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Ankle-brachial index in diabetic patients - which upper cut-off value is to be used?

M Homza, O Machaczka, M Porzer

    Bratislavske Lekarske Listy
    |January 29, 2019
    PubMed

    Insights

    For diabetic patients, using the lower ankle pressure (LAP) for ankle-brachial index (ABI) screening is preferred. An ABI upper limit of 1.4 is recommended for accurately detecting peripheral arterial disease (PAD).

    Area of Science:

    • Vascular Medicine
    • Diabetology
    • Diagnostic Imaging

    Background:

    • Guidelines for ankle-brachial index (ABI) screening for peripheral arterial disease (PAD) in diabetic patients lack consensus.
    • Discrepancies exist regarding the upper limit of normal ABI (1.3 vs. 1.4) and the preferred ankle pressure measurement (higher vs. lower).

    Purpose of the Study:

    • To evaluate the optimal method and cut-off values for ABI screening in diabetic patients to detect peripheral arterial disease (PAD).
    • To compare the efficacy of using higher ankle pressure (HAP) versus lower ankle pressure (LAP) in ABI calculations for PAD diagnosis.

    Main Methods:

    • Prospective study involving ABI measurements in 62 diabetic patients.
    • ABI results were compared with duplex ultrasound findings (stenosis ≥ 50% defined as PAD).
    • Analysis focused on discrepancies between HAP and LAP methods, and on patients with high or non-measurable ABI.

    Main Results:

    • Lower ankle pressure (LAP) ABI screening demonstrated higher sensitivity and negative predictive value for PAD in diabetics, particularly with an upper cut-off of 1.4.
    • An upper ABI cut-off of 1.4 showed excellent performance (93% sensitivity, 91% NPV), with no significant stenosis found between ABI 1.3 and 1.4.
    • Higher ankle pressure (HAP) identified additional PAD cases, and high or non-measurable ABI values were strongly associated with PAD.

    Conclusions:

    • Lower ankle pressure (LAP) is recommended for assessing low ABI (cut-off 0.9), while higher ankle pressure (HAP) is advised for detecting abnormally high ABI.
    • An upper ABI cut-off of 1.4 is preferable for PAD screening in diabetics.
    • Abnormally high or non-measurable ABI values should be considered indicative of PAD.
    Abstract

    Keywords:
    ankle-brachial indexdiabeteslower extremity arterial disease cut-off.peripheral arterial disease

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