Ankle Peak Systolic Flow Velocity (PSV) with Coronary Artery Disease in Diabetes Mellitus

Introduction: Ankle peak systolic flow velocity can measure peripheral arterial blood flow which can predict extent of peripheral arterial disease. Atherosclerosis is more common in patients with diabetes mellitus and can affect simultaneously coronary circulation and peripheral circulation. Aims and Objectives: The primary objective of the study was to determine the occurrence of peripheral vascular disease by ankle Peak Systolic Velocity (PSV) in patients admitted for coronary artery disease with diabetes mellitus .The secondary objective was to see the association between the ankle Peak Systolic Flow Velocity (PSV) with the extent of abnormality of coronary angiogram in diabetic patients. Materials and Methods: All patients admitted in the hospital with coronary artery disease with diabetes mellitus in whom coronary angiogram was done were included in the study over a period of one year Presence of significant vessel disease CAD was defined as at least >70 % stenosis at one or more major coronary arteries (left anterior descending, left circumflex and right coronary artery). Ankle Peak Systolic Velocity (PSV) was measured in all patients by the Duplex method. The peak systolic velocities in the distal posterior tibial artery and the distal anterior tibial artery was measured and the average peak systolic velocities within three cardiac cycles was recorded by the Original Research Article Bhat et al.; JPRI, 33(40B): 273-278, 2021; Article no.JPRI.72008 274 radiologist. The ankle peak systolic flow above 40cm/s was considered as good flow in the lower limb extremity [7]. The data was analysed using SPSS version 17.0 software and mean and standard deviation was used . Results: Out of the cases studied 24 patients (80%) were males and 6 patients (20%) were females. All the Coronary angiograms was classified to single 13(43.3%), double 8(26.7%) and triple 9 (30%) vessel disease by the cardiologist. Out of the 13 patients with single vessel disease 3 patients had < 40 cm/s flow in the right anterior tibial artery and 10 patients had >40 cm/s flow in the right tibial artery indicating good perfusion.Out of the 8 patients with double vessel disease 4 patients had flow <40 cm/s and 4 patients had flow >40 cm/s. In triple vessel disease category 5 patients had flow <40 cm/s and 4 patients had flow>40cm/s. The p value was 0.2 was not significant and the chi square was 2.79 Similar results were obtained while compared with left ankle peak systolic flow velocity. Conclusion: In this study patients with single vessel disease have higher ankle peak systolic velocity though statistically not significant. Lower ankle peak systolic flow velocity corroborates with peripheral arterial disease [12] and is seen in patients with coronary artery disease [13].


INTRODUCTION
Peripheral arterial disease (PAD) is the occlusive disease of the arteries distal to the aortic bifurcation [1]. Coronary Artery Disease (CAD) is the main cause of death and disability in diabetic patients [2]. Diabetes mellitus patients are at a greater risk of atherosclerosis and peripheral arterial disease [3]. The macrovascular complications can affect the entire arterial tree, therefore all these complications often occur simultaneously [4].
There are not many studies in India using the ankle peak systolic flow velocity(PSV) as a marker of peripheral ischemia [5] and correlating it with coronary artery disease. The primary objective of the study was to determine the occurrence of peripheral vascular disease by ankle Peak Systolic Velocity (PSV) in patients admitted for coronary artery disease with diabetes mellitus .The secondary objective was to correlate the degree of abnormality of ankle Peak Systolic Flow Velocity (PSV) with the extent of abnormality of coronary angiogram in diabetic patients .

MATERIALS AND METHODS
It was conducted according to the standards of the declaration of Helinski. The study was conducted during a period of one year on patients admitted in the hospital with coronary artery disease with diabetes mellitus in whom coronary angiogram was done. The general clinical data like age, sex, height, body weight, body mass index (BMI), hypertension, smoking habits was collected. The patients included in this study had to undergo fasting blood sugar, glycosolated Hb, fasting lipid profile, hemoglobin, serum creatinine, Coronary angiogram was done in all the patients and interpreted by the cardiologist .Presence of significant vessel disease CAD was defined as at least >70 % stenosis at one or more major coronary arteries (left anterior descending, left circumflex and right coronary artery). Ankle Peak Systolic Velocity (PSV) was measured in all patients by the Duplex method. The peak systolic velocities in the distal posterior tibial artery and the distal anterior tibial artery was measured and the average peak systolic velocities within three cardiac cycles [6] was recorded by the radiologist. The ankle peak systolic flow above 40cm/s was considered as good flow in the lower limb extremity [7]. The data was analysed using SPSS version 17.0 software using ANOVA, ttest Spearman's rank correlation coefficient and discriminant analysis.

Study Design
It was a cross sectional descriptive including all patients admitted with artery disease in the current admission assessed by coronary angiogram cardiologist .All patients whose sugar was above 126, HbA1C level was incuded as having diabetes mellitus coronary angiogram reports was the cardiologist and the divided into disease, double vessel disease and disease. The ankle Peak systolic (PSV) was recorded in all patients data was analysed. The ankle peak velocity above 40 cm/s was considered analytic study with coronary admission was angiogram by the fasting blood levels above 6.5% mellitus. All the evaluated by into single vessel and triple vessel flow velocity and then this peak systolic flow considered as good perfusion. Continuous data was mean ± standard deviation. comparisons between categorical was performed with chi-square Comparisons between large groups data was made with the unpaired Differences was considered significant 0.05 level.

RESULTS
The total number of cases included shown in Graph 1.Most of the patients the 5 th decade and 6 th decade respectively.
Out of the cases studied 24 patients males and 6 patients (20%) were females 2).

DISCUSSION
The presence of peripheral arterial increases risk of cardiovascular disease association between cerebrovascular and atherosclerotic disorders in different beds namely peripheral vascular cardiovascular was present in nearly patients. Ankle peak systolic flow velocity value in predicting peripheral vascular diabetes patients as per study by Dzhemilovo al. [9].
In this study though patients with disease on coronary angiogram had the lower limb we did not get significance beween the single/double/triple vessel disease systolic flow velocity. An Indian study al. [10] reported prevalence of vascular disease of 7.7% in pateints based on only ABI measurement in This present study revealed non statistical correlation between cardiovascular disease and ankle peak systolic velocity.This may be because of size of the study .Lower limb angiography not performed hence extent and underlying atherosclerosis in the lower have not been accurately reflected [11] In this study patients with single vessel have higher ankle peak systolic velocity statistically not significant. Lower   [11].

TYPE OF BLOCK V/S PSV
vessel disease velocity though Lower ankle peak systolic flow velocity corroborates arterial disease [12] and is seen in coronary artery disease [13].

CONCLUSION
Ankle peak systolic flow velocity is arterial flow measure which may measure vascular status. Lower peak systolic flow velocity is seen in coronary artery disease. Earlier peripheral arterial disease may help functional status of patients, early intervention peripheral artery disease may quality of life.
Larger studies are required to further conclusion as our sample size was CONSENT As per international standard standard, patient's written consent collected and preserved by the author(s).

ETHICAL APPROVAL
The study was approved by the ethics of Father Muller Medical College.

ACKNOWLEDGEMENT
The authors would like to acknowledge Muller Medical College Hospital,Mangalore allow us to carry out the present study.