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Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care. [ABSTRACT FROM AUTHOR]

Higher levels of hepatocyte growth factor (HGF) have been associated with the presence of peripheral arterial disease (PAD), but prospective associations are unknown. We examined the association of circulating HGF levels with incident PAD. Between 2000 and 2002, HGF was measured in 6742 Multi-Ethnic Study of Atherosclerosis participants without PAD. Incident clinical PAD, adjudicated on the basis of a positive history for the presence of disease-related symptoms or treatment, was ascertained through 2015. Incident low ankle-brachial index (ABI), defined as an ABI < 0.9 and a decline of ≥ 0.15, was assessed among 5736 individuals who had an ABI > 0.9 at baseline and ≥1 follow-up ABI measurement 3 to 10 years later. There were 116 clinical PAD and 197 low ABI events that occurred over a median follow-up of 14 and 9 years, respectively. After adjustment for demographic and clinical variables, a standard deviation increment of HGF (303 ng/L) was associated with an increased risk of clinical PAD (hazard ratio: 1.21; 95% confidence interval [CI]: 1.05-1.39) but not a low ABI (rate ratio: 1.03; 95% CI: 0.85-1.25). In conclusion, higher HGF levels were modestly associated with an increased risk of developing clinical PAD. [ABSTRACT FROM AUTHOR]

We evaluated the relationship between serum bilirubin levels and ankle-brachial index (ABI) to determine whether gender affected the relationship between bilirubin levels and peripheral arterial disease (PAD) in patients with hypertension. A total of 543 patients were included in our studies (78 patients with PAD and 465 without PAD). Peripheral arterial disease was defined as ABI <0.90 for either and/or both sides. Serum bilirubin levels were measured with a vanadate oxidation method by using fasting venous blood samples. Serum total bilirubin (TBiL) and direct bilirubin (DBiL) levels were higher in males compared with females (both P <.05). Total bilirubin and DBiL were significantly lower in the PAD group. After adjustment for cardiovascular risk factors, PAD was independently negatively related to TBiL and DBiL, with odds ratios (OR) 0.914 (95% confidence interval [CI]: 0.845-0.990) and 0.748 (95% CI: 0.572-0.977). In addition, there was a relationship between PAD and bilirubin levels (TBiL—OR = 0.884, 95% CI: 0.792-0.985; DBiL—OR = 0.621; 95% CI: 0.424-0.909) only in males but not in females. Future studies should further evaluate whether interventions that increase serum bilirubin levels will have a particular role in PAD prevention in males. [ABSTRACT FROM AUTHOR]

Surveillance of cardiovascular Events in Antiplatelet-treated arterioSclerosis Obliterans patients in JapaN (SEASON) is a 2-year, prospective, real-world, registry study conducted in Japan from 2009 to 2013. This post hoc analysis evaluated risk factors for limb ischemia in patients with peripheral arterial disease (PAD) and ankle–brachial index (ABI) <0.90. Vascular events were adjudicated by an Efficacy Endpoint Review Committee. Cox regression identified predictors of limb-specific peripheral vascular events (amputation, development of critical limb ischemia, and acute limb ischemia). Patients (n = 6565) were stratified according to ABI: normal (≥1.0; n = 1300), borderline (0.90 ≤ ABI ≤ 1.0; n = 776), and abnormal (<0.90; n = 4489). Compared to normal ABI, patients with ABI <0.90 had a significantly higher risk of any vascular event, all-cause death, and any limb-specific peripheral vascular event. Risk factors for limb-specific vascular events included history of lower extremity revascularization/amputation (adjusted hazard ratio: 2.18; 95% confidence interval [CI]: 1.49-3.20), chronic kidney disease (2.00; 1.33-3.00), diabetes (1.71; 1.16-2.52), and ABI <0.4 (4.45; 2.62-7.55) or <0.7 (1.78; 1.15-2.76). These findings from a Japanese real-world population confirm the increased vascular risk of patients with PAD and ABI <0.90 and identified risk factors for limb-specific peripheral vascular events. [ABSTRACT FROM AUTHOR]

