Vengojayaprassad, S (2010) Ankle Arm Pressure Index in Coronary Arterial Disease patients in Tertiary Care Centre, as compared with normal population. Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION : American heart association prevention conference V described Ankle brachial pressure index (ABPI) test as a “simple, inexpensive, noninvasive measure” of peripheral arterial disease and stated that an abnormal ABI “provides incremental coronary and all cardiovascular disease risk assessment information”. Measurement of ABPI has been recommended to improve cardiovascular risk assessment in individuals in individuals at “intermediate or higher risk of coronary arterial disease (CAD) on basis of traditional risk factor assessment”. Although several studies have demonstrated that ABPI <0.9 predicts future CAD mortality, there is little data regarding the utility of ABPI as a screening test in individuals for whom physicians actually order non invasive test for cardiovascular risk prediction. So, this study was performed to find the prevalence of low ABPI (<0.9) in clinical cases of coronary arterial disease patients and compare it with those who were free of disease clinically in the same group of population. Low ABPI reflects peripheral arterial disease of lower limbs, and is used as a tool in treating an ischaemic limb, due to any cause, most common of which is atherosclerosis. Epidemiological studies have demonstrated that subclinical cardiovascular disease in one vascular bed is associated with the presence of clinical disease in another bed, as well as with subsequent cardiovascular and total mortality. As, coronary arterial disease also shares a common etiology of atherosclerosis with peripheral arterial disease, ABPI can be used to predict its risk. Individuals with peripheral arterial disease of the lower extremities are among the highest-risk vascular patients. Therefore, presence of peripheral arterial disease is an indicator of widespread atherosclerosis in other vascular territories such as the coronary, carotid, and cerebrovascular arteries. AIM OF STUDY : The objectives of the study are: 1. To study the prevalence of low Ankle brachial pressure index in people with coronary arterial disease in patients of Coimbatore Medical College when compared with general population of same locality. 2. To find out whether ABPI is a significant individual risk factor for coronary arterial disease. MATERIALS AND METHODS : Duration: MARCH 2009 to NOVEMBER 2009. Method: ABPI was compared between 100 patients with clinical cardiovascular disease versus 100 controls taken from patients attending Coimbatore medical college and general population of Coimbatore respectively. ABPI <0.9 was taken as cut off, as it has a sensitivity of 90% in detecting peripheral vascular disease, which may also reflect similar pathology in other vascular bed, like coronary arteries. Prevalence of APBI less than 0.9 was compared and analysed between the two study populations. The ABPI was measured according to a standard protocol. Vascular lower limb examination was done, by feeling the foot pulses (dorsalispedis and posterior tibial arteries), and identifying the best palpable one. ABPI was measured, by using the sphygmomanometer and a sonic aid hand-held Doppler probe (GIMA Ultrasound Technology Ltd, UK), utilizing the best-identified note of foot arteries and measuring its index in relation to the brachial artery. The ABI measurements were compared between the two groups, with special concentration on patients with hypertension, diabetes , hypertension, smoking, PAD etc as comorbid associations of atherosclerosis. chi-square test was used to compare percentages. A p-value of ≤ 0.05 was considered statistically significant. Study Population: PATIENTS: 100 (50 men and 50 women) randomly selected coronary arterial disease patients (as evidenced by prior medical records, recent biochemical, ECG, echocardiographical data etc) attending cardiac department of coimbatore medical college were screened for ABPI. CONTROLS: Age and sex matched controls, hundred in number from general population, who showed no symptoms or signs of coronary arterial disease. SPECIAL REMARKS: Other confounders of CAD , like hypertension. Diabetes, dyslipidemia ,genetic predispositions, smokers etc were not matched .These were taken as separate variables for statistical analysis. Exclusion Criteria: Patients who were acutely ill or significantly morbid. CONCLUSIONS : • There is a definite increase in prevalence of low APBI in patients with coronary arterial disease in this study. • The study can be conclude by the remark that low ABPI is an individual risk factor for CAD, due to its increased prevalence in CAD group. • Increasing age has a lowering effect on ABPI, both in normal as well as patients with coronary arterial disease. • Diabetes has significant impact on ABPI in patients with CAD as observed in the study .It can be concluded that a diabetic has definite risk of lowering ABPI as a isolated factor , which needs future study. • Hypertension and Dyslipidemia were also found to increase the prevalence of low ABPI in coronary arterial disease patients. Dyslipidemia has definite role in CAD patient and low ABPI is an index which has been observed. • I conclude, as an early observation, which is only a beginning and more to come in future as far as this study is considered.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Ankle Arm Pressure Index ; Coronary Arterial Disease patients ; Tertiary Care Centre ; normal population. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Feb 2018 19:53 |
| Last Modified: | 17 Feb 2018 19:53 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5845 |
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