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[Ankle-brachial index: which clinical use?].

Luca Naldi1, Margherita Bernetti1, Francesca Baroni1

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Giornale Italiano Di Cardiologia (2006)
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The ankle-brachial index (ABI) is a gold standard for diagnosing peripheral arterial disease (PAD). Its utility as an independent cardiovascular risk marker is debated, with conflicting evidence on improving risk stratification and patient outcomes.

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Area of Science:

  • Vascular Medicine
  • Cardiovascular Disease Epidemiology

Context:

  • The ankle-brachial index (ABI) is the established diagnostic standard for peripheral arterial disease (PAD), with specific cut-off values for disease and critical limb ischemia.
  • Recent research suggests ABI may serve as an independent marker for cardiovascular (CV) risk, prompting investigation into its broader clinical utility.

Purpose:

  • To critically evaluate the role of the ankle-brachial index (ABI) in peripheral arterial disease (PAD) screening and diagnosis.
  • To assess the debated value of ABI as an independent early marker of cardiovascular (CV) risk, particularly coronary risk, by analyzing existing literature.

Summary:

  • The ankle-brachial index (ABI) is the gold standard for diagnosing peripheral arterial disease (PAD) (≤0.9) and critical limb ischemia (≤0.4).
  • While some studies indicate ABI enhances cardiovascular risk scoring, particularly for identifying high-risk asymptomatic individuals (≤0.9 or ≥1.4), others question its consistent improvement of risk prediction.
  • Concerns exist regarding whether optimizing therapy based on ABI leads to reduced CV events, with potential for side effects outweighing benefits.

Impact:

  • Clarifies the established role of ABI in PAD diagnosis.
  • Provides a balanced perspective on the controversial utility of ABI in cardiovascular risk assessment.
  • Informs clinical practice regarding the application of ABI beyond PAD diagnosis, considering its limitations and potential risks.