title: A Novel Index Using Ankle Hemodynamic Parameters to Assess the Severity of Peripheral Arterial Disease: A Pilot Study.
abstract: In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tanno
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Yodo
authors.initials: Y
authors.lastname: Gatate
authors.affiliation: Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Senbonmatsu
authors.affiliation: Department of Vascular Surgery Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sato
authors.affiliation: Department of Plastic and Reconstructive Surgery, Saitama Medical University, Saitama, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ichioka
authors.affiliation: Division of Anti-Aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuro-O
authors.affiliation: Department of Cardiology, Saitama Medical University, International Medical Center, Saitama, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D000842:Ankle / Q000503:physiopathology*; D055109:Ankle Brachial Index; D001794:Blood Pressure; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000150:complications; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D059289:Vascular Stiffness