‘Significant’ link between low Toe Brachial Index and coronary artery disease in people with diabetic foot

New research has highlighted a “significant association” between low Toe Brachial Index (TBI) and the presence of coronary artery disease (CAD) in diabetic foot syndrome patients, suggesting TBI could be a valuable screening tool for identifying CAD within this population.

CAD is a common problem amongst diabetic foot syndrome (DFS) patients, associated with peripheral arterial disease.

In what is believed to be the first study of its kind, researchers in Iran set out to investigate the accuracy of TBI in the association of CAD in 62 DFS patients.

The presence of CAD was assessed by longitudinal strain echocardiography, a sensitive method that provides a more accurate measure of intrinsic left ventricular contractility than left ventricular ejection fraction, especially in diabetic patients.

The study authors said: “There was a significant association between TBI and CAD, with each 0.01 increase in TBI associated with a 15% decrease in the odds of CAD development (odds ratio = 0.85, 95% CI: 0.72–0.99, p = 0.039).

“Overall accuracy for TBI and toe pressure was 77.4% and 74.2%, respectively, indicating their potential for CAD risk stratification in the DFS population.”

The researchers said that the ability to identify the co-existing CAD in DFS patients with an inexpensive, non-invasive and widely available test has important practical implications, particularly for CAD screening efforts in diabetic individuals, adding: “In this study, we demonstrate that TBI can overcome this challenge.”

They concluded: “Our findings highlight the significant association between low TBI values and the presence of CAD, suggesting that TBI can be a valuable screening tool for identifying CAD risk in this high-risk population.

“The combination of TBI and longitudinal strain echocardiography provides a comprehensive assessment of cardiovascular risk, allowing for more accurate detection and management of CAD in DFS patients.

“Future studies should explore the use of this integrated approach in clinical practice to improve patient outcomes and reduce cardiovascular morbidity and mortality in this vulnerable population.”

Read the study, Integrating Toe Brachial Index and longitudinal strain echocardiography for detecting coronary artery disease in patients with diabetic foot syndrome, here.