Assessing hemodynamic changes in diabetic patients with and without peripheral arterial disease using dynamic
Rabah Al Abdi1,2, Nesreen Saadeh3, Heba Hijazi4,5
1Electrical Computer and Biomedical Engineering Department, College of Engineering, Abu Dhabi University, Abu Dhabi, United Arab Emirates. rmalabdi@just.edu.jo.
Background:
Peripheral Arterial Disease (PAD) affects approximately 230 million people globally and is prevalent in 20%-50% of individuals with diabetes. Current diagnostic tools, such as the ankle-brachial index, have limited sensitivity in diabetic populations. This study utilizes dynamic vascular optical spectroscopy (DVOS) at thigh occlusion pressures of 60 and 100 mmHg to examine hemodynamic responses in the feet of diabetic patients, primarily aiming to enhance the detection of PAD in this group. We conducted a prospective cohort study involving 118 diabetic patients with PAD (50 males; age: 59.1 ± 7.9 years) and 118 diabetic subjects without PAD (52 males; age: 54.8 ± 13.7 years). DVOS was used to measure changes in oxyhemoglobin (ΔHbO), hemoglobin flow (HF), and tissue oxygen consumption (VO2) in the foot during occlusions. Group differences were assessed using the Mann-Whitney U test, and multivariable logistic regression was used to adjust for age, sex, diabetes duration, and hypertension duration, BMI, and smoking status. Diagnostic performance was measured using ROC analysis with stratified fivefold cross-validation.
Results:
The 60-mmHg occlusion revealed clearer hemodynamic differences than the 100-mmHg. During 60-mmHg occlusion, mean values for ΔHbO (2.0 ± 1.74 μmol), HF (0.86 ± 0.49 μmol/s), and VO2 (0.040 ± 0.022 mL O2/100 mL tissue/min) were significantly lower in the PAD group compared to the non-PAD group (ΔHbO: 6.81 ± 4.11 μmol; HF: 2.48 ± 0.85 μmol/s; VO2: 0.066 ± 0.035 mL O2/100 mL/min; p < 0.00625). After adjustment for covariates, HF during the 60-mmHg occlusion remained the strongest discriminator for PAD, with an AUC of 0.983, accuracy of 0.918, sensitivity of 0.932, and specificity of 0.904 (mean across folds).
Conclusions:
Hemodynamic parameters measured by DVOS during thigh venous occlusion differ significantly between diabetic patients with and without PAD. Our findings suggest that 60-mmHg occlusion is more effective than 100 mmHg for eliciting PAD-sensitive hemodynamic parameters. These results highlight the potential sensitivity of DVOS to PAD-related vascular impairment during low-pressure thigh occlusion.
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