Surrogates of Large Artery versus Small Artery Stiffness and Ankle-Brachial Index

 

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ABSTRACT

Peripheral artery tonometry (PAT) is a novel method for assessing arterial stiffness of small digital arteries. Pulse pressure can be regarded as a surrogate of large artery stiffness. When ankle-brachial index (ABI) is calculated using the higher of the two ankle systolic pressures as denominator (ABI-higher), leg perfusion can be reliably estimated. However, using the lower of the ankle pressures to calculate ABI (ABI-lower) identifies more patients with isolated peripheral arterial disease (PAD) in ankle arteries. We aimed to compare the ability of PAT, pulse pressure, and different calculations of ABI to detect atherosclerotic disease in lower extremities. We examined PAT, pulse pressure, and ABI in 66 cardiovascular risk subjects in whom borderline PAD (ABI 0.91 to 1.00) was diagnosed 4 years earlier. Using ABI-lower to diagnose PAD yielded 2-fold higher prevalence of PAD than using ABI-higher. Endothelial dysfunction was diagnosed in 15/66 subjects (23%). In a bivariate correlation analysis, pulse pressure was negatively correlated with ABI-higher (r = −0.347, p = 0.004) and with ABI-lower (r = −0.424, p < 0.001). PAT hyperemic response was not significantly correlated with either ABI-higher (r = −0.148, p = 0.24) or with ABI-lower (r = −0.208, p = 0.095). Measurement of ABI using the lower of the two ankle pressures is an efficient method to identify patients with clinical or subclinical atherosclerosis and worth performing on subjects with pulse pressure above 65 mm Hg. The usefulness of PAT measurement in detecting PAD is vague.

REFERENCES

• 1 Glasser S P, Arnett D K, McVeigh G E et al.. Vascular compliance and cardiovascular disease: a risk factor or a marker?.  Am J Hypertens. 1997;  10 (10 Pt 1) 1175-1189
  CrossrefPubMedGoogle Scholar
• 2 Hamburg N M, Benjamin E J. Assessment of endothelial function using digital pulse amplitude tonometry.  Trends Cardiovasc Med. 2009;  19 (1) 6-11
  CrossrefPubMedGoogle Scholar
• 3 Nohria A, Gerhard-Herman M, Creager M A, Hurley S, Mitra D, Ganz P. Role of nitric oxide in the regulation of digital pulse volume amplitude in humans.  J Appl Physiol. 2006;  101 (2) 545-548
  CrossrefPubMedGoogle Scholar
• 4 Norgren L, Hiatt W R, Dormandy J A et al.. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).  Eur J Vasc Endovasc Surg. 2007;  33 (Suppl 1) S1-S75
  CrossrefPubMedGoogle Scholar
• 5 Schröder F, Diehm N, Kareem S et al.. A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease.  J Vasc Surg. 2006;  44 (3) 531-536
  CrossrefPubMedGoogle Scholar
• 6 Espinola-Klein C, Rupprecht H J, Bickel C AtheroGene Investigators et al. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.  Circulation. 2008;  118 (9) 961-967
  CrossrefPubMedGoogle Scholar
• 7 Korhonen P, Aarnio P, Saaresranta T, Jaatinen P, Kantola I. Glucose homeostasis in hypertensive subjects.  Hypertension. 2008;  51 (4) 945-949
  CrossrefPubMedGoogle Scholar
• 8 Conroy R M, Pyörälä K, Fitzgerald A P et al.. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.  Eur Heart J. 2003;  24 (11) 987-1003
  CrossrefPubMedGoogle Scholar
• 9 Bonetti P O, Pumper G M, Higano S T, Holmes Jr D R, Kuvin J T, Lerman A. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia.  J Am Coll Cardiol. 2004;  44 (11) 2137-2141
  CrossrefPubMedGoogle Scholar
• 10 Franklin S S, Khan S A, Wong N D, Larson M G, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study.  Circulation. 1999;  100 (4) 354-360
  CrossrefPubMedGoogle Scholar
• 11 Glynn R J, Chae C U, Guralnik J M, Taylor J O, Hennekens C H. Pulse pressure and mortality in older people.  Arch Intern Med. 2000;  160 (18) 2765-2772
  CrossrefPubMedGoogle Scholar
• 12 Chae C U, Pfeffer M A, Glynn R J, Mitchell G F, Taylor J O, Hennekens C H. Increased pulse pressure and risk of heart failure in the elderly.  JAMA. 1999;  281 (7) 634-639
  CrossrefPubMedGoogle Scholar
• 13 Vaccarino V, Berger A K, Abramson J et al.. Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program.  Am J Cardiol. 2001;  88 (9) 980-986
  CrossrefPubMedGoogle Scholar
• 14 Nielsen W B, Lindenstrøm E, Vestbo J, Jensen G B. Is diastolic hypertension an independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly?.  Am J Hypertens. 1997;  10 (6) 634-639
  CrossrefPubMedGoogle Scholar
• 15 Domanski M J, Davis B R, Pfeffer M A, Kastantin M, Mitchell G F. Isolated systolic hypertension: prognostic information provided by pulse pressure.  Hypertension. 1999;  34 (3) 375-380
  CrossrefPubMedGoogle Scholar
• 16 Ferré R, Aragonès G, Plana N et al.. High-density lipoprotein cholesterol and apolipoprotein A1 levels strongly influence the reactivity of small peripheral arteries.  Atherosclerosis. 2011;  216 (1) 115-119
  CrossrefPubMedGoogle Scholar
• 17 Hamburg N M, Keyes M J, Larson M G et al.. Cross-sectional relations of digital vascular function to cardiovascular risk factors in the Framingham heart study.  Circulation. 2008;  117 (19) 2467-2474
  CrossrefPubMedGoogle Scholar
• 18 Korhonen P E, Syvänen K T, Vesalainen R K et al.. Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.  J Hypertens. 2009;  27 (10) 2036-2043
  CrossrefPubMedGoogle Scholar
• 19 Fowkes FGR, Murray G D, Butcher I et al.. Ankle brachial index collaboration. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.  JAMA. 2008;  300 (2) 197-208
  CrossrefPubMedGoogle Scholar

Päivi Korhonen M.D. Ph.D. 

Jokikatu 3

29200 Harjavalta, Finland

Email: paivi.e.korhonen@fimnet.fi