some patients.
  
  
  METHODS
  Participants referred for stress testing without known history of atherosclerotic disease underwent ABI testing (n = 451). Ankle-brachial index was assessed via simultaneous arm and leg pressure using standard measurement, automated blood-pressure cuffs at rest. Ankle-brachial index was measured after exercise in 296 patients and 30 healthy controls. Abnormal postexercise ABI was defined as a >20% drop in ABI or fall in ankle pressure by >30 mm Hg.
  
  
  RESULTS
  Overall, 2.0% of participants had resting ABI ≤0.90, 3.1% had ABI ≥1.40, and 5.5% had borderline ABI. No patient with abnormal or borderline ABI had an abnormal stress test. Participants who met peripheral arterial disease screening criteria (age ≥65 or 50-64 with diabetes or smoking) tended toward greater frequency of low ABI (2.9% vs 1.0%; P = 0.06) and were more likely to have borderline ABI (0.91 to 0.99; 7.8% vs 2.9%; P = 0.006). Postexercise ABI was abnormal in 29.4% of patients and 30.0% of controls (P not significant).
  
  
  CONCLUSIONS
  Ankle-brachial index screening at rest just before stress testing detected low ABI in 2.0% of participants, all of whom had negative stress tests.
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Amar
authors.initials: A
authors.lastname: Narula
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Benenstein
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Daisy
authors.initials: D
authors.lastname: Duan
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Zagha
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Lilun
authors.initials: L
authors.lastname: Li
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Alana
authors.initials: A
authors.lastname: Choy-Shan
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Konigsberg
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Ginger
authors.initials: G
authors.lastname: Lau
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Phillips
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Muhamed
authors.initials: M
authors.lastname: Saric
authors.forename: Lisa
authors.initials: L
authors.lastname: Vreeland
authors.affiliation: Division of Cardiology Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors