Diagnostic value of simultaneous brachial and ankle blood pressure measurements for the extent and severity of coronary artery disease as assessed by myocardial perfusion imaging

Abstract

Background: Although the simultaneous measurement of brachial and ankle blood pressure is a simple method of evaluating atherosclerosis, its diagnostic value for coronary artery disease (CAD) is undetermined. Methods and Results: To evaluate the diagnostic value of ankle-brachial pressure index (ABI) and brachial-to-ankle pulse wave velocity (baPWV), 334 consecutive patients with suspected CAD were evaluated. Patients with a previous myocardial infarction or coronary intervention were not included. The magnitude of myocardial ischemia was evaluated by myocardial perfusion imaging. Using a 20-segment model, the percent of ischemic segments to total segments was expressed as %myocardium ischemic. In patients with ≤1, 2 and ≥3 coronary risk factors, %myocardium ischemic was 2.7±0.4, 4.0±0.5, 7.9±0.8%, respectively (p<0.0001 for trend). Performing ABI with a cutoff of 1, the %myocardium ischemic was similar in patients with ≤1 or 2 risk factors. In patients with ≥3 coronary risk factors, however, an ABI <1 reflected greater %myocardium ischemic than an ABI ≥1 (10.1±1.3, 6.6±1.0%; p=0.03). No such additional value was observed with baPWV. Conclusions: The addition of simultaneous brachial and ankle blood pressure measurements will help further stratify patients with multiple risk factors. Although this approach is simple, it facilitates the identification of high-risk patients who require aggressive treatment because >10% myocardium ischemic is regarded as a scintigraphic indicator for coronary revascularization.