Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

• Published in: Hypertension research Vol. 35; no. 9; pp. 883 - 891
• Main Authors: Verberk, Willem J, Kollias, Anastasios, Stergiou, George S
• Format: Journal Article
• Language: English
• Published: England 01.09.2012
• Subjects: Ankle Brachial Index - methods; Blood Pressure - physiology; Cardiovascular Diseases - diagnosis; Humans; Oscillometry - methods; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - diagnostic imaging; Ultrasonography, Doppler - methods
• ISSN: 0916-9636; 1348-4214; 1348-4214
• DOI: 10.1038/hr.2012.83

Measurement of the ankle-brachial index (ABI) using a Doppler device is widely used to identify subjects with peripheral artery disease (PAD), and those who are at high risk of cardiovascular disease. This paper presents a systematic review (Medline/PubMed, Embase and Cochrane) and meta-analysis of studies assessing the usefulness of automated oscillometric devices for ABI estimation and PAD detection compared with the conventional Doppler method. A total of 25 studies including 4186 subjects were analyzed. A random-effects model analysis showed that the average oscillometric ABI was similar to the Doppler ABI (mean difference ± s.e. 0.020 ± 0.018, P=0.3) but that the absolute differences were significant (0.048 ± 0.009, P<0.01). The pooled correlation coefficient (r) between the oscillometric and Doppler ABI was 0.71 ± 0.05. Simultaneous arm-leg measurements resulted in a smaller difference between the average oscillometric ABI value and the average Doppler ABI value than did sequential measurements (-0.012 ± 0.022 vs. 0.040 ± 0.026, respectively, P<0.01). The average sensitivity and specificity of the oscillometric ABI estimation in PAD diagnosis was 69 ± 6% and 96 ± 1%, respectively (with Doppler ABI taken as the reference). These data suggest that an automated ABI measurement obtained by oscillometric blood pressure monitors is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD. To increase the sensitivity of the PAD diagnosis based on an oscillometric ABI, a higher threshold of 1.0 might be preferable.