Measurement characteristics of the ankle-brachial index: Results from the action for health in diabetes study

Mark A. Espeland, Judith G. Regensteiner, Sarah A. Jaramillo, Edward Gregg, William C. Knowler, Lynne E. Wagenknecht, Judy Bahnson, Steven Haffner, James Hill, William R. Hiatt, Frederick Brancati, Debi Celnik, Jeff Honas, Jeanne Clark, Jeanne Charleston, Lawrence Cheskin, Kerry Stewart, Richard Rubin, Kathy Horak, George A. BrayKristi Rau, Allison Strate, Frank L. Greenway, Donna H. Ryan, Donald Williamson, Elizabeth Tucker, Brandi Armand, Mandy Shipp, Kim Landry, Jennifer Perault, Cora E. Lewis, Sheikilya Thomas, Vicki DiLillo, Monika Safford, Stephen Glasser, Clara Smith, Cathy Roche, Charlotte Bragg, Nita Webb, Straci Gilbert, Amy Dobelstein, L. Christie Oden, Trena Johnsey, David M. Nathan, Heather Turgeon, Kristina P. Schumann, Enrico Cagliero, Kathryn Hayward, Linda Delahanty, Barbara Steiner, Valerie Goldman, Ellen Anderson, Laurie Bissett, Alan McNamara, Richard Ginsburg, Virginia Harlan, Theresa Michel, Edward S. Horton, Sharon D. Jackson, Osama Hamdy, Enrique Caballero, Sarah Ledbury, Maureen Malloy, Ann Goebel-Fabbri, Kerry Ovalle, Sarah Bain, Elizabeth Bovaird, Lori Lambert, George Blackburn, Christos Mantzoros, Ann McNamara, Heather McCormick, James O. Hill, Marsha Miller, Brent VanDorsten, Judith Regenseiner, Robert Schwartz, Richard Hamman, Michael McDermott, Jo Ann Phillipp, Patrick Reddin, Kristin Wallace, Paulette Cohrs, April Hamilton, Salma Benchekroun, Susan Green, Loretta Rome, Lindsey Munkwitz, John P. Foreyt, Rebecca S. Reeves, Henry Pownall, Peter Jones, Ashok Balasubramanyam, Molly Gee, Mohammed F. Saad, Ken C. Chiu, Siran Ghazarian, Kati Szamos, Magpuri Perpetua, Michelle Chan, Medhat Botrous, Karen C. Johnson, Leeann Carmichael, Lynne Lichtermann, Abbas E. Kitabchi, Jackie Day, Helen Lambeth, Debra Force, Debra Clark, Andrea Crisler, Donna Green, Gracie Cunningham, Maria Sun, Robert Kores, Renate Rosenthal, Judith Soberman, Robert W. Jeffery, Carolyn Thorson, John P. Bantle, Bruce Redmon, Richard S. Crow, Jeanne Carls, Carolyne Campbell, La Donna James, T. Ockenden, Kerin Brelje, M. Patricia Snyder, Amy Keranen, Cara Walcheck, Emily Finch, Birgitta Rice, Vicki A. Maddy, Tricia Skarpol, Xavier Pi-Sunyer, Jennifer Patricio, Jennifer Mayer, Stanley Heshka, Carmen Pal, Mary Anne Holowaty, Diane Hirsch, Thomas A. Wadden, Barbara J. Maschak-Carey, Gary D. Foster, Robert I. Berkowitz, Stanley Schwartz, Shiriki K. Kumanyika, Monica Mullen, Louise Hesson, Patricia Lipschutz, Anthony Fabricatore, Canice Crerand, Robert Kuehnel, Ray Carvajal, Renee Davenport, Helen Chomentowski, David E. Kelley, Jacqueline Wesche-Thobaben, Lewis Kuller, Andrea Kriska, Daniel Edmundo-wicz, Mary L. Klem, Janet Bonk, Jennifer Rush, Rebecca Danchenko, Barb Elnyczky, Karen Vujevich, Janet Krulia, Donna Wolf, Juliet Mancino, Pat Harper, Anne Mathews, Rina R. Wing, Vincent Pera, John Jakicic, Deborah Tate, Amy Gorin, Renee Bright, Pamela Coward, Natalie Robinson, Tammy Monk, Kara Gallagher, Anna Bertorelli, Maureen Daly, Tatum Charron, Rob Nicholson, Erin Patterson, Julie Currin, Linda Foss, Deborah Robles, Barbara Bancroft, Jennifer Gau-vin, Deborah Maier, Caitlin Egan, Suzanne Phelan, Hollie Raynor, Don Kieffer, Douglas Raynor, Lauren Lessard, Kimberley Chula-Maquire, Erica Ferguson, Richard Carey, Jane Tavares, Heather Chenot, J. P. Massaro, Maria Montez, Connie Mobley, Carlos Lorenzo, Steven E. Kahn, Brenda Montgomery, Robert H. Knopp, Edward W. Lipkin, Matthew L. Maciejewski, Dace L. Trence, Roque M. Murillo, Terry Barrett, Paula Bolin, Tina Killean, Carol Percy, Rita Donaldson, Bernadette Todacheenie, Justin Glass, Sarah Michaels, Jonathan Krakoff, Jeffrey Curtis, Peter H. Bennett, Tina Morgan, Ruby Johnson, Cathy Manus, Janelia Smiley, Sandra Sangster, Shandiin Begay, Minnie Roanhorse, Didas Fallis, Nancy Scurlock, Leigh Shovestull, David Reboussin, Jack Rejeski, Wei Lang, Alain Bertoni, Mara Vitolins, Gary Miller, Paul Ribisl, Kathy Dotson, Amelia Hodges, Patricia Hogan, Kathy Lane, Carrie Combs, Christian Speas, Delia S. West, William Herman, Michael Nevitt, Ann Schwartz, John Shepherd, Jason Maeda, Cynthia Hayashi, Michaela Rahorst, Lisa Palermo, Santica M. Marcovina, Greg Strylewicz, Ronald J. Prineas, Zhu Ming Zhang, Charles Campbell, Sharon Hall, Elizabeth J. Mayer-Davis, Cecilia Farach, Barbara Harrison, Susan Z. Yanovski, Van S. Hubbard, Mary Evans, Lawton S. Cooper, Eva Obarzanek, Denise Simons-Morton, David F. Williamson, Edward W. Gregg

