Armstrong David W J, Tobin Colleen, Matangi Murray F
Department of General Internal Medicine, University of Toronto, Toronto, Canada.
The Kingston Heart Clinic, Kingston, Ontario, Canada.
Clin Cardiol. 2017 Nov;40(11):1163-1168. doi: 10.1002/clc.22808. Epub 2017 Nov 27.
The postexercise ankle-brachial index (ABI) is useful in patients with suspected peripheral arterial disease (PAD) and a normal resting ABI. Our objective was to determine the independent predictors of an abnormal postexercise ABI.
We hypothesized that the lowest ankle systolic pressure to calculate the resting ABI would be associated with an abnormal post-exercise ABI.
Among 619 consecutive patients referred for suspected PAD, we calculated the postexercise ABI in patients with a normal resting ABI. An ABI <0.90 at rest was considered abnormal. We investigated 3 definitions of an abnormal postexercise ABI, defined as either <0.90, or >5% or >20% reduction compared with rest.
Using multivariate analysis, the lowest ABI (calculated using the lowest and not the highest ankle systolic pressure) was consistently the most powerful independent predictor of an abnormal postexercise ABI. Patients with an abnormal lowest resting ABI were significantly more likely to have an abnormal postexercise ABI, as well as a significantly greater reduction in the ABI compared with rest. The lowest ABI had a high specificity (95%) but low sensitivity (82%) for a postexercise ABI <0.90.
An abnormal lowest ABI (calculated with the lowest ankle systolic pressure) is the most important independent predictor of an abnormal ABI response to exercise in patients with a conventionally normal ABI. All such patients should be exercised and their ABI measured postexercise.
运动后踝臂指数（ABI）对于疑似外周动脉疾病（PAD）且静息ABI正常的患者很有用。我们的目的是确定运动后ABI异常的独立预测因素。
我们假设用于计算静息ABI的最低踝部收缩压与运动后ABI异常有关。
在619例因疑似PAD而转诊的连续患者中，我们计算了静息ABI正常患者的运动后ABI。静息时ABI<0.90被认为异常。我们研究了运动后ABI异常的3种定义，定义为<0.90，或与静息相比降低>5%或>20%。
使用多变量分析，最低ABI（使用最低而非最高的踝部收缩压计算）始终是运动后ABI异常的最有力独立预测因素。最低静息ABI异常的患者运动后ABI异常的可能性显著更高，与静息相比ABI降低也显著更大。对于运动后ABI<0.90，最低ABI具有高特异性（95%）但低敏感性（82%）。
异常的最低ABI（用最低踝部收缩压计算）是传统上ABI正常的患者运动后ABI异常的最重要独立预测因素。所有此类患者都应进行运动并在运动后测量其ABI。