Inflammation plays a pivotal role in peripheral artery disease (PAD). Cellular adhesion proteins mediate the interaction of leukocytes with endothelial cells during inflammation. To determine the association of cellular adhesion molecules with ankle–brachial index (ABI) and ABI category (≤1.0 vs >1.0) in a diverse population, 15 adhesion proteins were measured in the Multi-Ethnic Study of Atherosclerosis (MESA). To assess multivariable associations of each protein with ABI and ABI category, linear and logistic regression was used, respectively. Among 2364 participants, 23 presented with poorly compressible arteries (ABI > 1.4) and were excluded and 261 had ABI ≤ 1.0. Adjusting for traditional risk factors, elevated levels of soluble P-selectin, hepatocyte growth factor, and secretory leukocyte protease inhibitor were associated with lower ABI (P = .0004, .001, and .002, respectively). Per each standard deviation of protein, we found 26%, 20%, and 19% greater odds of lower ABI category (P = .001, .01, and .02, respectively). Further investigation into the adhesion pathway may shed new light on biological mechanisms implicated in PAD. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the association of the ankle-brachial index (ABI) and cardiovascular complications after noncardiac surgery. Methods: We prospectively evaluated patients referred for noncardiac surgery. The ABI was performed before surgery. Patients with abnormal ABI (≤0.9) were included in the peripheral artery disease (PAD) group and the remaining constituted the control group. Cardiac troponin and electrocardiogram were obtained 72 hours after surgery. Patients were followed up to 30 days, and primary end point was the occurrence of any cardiovascular event: cardiovascular death, acute coronary syndrome, isolated troponin elevation (ITE), decompensated heart failure, cardiogenic shock, unstable arrhythmias, nonfatal cardiac arrest, pulmonary edema, stroke, or PAD symptoms increase. Results: We evaluated 124 patients (61.3% male; mean age 65.4 years). During the study, 57.9% of patients in the PAD group had an event versus 25.7% in the control group (P = .011). The ITE was the most observed event (24.2%). After logistic regression, the odds ratio for ITE was 7.4 (95% confidence interval 2.2-25.0, P = .001). Conclusions: In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event. [ABSTRACT FROM AUTHOR]

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease. [ABSTRACT FROM PUBLISHER]

We determined the prevalence of peripheral arterial disease (PAD) and associated risk factors in an urban population age ≥30 years in Turkey and assessed the impact of incorporating ankle brachial index (ABI) measurement with coronary heart disease risk calculations to the risk reclassification of individuals. The sample was drawn from 4600 participants of Balcova Heart Study. The prevalence of low ABI (<0.9) was 6.3%. Current smoking (odds ratio [OR]: 5.07, 95% confidence interval [CI]: 1.85-13.88), cardiovascular disease history (OR: 6.83, 95% CI: 3.00-15.53), hypertension (OR: 2.58, 95% CI: 1.06-6.33), diabetes (OR: 3.25, 95% CI: 1.51-6.98), and high waist circumference (OR: 2.24, 95% CI: 1.02-4.94) were positively associated with prevalent PAD. When ABI measurement was taken into account, 3.5% of low or intermediate risk patients were reclassified as high risk. Screening individuals who have one of these risk factors with ABI can help reclassifying individuals toward the high-risk category. [ABSTRACT FROM PUBLISHER]

Peripheral artery disease (PAD) and heart failure (HF) share many risk factors; however, the prevalence and characteristics of HF in patients with PAD have not been fully examined. We investigated 120 consecutive patients with PAD, defined by an ankle-brachial index ≤0.9. In all, 36 (30%) patients had brain natriuretic peptide (BNP) levels ≥100 pg/mL (high BNP group), and 84 (70%) patients had BNP levels <100 pg/mL (low BNP group). Univariate analysis showed that high BNP was associated with age, estimated glomerular filtration rate, hypertension, and transmitral E-wave/early diastolic mitral annular velocity (E/e′) ratio. Multivariate logistic regression analysis established that a high BNP was strongly and independently associated with the highest quartile of E/e′, highlighting these patients’ diastolic dysfunction. The prevalence of high BNP levels in patients with PAD suggests that routine BNP measurements might be useful to detect HF. [ABSTRACT FROM PUBLISHER]

