Abstract

To the Editor:

In their articles, Pearson et al,¹ Salameh and Federman² and Aslam et al³ (November 2009 issue) emphasize the important role of the ankle-brachial index (ABI) as a consistent and significant predictor of cardiovascular events. However, ABI is rarely performed in primary care office settings due to time and training requirements and the interobserver variability.⁴ Pearson et al¹ suggests that with proper scheduling and training, the ABI can be completed in a timely manner. We alternatively propose that ABI measurement by the oscillometric method (OsM) is quick and easy and does not require specialized training.^5,6 We have compared the ability of nonspecialist physicians to perform these methods using arteriography as the gold standard.⁷ To this end, 158 legs of 85 patients with intermittent claudication were analyzed by DoM and OsM with an Omron M4-I automatic oscillometer. An ABI <0.9 was considered a positive test when at least 50% of the artery was occluded. Pressure was not detected in 35% of the patient's legs by DoM vs 44% by OsM. Diagnostic accuracies of the ABI <0.9 by DoM or OsM are (%): sensitivity: 97/95, specificity: 89/56, positive predictive value: 98/91, and negative predictive value: 86/68. Thus, the ABI was more accurately determined by nonspecialist physicians utilizing the easy and quick oscillometer method than with the classic DoM.