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15-07-2009 | Diabetes | Article

Oscillometric ABI measurement aids PAD diagnosis

Abstract

Free abstract

MedWire News: Oscillometric measurement of ankle–brachial pressure index (ABI) is an accurate and cost-effective tool for detecting peripheral arterial disease (PAD) in clinical practice, new research suggests.

The finding is reported by a French team who assessed the value and utility of involving nurses and clinical staff in screening for PAD. PAD is a frequent manifestation of atherosclerosis, especially in diabetes patients, and is associated with cardiovascular prognosis.

The researchers compared two methods for measuring ABI: Doppler, which is accurate but time-consuming and requires technical skill and a dedicated device; and automated oscillometry, which is commonly used for screening for hypertension and uses devices that are widely available and reliable.

The participants were 83 patients with diabetes and 63 without diabetes; all underwent ABI assessment of both legs using both Doppler and oscillometry.

Writing in Diabetes Care, Brigitte Escoubet (Institut National de la Santé et de la Recherche Médicale, Paris, France) and co-authors reveal that Doppler and oscillometry showed good agreement over a wide range of ABI values.

Using a Doppler value of 0.90 or less as the gold standard for PAD, oscillometry showed high diagnostic accuracy, with areas under the curve of receiver operating characteristic curves of 0.83 and 0.84 in diabetic and nondiabetic patients, respectively.

The oscillometry cutoff offering the greatest specificity and sensitivity was 1.02 overall, or 1.04 in diabetic and 1.00 in nondiabetic patients.

Escoubet’s team also evaluated the costs of PAD screening to the French medical system, finding that ABI measurement costs €66, €43, or €33 (US$ 93, 61, and 46, respectively), when delivered by a cardiologist, general practitioner, or nurse. By contrast, PAD diagnosed using vascular ultrasound cost €121 (US$ 170).

“Our study showed that oscillometric ABI measurement was feasible for clinical assistants using an automatic blood pressure monitoring device,” the authors conclude.

“This may be a low-cost and effective procedure to improve PAD management in at-risk patients, including subjects with diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Joanna Lyford