Despite its potential usefulness for assessing preclinical atherosclerosis
and cardiovascular risk, the ankle/arm blood pressure index (AAI) has not y
et been the matter of study evaluating its feasibility and reliability by n
onspecialist doctors in a general population. This study was planned for tw
o steps. In step 1, the measurement of AAI, (ratio between Doppler systolic
pressure at the ankle for each lower limb and the highest value of Doppler
systolic pressure of the two upper limbs), should be performed by 50 gener
al practitioners (GPs), 50 social security center physicians, and 50 occupa
tional health physicians in 3,000 male smokers, 40 to 59 years, without cli
nical cardiovascular disease. In step 2, AAI measurement, coupled with echo
graphy-Doppler of iliofemoral arteries, should be repeated by a specialist
in all subjects with decreased AAI (<0.90) and the first two subjects with
normal AAI recruited in step 1 by each nonspecialist. The number of physici
ans and subjects participating in step 1 was lower than planned (80 physici
ans and 962 subjects) with the greatest defect for GPs (six physicians and
35 subjects) and the prevalence of decreased AAI was low (28 subjects). AAI
measurement was repeated in step 2 in only 12 subjects with decreased AAI
in step 1 and in 124 subjects with normal AAI in step 1. Five of the six su
bjects with decreased AAI in step 2 also had decreased AAI in step 1 and 12
3 of the 130 subjects with normal AAI in step 2 also had normal AAI in step
1. As regards echographic stenosis, decreased AAI had a sensitivity of 44%
and a specificity of 98%. AAI seems more feasible for occupational health
physicians and social security center physicians and AAI is also reliable f
or nonspecialists previously trained, but its predictive value as regards e
chographic stenosis is poor in asymptomatic subjects, which may limit its u
sefulness for detecting preclinical atherosclerosis.