A Novel Algorithm with Sublingual Nitroglycerin to Diagnose the Patients with Borderline Peripheral Artery Disease

Kai-Hung Cheng ； Wen-Ter Lai ； Feng-Hsien Lin ； Chao-Ping Wang

《E-Da Medical Journal》 9卷1期 (2022/03) Pp. 8-15

https://doi.org/10.6966/EDMJ.202203_9(1).0002

摘要

Objectives: To improve the diagnosis of borderline peripheral artery disease (PAD) with resting ankle-brachial index (ABI) between 0.9-1.0 for those unable to do exercise ABI testing is challenging. The aim of this study is to develop an algorithm with NTG (nitroglycerine, sublingually) for the borderline PAD. Methods: Among the 180 limbs suspicious for PAD, 29 limbs had the resting ABI between 0.9-1.0. The values of ABI and brachial-ankle pulse wave velocity (baPWV) at rest and 3-minute after NTG sublingually were analyzed. MRA imaging was performed to confirm the diagnosis of PAD in all limbs. Results: In a total of 29 limbs, 24 limbs were found with PAD by MRA. After sublingual NTG, ABI dropped to ＜ 0.9 in 12/29 limbs which confirmed to be PAD. The relative change of baPWV with NTG (∆baPWV) ＜-350 cm/s was found in 11 PAD limbs among the rest 17 limbs with only one PAD left undiagnosed finally. The sensitivity, specificity, positive and false predictive values of the algorithm can be achieved up to 100%, 83.3%, 95.8% and 100 %, respectively. Conclusions: For the borderline PAD, this user-friendly algorithm developed by coupling with post-NTG ABI and ∆baPWV provides an easy method to diagnose PAD.

關鍵字

peripheral artery disease (PAD) ； ankle-brachial index (ABI) ； brachial-ankle pulse wave velocity (baPWV) ； nitroglycerine

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