Cardiology and Angiology: An International Journal

The Ankle–brachial Index in Peripheral Arterial Disease: A Critical Narrative Review of Diagnostic Performance, Prognostic Value and Contested Screening Roles

2026-10-15T11:29:03+00:00

Peripheral arterial disease is a common manifestation of systemic atherosclerosis that remains frequently unrecognised, partly because most affected people do not report classic intermittent claudication. The ankle–brachial index, the ratio of ankle to arm systolic pressure, has served for more than half a century as the principal non-invasive test for the condition and has acquired a second role as a marker of cardiovascular risk. Its apparent simplicity conceals unresolved questions about measurement standardisation, diagnostic sensitivity in people with diabetes or chronic kidney disease, the meaning of borderline and elevated values, and the value of population screening. This critical narrative review examined how far the evidence supports each of the diagnostic, prognostic, screening and limb-threat roles now assigned to the index. Peer-reviewed literature, clinical practice guidelines and consensus statements were identified through structured searching of international biomedical databases and scholarly indexes, supplemented by citation tracking, and were appraised thematically with attention to study design, reference standards, spectrum of participants and consistency of findings. The synthesis indicates that an index of 0.90 or lower is a highly specific marker of haemodynamically significant disease and a robust, reproducible predictor of cardiovascular events and mortality across diverse cohorts. Sensitivity is modest and deteriorates markedly where medial arterial calcification is common, so that a normal value cannot reliably exclude disease in diabetes, advanced kidney disease or older age. Calculation conventions, device type and operator training materially alter prevalence estimates, and the prognostic signal extends to borderline and non-compressible values, which current diagnostic categories treat inconsistently. Randomised evidence has not shown that screening asymptomatic populations with the index alone improves outcomes, and major guideline bodies therefore diverge. Toe pressures, waveform analysis and data-driven methods may complement the index, but their evidence base is still largely low in certainty. The index remains indispensable as a first-line, context-dependent test, provided that its limitations are acknowledged, its measurement is standardised, and a normal result in high-risk groups is followed by complementary testing. Pragmatic trials of targeted case-finding and diagnostic studies in under-represented populations are the most pressing research needs.

Gender Differences in the Clinical Presentation, Management, and Prognosis of Acute Coronary Syndrome: A Single-Center Observational Study

2026-09-19T13:47:33+00:00

Gender differences in acute coronary syndrome (ACS) are widely recognised. Women may present with ACS at an older age and with a different cardiovascular risk profile, including higher prevalences of hypertension, diabetes, and renal insufficiency in many cohorts. They may also have differences in symptom presentation, coronary anatomy, management, and outcomes. The objective of this study was to compare, by sex, the clinical characteristics, cardiovascular risk factors, electrocardiographic findings, echocardiographic data, therapeutic management, and prognosis of patients admitted for ACS. We conducted a single-centre, retrospective, observational study including 94 patients hospitalised for ACS in the cardiology department of the Mohammed VI University Hospital in Marrakesh. Of the 94 patients included, 69 were men (73.4%) and 25 were women (26.6%). Women had a higher prevalence of hypertension and diabetes, whereas smoking was observed only among men. Mean left ventricular ejection fraction was similar between women and men. In-hospital mortality was 32.0% among women (8/25) and 7.2% among men (5/69), with an overall mortality of 13.8% (13/94). In multivariable logistic regression adjusted for age, diabetes, renal insufficiency, and left ventricular ejection fraction, female sex was associated with an odds ratio of 4.18 (95% CI, 1.14–15.37; p=0.032); however, given the small sample and limited number of events, this estimate should be considered exploratory. These findings should therefore be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence of an independent prognostic effect of sex.

Correlation between SYNTAX Score and Myocardial Ischemia as Assessed by SPECT Myocardial Perfusion Imaging in Patients Undergoing Coronary Interventions

2026-09-28T09:33:12+00:00

Coronary artery disease (CAD) is a major cardiovascular health problem. Myocardial perfusion imaging (MPI), especially single-photon emission computed tomography (SPECT), provides valuable diagnostic and prognostic information after percutaneous coronary intervention (PCI). The Synergy Between PCI with TAXUS and Cardiac Surgery (SYNTAX) score evaluates coronary lesion complexity and predicts ischaemic burden and outcomes after revascularisation. The objective was to determine the correlation of the SYNTAX score with myocardial ischaemia measured by SPECT MPI among patients undergoing coronary interventions.

This prospective study was conducted in 85 patients undergoing coronary interventions. Each participant underwent clinical and local cardiac examination, together with laboratory testing comprising complete blood count (CBC), urea, serum creatinine, creatinine clearance, prothrombin time (PT), international normalised ratio (INR), and lipid profile.

SYNTAX I was significantly associated with myocardial ischaemia parameters, whereas SYNTAX II (PCI) was associated with SSS, SRS, SDS, and TPD (all P < 0.05). EF showed inverse correlations with SYNTAX I and SYNTAX II (PCI), whereas LDL showed no significant association. Patients with DM had higher SYNTAX I scores and TPD than those without DM (P < 0.05). SSS, SRS, SDS, and TPD differed significantly across SYNTAX I groups, whereas only SSS and SRS differed across SYNTAX II (PCI) groups. No significant associations were observed for SYNTAX II (CABG), HTN, dyslipidaemia, or smoking (P > 0.05).

SYNTAX I correlated with MPI parameters, while higher coronary complexity was associated with diabetes and reduced EF, supporting combined anatomical and functional assessment in CAD.

Valvular Prosthesis Dysfunction: A Single-Center Experience of 77 Cases — Clinical, Echocardiographic, and Etiological Profiles

2026-10-12T11:02:44+00:00

Background: Prosthetic valve dysfunction is a clinically important complication of valve replacement, with potentially serious haemodynamic, thromboembolic and infectious consequences. Its assessment requires evaluation of the clinical presentation, prosthetic valve haemodynamics and underlying mechanisms.

Objective: To describe the clinical, echocardiographic and aetiological characteristics of patients with prosthetic valve dysfunction managed at Mohammed VI University Hospital Centre, Marrakech.

Methods: This retrospective, observational, single-centre study included 77 patients with suspected or confirmed prosthetic valve dysfunction. Clinical characteristics, echocardiographic findings, cinefluoroscopic assessments and aetiological investigations were reviewed using the available hospital records.

Results: The mean patient age was 54.1 ± 13.6 years, and 53.2% were women. Most patients were symptomatic, with 62.3% classified as New York Heart Association functional class III–IV. Ischaemic neurological events were documented in 26.0% of patients, while respiratory instability occurred in 14.3%. Transthoracic echocardiography demonstrated satisfactory prosthetic valve opening in 48 patients (62.3%). Left ventricular systolic dysfunction was identified in 23 patients, including eight with severe dysfunction. The mean systolic pulmonary artery pressure was 38.3 ± 10.9 mmHg. Haemolysis was identified in 28 patients (36.4%), prosthetic valve thrombosis in 17 (22.1%), pannus formation in 15 (19.5%) and infective endocarditis in nine (11.7%). Several mechanisms coexisted or remained difficult to differentiate.

Conclusion: Prosthetic valve dysfunction demonstrated heterogeneous clinical and aetiological characteristics. An integrated assessment using echocardiography and complementary imaging was important for identifying the underlying mechanisms and informing clinical management.