Prevalence of Lower Extremities Peripheral Arterial Disease among Ischemic Patients Admitted to Cardiac Rehabilitation

Abstract

SUMMARY A therosclerosis is progressive and diffuse pathological disorders which can simultaneously affect multiple vascular beds, PAD often coexist with other manifestations of systemic atherosclerotic process including CAD. Diagnosing PAD in patients with CAD admitted to cardiac rehabilitation program can help to tailor exercise regimen to fit these patients, in addition, early treatment and/or intervention may help to control progression of the disease. Aim of the study is to search for the prevalence of undiagnosed PAD using ankle brachial index in Egyptian patients with documented CAD undergoing cardiac rehabilitation program. The study included 200 patients presented to Ain Shams university hospitals with documented CAD starting from January 2015 for detection of PAD using ABI with exclusion of patients with known (diagnosed) PAD and Patients refusing the test. All patients were subjected to: *History taking: stressing on - Risk factors, details of CAD, and symptoms of claudication or limb ischemia, in addition to medications. * Clinical examination; including palpation of peripheral pulses in both lower limbs. * 12 lead ECG * Laboratory investigations: Basic labs included CBC, renal functions and lipid profile. * Echocardiography, with emphasis on EF and SWMA at rest. * Coronary angiography documentation for degree of CAD and if any intervention has been done. * ABI using Doppler ultrasonography. patients were divided into two groups according to the results of ABI measurements as follows: Study group with positive ABI (≤0.9) Control group with negative ABI (>0.9) We found that the prevalence of undiagnosed PAD in those patients was 14.5% (29 patients), and The incidence of PAD is increased in patients with CAD with age above 60 years (p=0.001) and in presence of history of HTN (p=0.000), DLP (p=0.005), or family history of ischemic heart disease (p=0.035), and in presence of uncontrolled SBP (p=0.002). PAD was associated with impaired left ventricular systolic function and presence of SWMA.