Vascular Medicine Unit, CHU Rennes, Rennes, France.
Vascular Medicine, CH de Saint Malo, Saint-Malo, France.
PLoS One. 2019 Jun 27;14(6):e0219082. doi: 10.1371/journal.pone.0219082. eCollection 2019.
The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whether or not defined criteria defined in patients suspected of having a PAD show a difference dependent on the resting ABI.
In this prospective study, consecutive patients with exertional limb pain referred to our vascular center were included. All patients had an ABI, a treadmill exercise-oximetry test, a second treadmill test (both 10% slope; 3.2km/h speed) with post-exercise pressures, and a computed-tomography-angiography (CTA). The receiver-operating-characteristic curve was used to define a cut-off point corresponding to the best area under the curve (AUC; [CI95%]) to detect arterial stenosis ≥50% as determined by the CTA.
Sixty-three patients (61+/-11 years-old) were included. Similar AUCs from 0.72[0.63-0.79] to 0.83[0.75-0.89] were found for the different tests in the overall population. To detect arterial stenosis ≥50%, cut-off values of ABI, post-exercise ABI, post-exercise ABI decrease, post-exercise ankle pressure decrease, and distal delta from rest oxygen pressure (DROP) index were ≤0.91, ≤0.52, ≥43%, ≥20mmHg and ≤-15mmHg, respectively (p<0.01). In the subset of patients with an ABI >0.91, cut-off values of post-exercise ABI decrease (AUC = 0.67[0.53-0.78]), and DROP (AUC = 0.67[0.53-0.78]) were ≥18.5%, and ≤-15mmHg respectively (p<0.05).
Resting ABI is as accurate as exercise testing in patients with exertional limb pain. Specific exercise testing cut-off values should be used in patients with normal ABI to diagnose PAD.
运动试验的敏感性和特异性从未同时针对动脉狭窄的客观量化进行过研究。目的是定义几种运动试验检测外周动脉疾病（PAD）的敏感性和特异性，并评估在疑似患有 PAD 的患者中，根据静息ABI 定义的标准是否存在差异。
在这项前瞻性研究中，连续纳入因运动性肢体疼痛而就诊于我们血管中心的患者。所有患者均进行了 ABI、跑步机运动氧饱和度试验、第二次跑步机试验（均为 10%坡度；速度为 3.2km/h），并进行了运动后压力检查和计算机断层血管造影（CTA）。使用受试者工作特征曲线来定义与最佳曲线下面积（AUC；[95%CI]）相对应的截断点，以检测 CTA 确定的≥50%的动脉狭窄。
共纳入 63 例患者（61±11 岁）。在整个人群中，不同试验的 AUC 相似，从 0.72[0.63-0.79]到 0.83[0.75-0.89]。为了检测≥50%的动脉狭窄，ABI、运动后 ABI、运动后 ABI 下降、运动后踝部压力下降和远端与休息时氧压（DROP）差值的截断值分别为≤0.91、≤0.52、≥43%、≥20mmHg 和≤-15mmHg（p<0.01）。在 ABI>0.91 的患者亚组中，运动后 ABI 下降的截断值（AUC=0.67[0.53-0.78]）和 DROP（AUC=0.67[0.53-0.78]）分别为≥18.5%和≤-15mmHg（p<0.05）。
在有运动性肢体疼痛的患者中，静息 ABI 与运动试验一样准确。在 ABI 正常的患者中，应使用特定的运动试验截断值来诊断 PAD。