Most patients with peripheral arterial disease (PAD) are asymptomatic and have similar vascular morbidity and mortality with patients with symptomatic PAD. Despite being a very highly prevalent disease, physicians underdiagnose and undertreat PAD. A total of 100 participants with aortic valve sclerosis (AVS) and 100 participants without AVS and age-, gender-, and cardiovascular risk factor–matched participants were enrolled. Ankle–brachial index (ABI) and AVS were evaluated by handheld Doppler device and echocardiography, respectively. There was significantly lower ABI in participants with AVS compared with those without AVS (1.04 ± 0.14 v 1.11 ± 0.07, P = .001). There was a negative correlation between ABI and AVS (r = −.29, P < .001). Linear regression analysis demonstrated an independent association between ABI and AVS (95% confidence interval [CI]: −0.91 to −0.27, P < .001) and β-blocker use (95% CI: −0.96 to −0.02, P: .04). Our findings confirm an association between AVS and PAD that may be attributed to shared vascular risk factors. [ABSTRACT FROM PUBLISHER]

Ankle–brachial index (ABI) assessment by Doppler is operator dependent and limited in calcified arteries. For the detection of peripheral arterial disease (PAD), we evaluated ABI and toe–finger (ToFi) pressures by infrared (IR) sensors at the digits and compared with standard Doppler (Doppler-ABI) in 100 patients with PAD and in 15 controls. Pressure indices were obtained in 86% for Doppler-ABI, 82% for IR-ABI, and 94% for IR-ToFi (P < .01). According to Bland–Altmann analysis, IR-ABI and Doppler-ABI are exchangeable (limits of agreement [loa] −0.30; 0.30, bias −0.003, 95% confidence interval [CI] −0.02; 0.02), whereas IR-ToFi was not (loa −0.23; 0.61, bias of 0.2, 95% CI 0.16; 0.23). The IR-ToFi revealed the best inter- and intrarater agreement (0.92/0.98) followed by IR-ABI (0.74/0.98) and Doppler-ABI (0.66/0.89). Ankle–brachial arterial pressure index can be assessed by IR photosensors. Although toe–finger index is not exchangeable with standard Doppler, it will need further exploration to define its value for the diagnosis of PAD due to its excellent inter- and intrarater agreement. [ABSTRACT FROM PUBLISHER]

We present the midterm clinical outcomes and predictors of balloon angioplasty and stent placement in atherosclerotic femoropopliteal (FP) arterial disease. Between January 2002 and August 2006, 155 patients (men = 56%; 71.4 ± 10.5 years) underwent 171 FP angioplasty or stent for claudication (n = 82, 54%) or critical limb ischemia ([CLI] n = 70, 46%). Follow-up was obtained through September 30, 2009. The average follow-up was 3.25 ± 1.73 years. In claudicants versus CLI, the 12-month patency for TransAtlantic InterSociety Consensus II (TASC II) classification (TASC A/B) was 93% versus 80%, respectively, and TASC C/D 83% versus 80%. At 3 years, TASC A/B was 82% versus 80%, respectively, and TASC C/D was 56% versus 80%, respectively. The predictor of clinical failure in claudicants was chronic renal insufficiency (CRI) and in CLI, the predictor of amputation was hyperlipidemia. [ABSTRACT FROM AUTHOR]

We enrolled 1461 Taiwanese type 2 diabetic outpatients with ankle-brachial index (ABI) and toe-brachial index (TBI) examinations, excluding participants with history of stroke, end-stage renal disease, malignancy, acute myocardial infarction, amputation, and overt calcification of the lower limbs (ABI >1.3). Ankle-brachial index values <0.9 were found in 2.8% of the patients and 5.7% had TBI <0.6. Estimated glomerular filtration rate (eGFR; 90 ± 33 mL/min per 1.73 m2) obtained from 473 patients correlated significantly with both ABI and TBI. Progressive eGFR decline was observed in 419 participants with normal ABI and TBI, 35 with normal ABI but low TBI, and 19 with low ABI and normal or low TBI (P for trend <.001). After adjusting for confounding factors, age and eGFR were significantly associated with TBI and ABI. Low eGFR is associated with peripheral arterial disease in type 2 diabetes with mild to moderate renal insufficiency. [ABSTRACT FROM PUBLISHER]