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Colegio de Medicina Interna de México.

2012, Number 6

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Med Int Mex 2012; 28 (6)

The ankle-brachial index in the differential diagnosis of cerebral vascular event

Ayala SJA, Huerta RS, Vargas AG, Márquez SM, Rodríguez HA, Cabrera MLJ, Chávez TR

Language: Spanish
References: 28
Page: 547-553
PDF size: 207.82 Kb.


ABSTRACT

Background: Anormal Ankle/brachial index or 0.9 has a hazard ratio of 1.6 to cardiovascular mortality, 1.3 for stroke, low value is associated with higher NIHSS score in ischemic stroke and recurrence of the event is greater. For therapeutic decision must be certain in the type of stroke, requiring the use of imaging studies for diagnosis, however this technology is not avaible in all hospitals.
Methods: We performed cross sectional study to evaluate the usefulness of ankle-brachial index in the differential diagnosis of stroke, we incluided 49 patients with stroke imaging confirmation and correlated the cardiovascular risk factors.
Results: The anormal ankle-brachial index has sensivity of 70%, specificity 68%, positive predictive value 77%, negative predictive value 59%, p=0.008, the only independent riskfor stroke was LDL p=0.005 with odd ratio for isquemic stroke of 0.097 p=0.005, LDL has sensivity (89.4%) and specific (80%) to hemorrhagic stroke.
Conclusions: The ankle-brachial index is not inferior to clinical scores for EVC diagnosis; LDL is sensitive ans especific with 89.47% and 80 % to diagnostic of hemorrhagic stroke.



REFERENCES

  1. Aguilar G, Alegría L. Enfermedad vascular cerebral en el Hospital Central Militar: estudio descriptivo. Neurología, Neurocirugía y Psiquiatría 2005;38(4):135-139.

  2. Tunstall PH, for the WHO Monica Project Principal Investigators The World Health Organization. Monica Project. J Clin Epidemiol 1988;41:1051.

  3. Broderick J, Chair, Sander C. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults 2007 Update.

  4. The NINDS t-PA Stroke Study Group. Generalized efficacy of tPA for acute stroke. Subgroup analysis of the NINDS t-PA stroke trial. Stroke 1997;28:2119-2125.

  5. Rodríguez D. Factores de riesgo cardiovascular en enfermos adultos con evento vascular cerebral. Enf Neurol (Mex) 2007;9(20):90-93.

  6. Herranz M. Índice tobillo brazo para la evaluación de la enfermedad arterial periférica. Av Diabetol 2005;21:224-226.

  7. Harold PA, MD, FAHA, Chair; Gregory del Zoppo, MD. Guidelines for the Early Management of Adults With Ischemic Stroke. Stroke 2007;38:1655-1711.

  8. Broderick Ch, Sander C. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults 2007 Update. Stroke 2007;38:2001-2023.

  9. Poungavarin N, Viriyavejakul A, Kpomontric C. Siriraj-stroke and Validation study to distinguish supratentorial intracerebral haemorrhage from infarction. BMJ 1991;302:1565-1567.

  10. Rivera SA, Jiménez SG, Parra RJ. Escala de Siriraj vs escala modificada en el diagnóstico de enfermedad vascular cerebral. Med Int Mex 2010;26(6):544-551.

  11. Ogun SA, Oluwole O, Fatade B, Ojini F, Odusote KA, OgunseyindeAO. Accuracy of the Siriraj stroke score in differentiating cerebral haemorrhage and infarction in African Nigerians. African J Neurological Sci 2001;20:21-26.

  12. Soman A, Joshi SR, Tarvade S, Jayaram S. Greek Stroke Score, Siriraj Score snd Allen Score in clinical diagnosis of intracerebral hemorrhage and infarct: validation and comparison study. Indian J Med Sci 2004; 58(10).

  13. Connor MD, Modi G, Warlow CP. Accuracy of the Siriraj and Guy’s Hospital Stroke Scores in Urban South Africans. Stroke 2007;38:62

  14. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin- converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145-153.

  15. Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for End point reduction in hypertension (LIFE): A randomized trial against atenolol. Lancet 2002; 359:995-1003.

  16. Progress Collaborative Group. Randomized trial of a perindopril- based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001;358:1033-1041.

  17. Josep G, Martínez RM. Métodos diagnósticos de la enfermedad arterial periférica. Importancia del índice tobillo-brazo como técnica de criba. Rev Esp Cardiol 2009;9:11D-17D.

  18. Nathaniel C. American Diabetes Association. Peripheral arterial disease in people with diabetes. Consensus statement. Diabetes Care 2003;26:3333-3341.

  19. Edmons ME. Blood Flow in the diabetic neuropathic foot. Diabetologia 1985;22:9-15.

  20. Coccheri S. Distribution of symptomatic atherothrombosis and influence of atherosclerotic disease burden of risk on secondary ischemic events: results from CAPRIE. Eur Heart J 1998;19 Suppl:P1268.

  21. Bertomeu V, Morillas P, González-Juanatey JR, Quiles J, Guindo J, Soria F, et al. Prevalence and prognostic influence of peripheral arterial disease in patients ≥ 40 years old admitted into hospital following an acute coronary event. Eur J Vasc Endovasc Surg 2008;36:189-196.

  22. Morillas P, Cordero A, Bertomeu V, González-Juanatey JR, Quiles J, Guindo J, et al. Prognostic value of low anklebrachial index in patients with hypertension and acute coronary syndromes. J Hypertens 2009;27:341.

  23. Heald CL, F.G.R. Fowkes. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: Systematic review. Atheroesclerosis 2006;189(1):61-69.

  24. Murphy TP, Rajoo D. Ankle-brachial index and cardiovascular risk prediction: An analysis of 11,594 individuals with 10-year follow-up. Atheroesclerosis 2012;220:160-167.

  25. Lee DH, Kim J. Low ankle-brachial index is a predictive factor for initial severity of acute ischaemic stroke. Eur J Neurol 2012;1468-1331.

  26. Tsivgoulis G, Bogiatzi C, Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia. Atherosclerosis 2012;220(2):407-412.

  27. Busch MA, Lutz K. Low Ankle-Brachial Index Predicts Cardiovascular Risk After Acute Ischemic Stroke or Transient Ischemic Attack. Stroke 2009;40:3700-3705.

  28. Guo WW, Li J. Relationship between low ankle-brachial index and mortality of men with several atherosclerotic risk factors: a cohort study of 1941 cases. Chinese journal of preventive medicine 2007; 41(6): 487-491.




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