Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2...

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Autores principales: Olivier Stivalet, Anita Paisant, Dihia Belabbas, Alexis Le Faucheur, Philippe Landreau, Estelle Le Pabic, Loukman Omarjee, Guillaume Mahé
Formato: article
Lenguaje:EN
Publicado: Frontiers Media S.A. 2021
Materias:
peripheral artery disease (PAD)
exercise test
ankle brachial index (ABI)
transcutaneous oxygen pressure (TcPO2)
claudication
Diseases of the circulatory (Cardiovascular) system
RC666-701
Acceso en línea:https://doaj.org/article/8817f1d043ed4d08aa143fbee2601b29
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spelling oai:doaj.org-article:8817f1d043ed4d08aa143fbee2601b292021-11-17T05:20:26ZCombination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease2297-055X10.3389/fcvm.2021.759666https://doaj.org/article/8817f1d043ed4d08aa143fbee2601b292021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.759666/fullhttps://doaj.org/toc/2297-055XObjectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone.Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test.Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71–92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43–70]) or exercise-TcPO2 alone (sensitivity = 59% [45–72]).Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.Olivier StivaletAnita PaisantDihia BelabbasAlexis Le FaucheurPhilippe LandreauEstelle Le PabicLoukman OmarjeeLoukman OmarjeeGuillaume MahéGuillaume MahéGuillaume MahéGuillaume MahéFrontiers Media S.A.articleperipheral artery disease (PAD)exercise testankle brachial index (ABI)transcutaneous oxygen pressure (TcPO2)claudicationDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution DOAJ
collection DOAJ
language EN
topic peripheral artery disease (PAD)
exercise test
ankle brachial index (ABI)
transcutaneous oxygen pressure (TcPO2)
claudication
Diseases of the circulatory (Cardiovascular) system
RC666-701
spellingShingle peripheral artery disease (PAD)
exercise test
ankle brachial index (ABI)
transcutaneous oxygen pressure (TcPO2)
claudication
Diseases of the circulatory (Cardiovascular) system
RC666-701
Olivier Stivalet
Anita Paisant
Dihia Belabbas
Alexis Le Faucheur
Philippe Landreau
Estelle Le Pabic
Loukman Omarjee
Loukman Omarjee
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
description Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone.Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test.Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71–92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43–70]) or exercise-TcPO2 alone (sensitivity = 59% [45–72]).Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.
format article
author Olivier Stivalet
Anita Paisant
Dihia Belabbas
Alexis Le Faucheur
Philippe Landreau
Estelle Le Pabic
Loukman Omarjee
Loukman Omarjee
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
author_facet Olivier Stivalet
Anita Paisant
Dihia Belabbas
Alexis Le Faucheur
Philippe Landreau
Estelle Le Pabic
Loukman Omarjee
Loukman Omarjee
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
Guillaume Mahé
author_sort Olivier Stivalet
title Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
title_short Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
title_full Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
title_fullStr Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
title_full_unstemmed Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease
title_sort combination of exercise testing criteria to diagnose lower extremity peripheral artery disease
publisher Frontiers Media S.A.
publishDate 2021
url https://doaj.org/article/8817f1d043ed4d08aa143fbee2601b29
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