Low ankle brachial index is associated with the magnitude of impaired walking endurance in patients with heart failure.
BACKGROUND
Measurement of the ankle brachial index (ABI) is a simple, noninvasive means of diagnosing peripheral arterial disease, and has been shown to be associated with mortality rate. Here, we examined the association between ABI and physical function in patients with heart failure (HF).


METHODS
The study population consisted of 524 admitted patients (67.2±13.9years, 343 males) with HF. Blood pressure and the ABI were determined by oscillometry. Prior to hospital discharge, ABI, 6-minute walking distance, walking velocity, handgrip strength, quadriceps isometric strength, and standing balance were determined. The 524 patients were divided according to ABI as follows: ABI≤0.90 (low ABI), ABI 0.91 to 0.99 (borderline ABI), and ABI 1.00 to 1.40 (normal ABI).


RESULTS
Lower ABI values were associated with shorter 6-minute walking distance (p trend=0.001), slower walking velocity (p trend=0.023), and poorer standing balance (p trend=0.048). There were no significant associations between ABI and handgrip strength or quadriceps isometric strength. After adjusting for potential confounders, patients with ABI≤0.90 had shorter 6-minute walking distance compared to those with ABI 1.00 to 1.40 (adjusted mean value: 344m vs. 395m, respectively, p<0.001). There were no significant differences in any of the other physical function parameters examined.


CONCLUSIONS
In patients with HF, low ABI is associated with the magnitude of impairment in walking endurance.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan.
Shinya
S
Tanaka
Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. Electronic address: k-kamiya@kitasato-u.ac.jp.
Kentaro
K
Kamiya
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
Takashi
T
Masuda
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Nobuaki
N
Hamazaki
Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Ryota
R
Matsuzawa
Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Kohei
K
Nozaki
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Emi
E
Maekawa
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Chiharu
C
Noda
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
Minako
M
Yamaoka-Tojo
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
Atsuhiko
A
Matsunaga
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Junya
J
Ako
D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D001795:Blood Pressure Determination / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D013223:Statistics as Topic; D000070857:Walk Test / Q000379:methods*
Ankle brachial index; Exercise testing; Heart failure; Peripheral arterial disease