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Many protocols have been used in clinical and research settings for collecting systolic blood pressure (SBP) measurements to calculate the ankle-brachial index (ABI); however, it is not known how useful it is to replicate measurements and which measures best reflect cardiovascular risk. Standardized measurements of ankle and arm SBP from 5140 overweight or obese individuals with type 2 diabetes were used to estimate sources of variation. Measurement characteristics of leg-specific ABI, as calculated using a standard algorithm based on the highest SBP of the dorsalis pedis or posterior tibial arteries, were projected using simulations. Coefficients of variability ranged from 2% to 3% when single SBP measurements were used and ABI was overestimated by 2-3%. Taking two SBP measurements at each site reduced standard errors and bias each by 30-40%. The sensitivity of detecting low ABI ranges exceeded 90% for ABI within 0.05 of the 0.90 clinical cut-point. The average and the minimum of the two (i.e. right and left) leg-specific ABI values had similar U-shaped relationships with Framingham risk scores; however, the average leg ABI had slightly greater precision. Replicating SBP measurements reduces the error and bias of ABI. Averaging leg-specific values may increase power for characterizing cardiovascular disease risk.

Original languageEnglish (US)
Pages (from-to)225-233
Number of pages9
JournalVascular Medicine
Volume13
Issue number3
DOIs
StatePublished - 2008

Keywords

  • Diagnostic error
  • Peripheral arterial disease
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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