Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

Olivier Stivalet; Anita Paisant; Dihia Belabbas; Alexis Le Faucheur; Philippe Landreau; Estelle Le Pabic; Loukman Omarjee; Guillaume Mahé

doi:10.3389/fcvm.2021.759666

Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

Front Cardiovasc Med. 2021 Nov 17:8:759666. doi: 10.3389/fcvm.2021.759666. eCollection 2021.

Authors

Olivier Stivalet¹, Anita Paisant², Dihia Belabbas², Alexis Le Faucheur³, Philippe Landreau¹, Estelle Le Pabic⁴, Loukman Omarjee^{1

5}, Guillaume Mahé^{1

3

4

6}

Affiliations

¹ Vascular Medicine Unit, CHU Rennes, Rennes, France.
² Radiology Department, CHU Rennes, Rennes, France.
³ University of Rennes 2, M2S-EA 7470, Rennes, France.
⁴ Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France.
⁵ Vascular Medicine, Centre Hospitalier de Redon, Redon, France.
⁶ University of Rennes 1, Rennes, France.

Abstract

Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone. Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test. Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71-92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43-70]) or exercise-TcPO2 alone (sensitivity = 59% [45-72]). Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.

Keywords: ankle brachial index (ABI); claudication; exercise test; peripheral artery disease (PAD); transcutaneous oxygen pressure (TcPO2).