Ankle-Brachial Index in Patients With Nonvalvular Atrial Fibrillation

Violi et al. (1) are to be commended for their large study on the prevalence of subclinical peripheral artery disease (PAD) among patients with nonvalvular atrial fibrillation. Indeed, the ankle-brachial index (ABI) enables the detection of a substantial subset of individuals with asymptomatic (or with atypical symptoms of) PAD in diverse populations, and beyond its diagnostic interest, a low ABI is predictive for stroke, as highlighted recently in a meta-analysis (2). Violi et al. (1) reported an even higher than expected 21% prevalence of PAD detected by an ABI ≤0.90, almost doubling the proportion of patients with “vascular disease” as defined in the CHADS2-VASc (congestive heart failure [or left ventricular systolic dysfunction]; hypertension [blood pressure consistently >140/90 mm Hg or on hypertension medication]; age ≥75 years; diabetes mellitus; previous stroke, transient ischemic attack, or thromboembolism; vascular disease [e.g., peripheral artery disease, myocardial infarction, aortic plaque]; age 65 to 74 years; sex category [male or female]) score (i.e., myocardial infarction, complex aortic plaque, and PAD), advocated by the European Society of Cardiology guidelines on the management of atrial fibrillation, to assess the risk of stroke (3). However, we think that prior to proposing the measurement of ABI in patients with nonvalvular atrial fibrillation, several issues should be discussed.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research