Original Article | Published:

Clinical Science

Atrial fibrillation does not affect ankle–brachial index measured using the Doppler method

Hypertension Research volume 41, pages 6065 (2018) | Download Citation

Abstract

Atrial fibrillation may affect blood pressure measurements. The ankle–brachial index (ABI) is a ratio of systolic blood pressure measured on the lower and upper limbs that may also be affected by arrhythmia. The purpose of the study was to investigate whether atrial fibrillation influenced ABI results. Ninety-nine patients (age 66.6±11 years, 63 males and 36 females) who underwent electrical cardioversion of atrial fibrillation were investigated. ABI measurements using the Doppler method were performed on both lower extremities before and after electrical cardioversion. Measurements were repeated three times and then averaged. The ABI using both lower limbs was lower before electrical cardioversion than after restoration to sinus rhythm (right side: 1.132 (1.065–1.210) during atrial fibrillation vs. 1.179 (1.080–1.242) in sinus rhythm, P=0.019; left side: 1.142 (1.075–1.222) during atrial fibrillation vs. 1.170 (1.098–1.255) in sinus rhythm, P=0.011). However, the upper 95% confidence interval (CI) margins for the median differences in ABI were 0.045 and 0.040 for right and left, respectively, suggesting that the observed difference was clinically insignificant. There was a significant correlation between measurements obtained before and after electrical cardioversion on both lower limbs (r=0.61, P<0.001 and r=0.67, P<0.001). The Bland–Altman plot showed good agreement between measurements performed using the Doppler method during atrial fibrillation and sinus rhythm. Study results showed that atrial fibrillation did not have a clinically important effect on ABI measurements.

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References

  1. 1.

    . Indirect systolic pressures and pulse waves in arterial occlusive diseases of the lower extremities. Circulation 1968; 37: 624–637.

  2. 2.

    , , . Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg 1969; 56: 676–679.

  3. 3.

    , , , , , , . Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381–386.

  4. 4.

    , , , , , . Comparison of arteriosclerotic indicators in patients with ischemic stroke: ankle-brachial index, brachial-ankle pulse wave velocity and cardio-ankle vascular index. Hypertens Res 2015; 38: 323–328.

  5. 5.

    , , , . Combination of pulse volume recording (PVR) parameters and ankle-brachial index (ABI) improves diagnostic accuracy for peripheral arterial disease compared with ABI alone. Hypertens Res 2016; 39: 430–434.

  6. 6.

    , , , , , , , , , , , , , , , , American Heart Association Council on Peripheral Vascular DiseaseCouncil on Epidemiology and PreventionCouncil on Clinical CardiologyCouncil on Cardiovascular NursingCouncil on Cardiovascular Radiology and InterventionCouncil on Cardiovascular Surgery and Anesthesia. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126: 2890–2909.

  7. 7.

    , , , , , , . Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability? BMJ 1990; 300: 162–163.

  8. 8.

    , , , , , , , , , . Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111: 697–716.

  9. 9.

    , , , , , , . Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries. Circ J 2008; 72: 605–610.

  10. 10.

    , , . Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower extremities. Catheter Cardiovasc Interv 2006; 68: 788–792.

  11. 11.

    , , , , , . Effects of stress on heart rate complexity—a comparison between short-term and chronic stress. Biol Psychol 2009; 80: 325–332.

  12. 12.

    , . Epidemiology of peripheral artery disease. Circ Res 2015; 116: 1509–1526.

  13. 13.

    , , , , , , . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370–2375.

  14. 14.

    , , , , , , , , , , , , , , , , , , , , , , , , ESH Working Group on Blood Pressure Monitoring. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens 2008; 26: 1505–1526.

  15. 15.

    , , , . Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertens 2012; 30: 2074–2082.

  16. 16.

    , . Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation. Clin Exp Pharmacol Physiol 2014; 41: 9–15.

  17. 17.

    , , , , , , , , , . Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension 2013; 62: 579–584.

  18. 18.

    , , , . Ambulatory blood pressure monitoring in atrial fibrillation. Am J Cardiol 1996; 78: 350–353.

  19. 19.

    , , . Blood pressure measurement in patients with rate controlled atrial fibrillation using mercury sphygmomanometer and Omron HEM-750CP deice in the clinic setting. J Hum Hypertens 2006; 20: 543–545.

  20. 20.

    , , , , , , , . How to evaluate BP measurements using the oscillometric method in atrial fibrillation: the value of pulse rate variation. Hypertens Res 2016; 39: 588–592.

  21. 21.

    , , , , , , , , . Heart rate significantly influences the relationship between atrial fibrillation and ankle-brachial index. J Cardiol 2015; 66: 143–147.

  22. 22.

    , . Automated plethysmographic measurement of the ankle-brachial index: a comparison with the doppler ultrasound method. Hypertens Res 2016; 39: 100–106.

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Acknowledgements

This study was supported by the Medical University of Warsaw.

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Affiliations

  1. Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland

    • Michał Dąbrowski
    • , Jacek Lewandowski
    • , Piotr Abramczyk
    • , Izabela Łoń
    • , Zbigniew Gaciong
    •  & Maciej Siński

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The authors declare no conflict of interest.

Corresponding author

Correspondence to Maciej Siński.

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DOI

https://doi.org/10.1038/hr.2017.89

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