摘要
Background: Although Peripheral arterial disease (PAD) is a strong predictor of adverse cardiovascular events, it is frequently unrecognized and under diagnosed. When the diagnosis is considered, it is often made by eliciting the presence of intermittent claudication using the Edinburgh Claudication Questionnaire (ECQ) whereas the Ankle Brachial Index (ABI) is a simpler and more objective means of making the diagnosis with a sensitivity and specificity of > 90%.
Objective : To determine the predictive values of Edinburgh Claudication Questionnaire in the diagnosis of PAD among adult patients in Sagamu, south western Nigeria.
Methods: A cross-sectional study of 400 patients aged > 50 years attending the General Out- Patients Clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was carried out. ECQ was administered on all the subjects to determine the presence of intermittent claudication (IC) and their ABI were also measured. A value of ABI d” 0.9 was taken as diagnostic of PAD. The prevalence of PAD, the sensitivity, specificity, positive and negative predictive values of ECQ against ABI were evaluated.
Results: Using ECQ 25 (6.3%) of the patients had PAD while 99 (24.8%) had PAD when ABI was used. Among these 99 patients, 17 (17.2%) had symptoms consistent with IC based on ECQ. The presence of IC was significantly associated with ABI values d”0.9 (p = 0.000).The sensitivity of ECQ was 17.2% while the specificity was 99% with a positive predictive value of 85% and a negative predictive value of 77.7%.
Conclusion: The ECQ is not a useful tool for the screening of PAD given its low sensitivity. Its use would result in missing a large number of patients with asymptomatic PAD who would have benefitted from interventions.
Keywords: Intermittent Claudication, Peripheral arterial disease, Ankle brachial index, Edinburgh Claudication Questionnaire, sensitivity, specificity.
Résumé
Contexte: Bien que la maladie artérielle périphérique (MAP) soit un prédicteur puissant des événements cardiovasculaires indésirables, elle est souvent méconnue et sous-diagnostiquée. Lorsque le diagnostic est pris en considération, on le fait souvent en provoquant la présence d’une claudication intermittente en utilisant l’Edinburgh Claudication Questionnaire (ECQ), alors que l’index Brachial de la cheville (ABI)est un moyen plus simple et plus objectif de faire le diagnostic avec une sensibilité et une spécificité de > 90%.
Objectif: Déterminer les valeurs prédictives d’Edinburgh Claudication Questionnaire dans le diagnostic de MAP chez des patients adultes à Sagamu, sud-ouest du Nigeria.
Méthodes: Une étude transversale de 400 patients âgés de e” 50 ans fréquentant la Clinique Générale pour Patients NonHospitalisés de l’Hôpital d’Enseignement Universitaire OlabisiOnabanjo, Sagamu, Nigéria, a été réalisée. ECQ a été administré sur tous les sujets pour déterminer la présence de claudication intermittente (IC) et leur ABI ont également été mesurés. Une valeur d’ABI d” 0,9 a été prise comme diagnostic de MAP. On a évalué la prévalence de la MAP, la sensibilité, la spécificité, les valeurs prédictives positives et négatives de l’ECQ par rapport à ABI.
Résultats: En utilisant l’ECQ, 25 (6,3%) des patients avaient MAPcependant 99 (24,8%) avaient MAP quand ABI a été utilisé. Parmi ces 99 patients, 17 (17,2%) avaient des symptômes compatibles avec l’IC basée sur l’ECQ. La présence de l’IC était significativement associée aux valeurs d’ABI d”0,9 (p = 0,000).La sensibilité de l’ECQ était de 17,2% alors que la spécificité était de 99% avec une valeur prédictive positive de 85% et une valeur prédictive négative de 77,7%.
Conclusion: L’ECQ n’est pas un outil utile pour le dépistage du MAPétant donné sa faible sensibilité. Son utilisation entraînerait la disparition d’un grand nombre de patients atteints de MAP asymptomatique qui auraient bénéficié d’interventions.
Mots-clés: Claudication intermittente, Maladie artérielle périphérique, Index brachialde la cheville, Edinburgh Claudication Questionnaire, sensibilité, spécificité.
Correspondence: Dr. Oluseun O. Adeko, Department of Family Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu. E-mail: dradekooluseun@gmail.com.
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