Herráiz-Adillo Ángel, Soriano-Cano Alba, Martínez-Hortelano José Alberto, Garrido-Miguel Miriam, Mariana-Herráiz Julián Ángel, Martínez-Vizcaíno Vicente, Notario-Pacheco Blanca
a Department of Primary Care , Health Service of Castilla-La Mancha (SESCAM) , Tragacete , Spain.
b Health and Social Research Center , Universidad de Castilla-La Mancha , Cuenca , Spain.
Blood Press. 2018 Apr;27(2):112-119. doi: 10.1080/08037051.2017.1400903. Epub 2017 Nov 10.
Inter-arm systolic blood pressure differences (IASBPD) and inter-leg systolic blood pressure differences (ILSBPD) have arisen as potential tools to detect peripheral artery disease (PAD) and individuals at high cardiovascular risk. This study aims to evaluate the diagnostic accuracy of IASBPD and ILSBPD to detect PAD, and whether IASBPD or ILSBPD improves diagnostic accuracy of the oscillometric ankle-brachial index (ABI).
In this prospective study, eligible for inclusion were consecutive adults, with at least one of the following cardiovascular risk factors: diabetes, dyslipidemia, hypertension, smoking habit or age ≥65. IASBPD, ILSBPD and ankle-brachial index (ABI) were measured in all participants through four-limb simultaneous oscillometric measurements and compared with Doppler ABI (reference test, positive cut-off: ≤ 0.9).
Of 171 subjects included, PAD was confirmed in 23 and excluded in 148. Thirteen and 38 subjects had IASBPD and ILSBPD ≥10 mmHg, respectively. Pearson correlation with Doppler ABI of IASBPD and ILSBPD was 0.073 (P = .343) and -0.628 (P < .001), respectively. Diagnostic accuracy of an ILSBPD ≥10 mmHg to detect PAD was: sensitivity = 69.6% (95%CI = 48.6-90.5), specificity = 85.1% (79.1-91.2), diagnostic odds ratio (dOR) = 13.1 (4.8-35.5) and area under ROC curve (AUC) = 0.765 (0.616-0.915). IASBPD had an AUC = 0.532 (0.394-0.669), and oscillometric ABI had an AUC = 0.977 (0.950-1.000). The addition of ILSBPD to oscillometric ABI reduced dOR from 174.0 (38.3-789.9) to 34.4 (9.5-125.1). Similarly, the addition of IASBPD reduced dOR to 49.3 (14.6-167.0).
In a Primary Care population with ≥1 cardiovascular risk factors, ILSBPD showed acceptable diagnostic accuracy for PAD, whilst IASBPD accuracy was negligible. However, the combination of ILSBPD (or IASBPD) with oscillometric ABI did not improve the ability to detect PAD. Thus, oscillometer ABI seems to be preferable to detect PAD and individuals at high cardiovascular risk. ILSBPD could be uniquely recommended for the diagnosis of PAD when blood pressure measurements in upper limbs are not possible.
双臂收缩压差异（IASBPD）和双腿收缩压差异（ILSBPD）已成为检测外周动脉疾病（PAD）和心血管高风险个体的潜在工具。本研究旨在评估IASBPD和ILSBPD检测PAD的诊断准确性，以及IASBPD或ILSBPD是否能提高示波踝臂指数（ABI）的诊断准确性。
在这项前瞻性研究中，纳入的合格对象为连续的成年人，至少具有以下心血管危险因素之一：糖尿病、血脂异常、高血压、吸烟习惯或年龄≥65岁。通过四肢体同步示波测量法对所有参与者测量IASBPD、ILSBPD和踝臂指数（ABI），并与多普勒ABI（参考测试，阳性临界值：≤0.9）进行比较。
在纳入的171名受试者中，23名确诊为PAD，148名排除。分别有13名和38名受试者的IASBPD和ILSBPD≥10 mmHg。IASBPD和ILSBPD与多普勒ABI的Pearson相关性分别为0.073（P = 0.343）和 -0.628（P < 0.001）。ILSBPD≥10 mmHg检测PAD的诊断准确性为：敏感性 = 69.6%（95%CI = 48.6 - 90.5），特异性 = 85.1%（79.1 - 91.2），诊断比值比（dOR） = 13.1（4.8 - 35.5），ROC曲线下面积（AUC） = 0.765（0.616 - 0.915）。IASBPD的AUC = 0.532（0.394 - 0.669），示波ABI的AUC = 0.977（0.950 - 1.000）。将ILSBPD添加到示波ABI中可使dOR从174.0（38.3 - 789.9）降至34.4（9.5 - 125.1）。同样，添加IASBPD可使dOR降至49.3（14.6 - 167.0）。
在具有≥1种心血管危险因素的初级保健人群中，ILSBPD对PAD显示出可接受的诊断准确性，而IASBPD的准确性可忽略不计。然而，ILSBPD（或IASBPD）与示波ABI联合使用并不能提高检测PAD的能力。因此，示波ABI似乎更适合检测PAD和心血管高风险个体。当无法测量上肢血压时，ILSBPD可唯一推荐用于PAD的诊断。
