Simon A, Papoz L, Ponton-Sanchez A, et al. Feasibility and reliability of ankle arm blood pressure index in preventive medicine. Angiology, 51(6):463-71,2000.
Centre de Medecine Preventive Cardiovasculaire, CRI INSERM, Hopital Broussais, Paris, France.
Despite its potential usefulness for assessing preclinical atherosclerosis
and cardiovascular risk, the ankle/arm blood pressure index (AAI) has
not yet been the matter of study evaluating its feasibility and reliability
by nonspecialist doctors in a general population. This study was planned
for two steps. In step 1, the measurement of AAI, (ratio between Doppler
systolic pressure at the ankle for each lower limb and the highest value
of Doppler systolic pressure of the two upper limbs), should be performed
by 50 general practitioners (GPs), 50 social security center physicians,
and 50 occupational health physicians in 3,000 male smokers, 40 to 59
years, without clinical cardiovascular disease. In step 2, AAI measurement,
coupled with echography-Doppler of iliofemoral arteries, should be repeated
by a specialist in all subjects with decreased AAI (<0.90) and the
first two subjects with normal AAI recruited in step 1 by each nonspecialist.
The number of physicians and subjects participating in step 1 was lower
than planned (80 physicians and 962 subjects) with the greatest defect
for GPs (six physicians and 35 subjects) and the prevalence of decreased
AAI was low (28 subjects). AAI measurement was repeated in step 2 in
only 12 subjects with decreased AAI in step 1 and in 124 subjects with
normal AAI in step 1. Five of the six subjects with decreased AAI in
step 2 also had decreased AAI in step 1 and 123 of the 130 subjects with
normal AAI in step 2 also had normal AAI in step 1. As regards echographic
stenosis, decreased AAI had a sensitivity of 44% and a specificity of
98%. AAI seems more feasible for occupational health physicians and social
security center physicians and AAI is also reliable for nonspecialists
previously trained, but its predictive value as regards echographic stenosis
is poor in asymptomatic subjects, which may limit its usefulness for
detecting preclinical atherosclerosis.