Diagnostic accuracy of the postexercise ankle–brachial index for detecting peripheral artery disease in suspected claudicants with and without diabetes
Open accessAbstract
The postexercise ankle–brachial index (ABI) is recommended in patients with normal resting ABI when peripheral artery disease (PAD) is suspected. The aims of this study were to determine the comparative diagnostic accuracy of the resting and postexercise ABI for detecting PAD, and, the effect of the presence of diabetes on these. Three methods of interpretation currently in use were also investigated: a reduction in postexercise ABI by >20% compared to resting ABI, an ABI value of ≤0.90 postexercise, or a reduction in systolic ankle pressure of >30 mmHg postexercise. This retrospective study used colour duplex ultrasound (CDU) as the reference standard. In 278 limbs (whole group), the resting ABI had an overall area under the curve (AUC) of 0.71, with the postexercise ABI yielding a similar diagnostic accuracy of AUC 0.72. In the non-diabetes group ( n=171), the resting ABI had an overall AUC of 0.74 and the postexercise ABI had a similar AUC of 0.76. In the diabetes group ( n=107), overall accuracy was reduced compared to the non-diabetes group, with the resting ABI having an overall AUC of 0.65 and the postexercise ABI yielding a similar accuracy with an AUC of 0.64. The overall diagnostic accuracy of the postexercise ABI for diagnosing PAD was not greatly improved compared to resting ABI. Given the lower overall diagnostic accuracy in the diabetes group, both the resting and the postexercise ABI results in diabetes populations should be interpreted with caution. There is a risk of undiagnosed disease if relying on these results alone to determine lower limb vascular status.
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The medical management of LEAD in patients with diabetes does not differ from that recommended for patients with ASCVD in general including SGLT2 inhibitors and GLP-1 RAs.
“The medical management of LEAD in patients with diabetes does not differ from that recommended for patients with ASCVD in general including SGLT2 inhibitors and GLP-1 RAs.747,757,764,765”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [764]
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Diretriz Brasileira de Cardiogeriatria – 2026
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- Authors
- Tehan, P. E., Barwick, A. L., Sebastian, M., & Chuter, V. H.
- Affiliations
- Hunter Medical Research Institute (AU)
- Southern Cross University (AU)
- John Hunter Hospital (AU)
- University of Newcastle Australia (AU)
- Corresponding author
- Tehan, Peta Ellen
- Venue
- Vascular Medicine
- Publisher
- SAGE Publications
- Published
- 2018-02-12
- Volume
- 23
- Issue
- 2
- Pages
- 116-125
- ISSN
- 1358-863X (ISSN-L)
- 1477-0377
- OpenAlex
- W2790333267
- Cited by
- 30
- References
- 30
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 2
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Vascular Medicine (publishedVersion)
- PubMed (publishedVersion)
- Cross Connect (Southern Cross University) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Hunter Medical Research Institute (G1600381)
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Keywords
- peripheral arterial disease, intermittent claudication, diabetes mellitus, diagnostic accuracy, ankle systolic pressure, duplex ultrasound
- MeSH terms
- Aged, Aged, 80 and over, Ankle, Blood Pressure, Brachial Artery, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Rest, Retrospective Studies, Lower Extremity, Ankle Brachial Index, Peripheral Arterial Disease
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