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Pulse volume recordings to identify falsely elevated ankle brachial index

Takuro Shirasu1, Katsuyuki Hoshina2, Daisuke Akagi1

  • 1Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Asian Cardiovascular & Thoracic Annals
|May 28, 2016
PubMed

Insights

Pulse volume recording parameters, specifically percentage mean artery pressure, can help identify falsely elevated ankle-brachial index (ABI) in patients with diabetes and medial arterial calcification. This improves diagnostic accuracy for peripheral arterial disease.

Area of Science:

  • Vascular Medicine
  • Diagnostic Imaging
  • Diabetology

Background:

  • Ankle-brachial index (ABI) can be falsely elevated due to medial arterial calcification, limiting its use, particularly in diabetic patients.
  • Peripheral arterial disease (PAD) diagnosis relies on accurate ABI measurements, but calcification poses a significant challenge.

Purpose of the Study:

  • To evaluate the utility of pulse volume recording (PVR) in detecting falsely elevated ABI.
  • To assess if PVR parameters can improve the accuracy of PAD diagnosis in at-risk populations.

Main Methods:

  • Retrospective analysis of PVR in 171 patients (342 limbs), with 43% diagnosed with diabetes.
  • Automatic calculation of pulse waveform parameters: upstroke time and percentage mean artery pressure.
  • Comparison of ABI with toe-brachial index (TBI) to identify discrepancies.

Main Results:

  • Diabetes, low ABI (≤0.90), prolonged upstroke time (≥180 ms), and high percentage mean artery pressure (≥45%) were associated with a low TBI (<0.60).
  • In patients with ABI > 0.90, percentage mean artery pressure ≥45% differentiated diabetic patients from controls (0.45 ± 0.17 vs. 0.35 ± 0.16, p=0.03).
  • Upstroke time did not significantly discriminate falsely elevated ABI.

Conclusions:

  • While ABI is the gold standard for PAD diagnosis, percentage mean artery pressure offers a valuable adjunct.
  • Percentage mean artery pressure, derived during ABI measurement, can help identify falsely elevated ABI, especially in diabetic individuals.
  • PVR parameters, particularly percentage mean artery pressure, enhance the diagnostic capability of ABI in complex cases.
Abstract

Keywords:
AnkleAtherosclerosisBlood pressureBrachial arteryDiabetes complicationsPeripheral vascular diseases

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