Endofibrosis in Athletes: Is a Simple Bedside Exercise Helpful or Sufficient for the Diagnosis?

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Objective:Ankle-to-brachial index (ABI) can be easily performed by all physicians. The Ruffier-Dickson (RD) test is an easy procedure to attain moderate exercise at the bedside for physicians who do not have an ergometer.Design:Retrospective analysis.Setting:Tertiary care, institutional practice.Patients:Fifty-three asymptomatic athletes and 22 patients suffering from unilateral pain due to histologically proven exercise-induced arterial endofibrosis (EIAE).Intervention:Brachial and ankle systolic blood pressures were measured in the supine position on the suspected leg in EIAE or left leg in controls, at rest (rest) and at the first minute of the recovery from incremental maximal cycle ergometer exercise (maxCE) and Ruffier-Dickson (RD) exercise tests.Main Outcome Measures:Comparison of ABIrest, ABImaxCE, and ABIRD in discriminating patients from normal subjects, using receiver operating characteristics (ROC) curves.Results:Area (±SE of area) of ROC curve was 0.76 ± 0.06 for ABIrest, 0.83 ± 0.05 for ABIRD (nonsignificant from rest), and 0.99 ± 0.01 for ABImaxCE (P < 0.01 from ABIRD and P < 0.001 from ABIrest). An ABImaxCE below 0.48 was 100% specific and 80% sensitive for EIAE. For the RD test, a 100% negative predictive value was only attained for postexercise ABI values higher than 0.92.Conclusion:ABI after maximal cycle ergometer exercise is more accurate than ABI after an RD test to search for unilateral EIAE in athletes.

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