Department of Internal Medicine, Catholic University of Rome, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2018 May;22(10):3160-3165. doi: 10.26355/eurrev_201805_15076.
Most studies on atherosclerotic processes include peripheral arterial disease diagnosis only if patients report symptoms suggestive of peripheral arterial disease and/or an instrumental demonstration of lower limbs perfusion deficit is provided, rather than the sole presence of atherosclerotic lesions localized at lower limbs, this attitude leading to ignore early stages of the disease. To overcome these limitations, we have proposed a new ultrasonographic semiquantitative score to better identify all disease stages. The aim of this study is to compare ultrasonography versus ankle-brachial index in the association between peripheral arterial disease and cardiovascular risk factors.
This cross-sectional observational study included subjects undergoing lower limbs evaluation through ultrasonography and ankle-brachial index determination because of symptoms suggestive of peripheral arterial disease or presence of known cardiovascular risk factors. Associations between ultrasonography and ankle-brachial index with cardiovascular risk factors were assessed by first fitting logistic regression models and then comparing the respective areas under the Receiver Operating Characteristic and 95% confidence intervals.
The areas under the Receiver Operating Characteristic for each cardiovascular risk factors were consistently larger in magnitude for ultrasonography compared with ankle-brachial index, this comparison being statistically significant for age, male gender, smoking status, hypertension, diabetes mellitus and previous cardiovascular events.
Our study demonstrates that ultrasonography is a better method to screen peripheral arterial disease respect to ankle-brachial index in order to identify all disease stages. These findings are useful in particular when including peripheral arterial disease as organ damage marker in cardiovascular risk stratification.
大多数关于动脉粥样硬化过程的研究仅在患者报告提示周围动脉疾病的症状和/或提供下肢灌注不足的仪器证明时才包括周围动脉疾病的诊断，而不是仅存在下肢局部的动脉粥样硬化病变，这种态度导致忽视了疾病的早期阶段。为了克服这些限制，我们提出了一种新的超声半定量评分，以更好地识别所有疾病阶段。本研究的目的是比较超声与踝肱指数在周围动脉疾病与心血管危险因素之间的相关性。
这项横断面观察性研究纳入了因周围动脉疾病症状或已知心血管危险因素而接受下肢超声和踝肱指数检查的受试者。通过首先拟合逻辑回归模型，然后比较各自的接收者操作特征曲线下面积和 95%置信区间，评估超声与踝肱指数与心血管危险因素之间的相关性。
与踝肱指数相比，超声对每个心血管危险因素的接收者操作特征曲线下面积的幅度始终更大，这一比较在年龄、性别、吸烟状况、高血压、糖尿病和既往心血管事件方面具有统计学意义。
我们的研究表明，超声是一种比踝肱指数更好的方法来筛查周围动脉疾病，以识别所有疾病阶段。当将周围动脉疾病作为心血管风险分层中的器官损伤标志物纳入时，这些发现尤其有用。
