Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
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
_version_ 1783430552161878016
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
work_keys_str_mv AT stivaleto exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT paisanta exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT belabbasd exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT omarjeel exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT lefaucheura exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT landreaup exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT garlantezecr exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT jaquinandiv exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT liedlda exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT wennbergpw exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography
AT maheg exercisetestingcriteriatodiagnoselowerextremityperipheralarterydiseaseassessedbycomputedtomographyangiography