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Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography
BACKGROUND: The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whet...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597112/ https://www.ncbi.nlm.nih.gov/pubmed/31247050 http://dx.doi.org/10.1371/journal.pone.0219082 |
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author | Stivalet, O. Paisant, A. Belabbas, D. Omarjee, L. Le Faucheur, A. Landreau, P. Garlantezec, R. Jaquinandi, V. Liedl, D. A. Wennberg, P. W. Mahé, G. |
author_facet | Stivalet, O. Paisant, A. Belabbas, D. Omarjee, L. Le Faucheur, A. Landreau, P. Garlantezec, R. Jaquinandi, V. Liedl, D. A. Wennberg, P. W. Mahé, G. |
author_sort | Stivalet, O. |
collection | PubMed |
description | BACKGROUND: The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whether or not defined criteria defined in patients suspected of having a PAD show a difference dependent on the resting ABI. METHODS: In this prospective study, consecutive patients with exertional limb pain referred to our vascular center were included. All patients had an ABI, a treadmill exercise-oximetry test, a second treadmill test (both 10% slope; 3.2km/h speed) with post-exercise pressures, and a computed-tomography-angiography (CTA). The receiver-operating-characteristic curve was used to define a cut-off point corresponding to the best area under the curve (AUC; [CI95%]) to detect arterial stenosis ≥50% as determined by the CTA. RESULTS: Sixty-three patients (61+/-11 years-old) were included. Similar AUCs from 0.72[0.63–0.79] to 0.83[0.75–0.89] were found for the different tests in the overall population. To detect arterial stenosis ≥50%, cut-off values of ABI, post-exercise ABI, post-exercise ABI decrease, post-exercise ankle pressure decrease, and distal delta from rest oxygen pressure (DROP) index were ≤0.91, ≤0.52, ≥43%, ≥20mmHg and ≤-15mmHg, respectively (p<0.01). In the subset of patients with an ABI >0.91, cut-off values of post-exercise ABI decrease (AUC = 0.67[0.53–0.78]), and DROP (AUC = 0.67[0.53–0.78]) were ≥18.5%, and ≤-15mmHg respectively (p<0.05). CONCLUSION: Resting ABI is as accurate as exercise testing in patients with exertional limb pain. Specific exercise testing cut-off values should be used in patients with normal ABI to diagnose PAD. |
format | Online Article Text |
id | pubmed-6597112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-65971122019-07-05 Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography Stivalet, O. Paisant, A. Belabbas, D. Omarjee, L. Le Faucheur, A. Landreau, P. Garlantezec, R. Jaquinandi, V. Liedl, D. A. Wennberg, P. W. Mahé, G. PLoS One Research Article BACKGROUND: The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whether or not defined criteria defined in patients suspected of having a PAD show a difference dependent on the resting ABI. METHODS: In this prospective study, consecutive patients with exertional limb pain referred to our vascular center were included. All patients had an ABI, a treadmill exercise-oximetry test, a second treadmill test (both 10% slope; 3.2km/h speed) with post-exercise pressures, and a computed-tomography-angiography (CTA). The receiver-operating-characteristic curve was used to define a cut-off point corresponding to the best area under the curve (AUC; [CI95%]) to detect arterial stenosis ≥50% as determined by the CTA. RESULTS: Sixty-three patients (61+/-11 years-old) were included. Similar AUCs from 0.72[0.63–0.79] to 0.83[0.75–0.89] were found for the different tests in the overall population. To detect arterial stenosis ≥50%, cut-off values of ABI, post-exercise ABI, post-exercise ABI decrease, post-exercise ankle pressure decrease, and distal delta from rest oxygen pressure (DROP) index were ≤0.91, ≤0.52, ≥43%, ≥20mmHg and ≤-15mmHg, respectively (p<0.01). In the subset of patients with an ABI >0.91, cut-off values of post-exercise ABI decrease (AUC = 0.67[0.53–0.78]), and DROP (AUC = 0.67[0.53–0.78]) were ≥18.5%, and ≤-15mmHg respectively (p<0.05). CONCLUSION: Resting ABI is as accurate as exercise testing in patients with exertional limb pain. Specific exercise testing cut-off values should be used in patients with normal ABI to diagnose PAD. Public Library of Science 2019-06-27 /pmc/articles/PMC6597112/ /pubmed/31247050 http://dx.doi.org/10.1371/journal.pone.0219082 Text en © 2019 Stivalet et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Stivalet, O. Paisant, A. Belabbas, D. Omarjee, L. Le Faucheur, A. Landreau, P. Garlantezec, R. Jaquinandi, V. Liedl, D. A. Wennberg, P. W. Mahé, G. Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title | Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title_full | Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title_fullStr | Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title_full_unstemmed | Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title_short | Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
title_sort | exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597112/ https://www.ncbi.nlm.nih.gov/pubmed/31247050 http://dx.doi.org/10.1371/journal.pone.0219082 |
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