Siem A. Willems, Obrecht O. van Bennekom, Abbey Schepers, Jan van Schaik, Joost R. van der Vorst, Jaap F. Hamming, Jeroen J.W.M. Brouwers
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引用次数: 0
Abstract
Background
Detecting peripheral arterial disease (PAD) can be particularly challenging in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) due to medial arterial calcification (MAC). Current bedside tests, such as the ankle-brachial index, are less accurate in these patient groups. The primary aim of this study is to evaluate the diagnostic accuracy of point-of-care duplex ultrasound parameters maximal systolic acceleration (ACCmax) and acceleration time (AT) to detect PAD, including a comparison of both metrics.
Methods
Patients suspected of having PAD, who underwent point-of-care duplex ultrasound measurements (ACCmax and AT) of the posterior tibial artery (PTA) and/or anterior tibial artery (ATA) at ankle level along with computed tomography angiography were eligible for inclusion. PAD was defined as a stenosis >50% on computed tomography angiography. Diagnostic accuracy of AT was evaluated at calculated (Youden index) and prespecified cut-off values (121 ms), using the sensitivity, specificity, positive likelihood ratio, negative likelihood ratios, and area under the curve. The McNemar test compared ACCmax with AT at prespecified and calculated cut-off values. Subgroup analyses of patients prone to MAC (i.e., those with DM and/or CKD) were also performed.
Results
This study included 184 patients (267 legs) with a high prevalence of DM (53%) and CKD (36%). The diagnostic accuracy of AT to identify PAD for PTA showed a sensitivity of 84%, specificity of 98%, positive likelihood ratio of 42.00, negative likelihood ratio of 0.16 and area under the curve of 0.96. Regarding the ATA, the results were 81%, 93%, 11.57, 0.20, and 0.92, respectively. Statistical comparisons favored ACCmax over AT in detecting PAD at prespecified and calculated cut-off values for both the PTA and ATA (P < 0.001). Additionally, in patients prone to MAC, ACCmax also outperformed AT in detecting PAD (P values ranging from <0.001 to 0.039). For patients without PAD, no significant differences were observed in the ability to rule out the disease.
Conclusions
ACCmax proved to be more accurate than AT in detecting PAD, also in patients prone to MAC. While no significant difference was found between ACCmax and AT in their diagnostic accuracy to exclude PAD, ACCmax should be favored in the diagnostic work-up in patients suspected of PAD due to its superior ability to detect an arterial stenosis.
目的：糖尿病（DM）或慢性肾病（CKD）患者由于内侧动脉钙化（MAC），检测外周动脉疾病（PAD）尤其具有挑战性。目前的床旁测试，如踝肱指数，对这些患者群体的准确性较低。本研究的主要目的是评估床旁双工超声（DUS）参数最大收缩加速度（ACCmax）和加速时间（AT）在检测 PAD 方面的诊断准确性，包括两种指标的比较：疑似 PAD 患者在接受计算机断层扫描血管造影术 (CTA) 的同时，还接受了踝关节水平的胫后动脉 (PTA) 和/或胫前动脉 (ATA) 的护理点 DUS 测量（ACCmax 和 AT）。PAD的定义是CTA血管狭窄>50%。使用灵敏度、特异性、阳性似然比 (PLR)、阴性似然比 (NLR) 和曲线下面积 (AUC) 对计算得出的（尤登指数）和预先指定的截断值（121 毫秒）评估 AT 的诊断准确性。McNemar 检验比较了 ACCmax 与 AT 在预先指定和计算的临界值上的差异。还对易患 MAC 的患者（即患有糖尿病和/或慢性肾脏病的患者）进行了分组分析：该研究纳入了 184 名患者（267 条腿），其中糖尿病（53%）和慢性肾脏病（36%）的发病率较高。AT 对 PTA 鉴定 PAD 的诊断准确性显示灵敏度为 84%，特异性为 98%，PLR 为 42.00，NLR 为 0.16，AUC 为 0.96。而 ATA 的结果分别为 81%、93%、11.57、0.20 和 0.92。统计比较结果表明，ACCmax 在按预先指定和计算的 PTA 和 ATA 临界值检测 PAD 方面优于 AT（pmax 在检测 PAD 方面也优于 AT（p 值范围为 结论：ACCmax 在检测 PAD 方面也优于 AT（p 值范围为 结论：ACCmax 在检测 PAD 方面也优于 AT）：事实证明，ACCmax 在检测 PAD 方面比 AT 更准确，同样适用于易患 MAC 的患者。虽然 ACCmax 和 AT 在排除 PAD 的诊断准确性上没有明显差异，但由于 ACCmax 检测动脉狭窄的能力更强，因此在诊断疑似 PAD 患者时应首选 ACCmax。
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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