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

Olivier Stivalet (1) , Anita Paisant (1) , Dihia Belabbas (1) , Alexis Le Faucheur (2) , Philippe Landreau (1) , Estelle Le Pabic (3, 1) , Loukman Omarjee (1) , Guillaume Mahe (1, 2, 3)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 M2S - Laboratoire Mouvement Sport Santé
3 CIC - Centre d'Investigation Clinique [Rennes]

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.

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

Domaines: Sciences du Vivant [q-bio]

Olivier Stivalet, Anita Paisant, Dihia Belabbas, Alexis Le Faucheur, Philippe Landreau, et al.. Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease. Frontiers in Cardiovascular Medicine, 2021, 8, pp.759666. ⟨10.3389/fcvm.2021.759666⟩. ⟨hal-03510804⟩