scholarly journals Automated Measurements of Ankle-Brachial Index: A Narrative Review

2021 ◽  
Vol 10 (21) ◽  
pp. 5161
Author(s):  
Aleksandra Danieluk ◽  
Sławomir Chlabicz
Keyword(s):  
Lower Limb ◽  
Reliable Method ◽  
Ankle Brachial Index ◽  
Diagnostic Tools ◽  
Peripheral Artery ◽  
Asymptomatic Patients ◽  
Pubmed Database ◽  
Automated Measurements ◽  
Air Plethysmography ◽  
Artery Disease

Peripheral artery disease (PAD) is an atherosclerotic disease that causes obstruction in lower limb arteries. It increases cardiovascular risk even in asymptomatic patients. Accurate diagnostic tools for identification of affected individuals are needed. Recently, there have been attempts to establish a reliable method of automated ankle-brachial index (ABI) identification. A search of PubMed database to identify studies assessing automatic ABI measurements in agreement with standard PAD diagnosis methods was conducted in December 2020. A total of 57 studies were analyzed in the review. The majority of analyzed studies found ABI measured by automatic oscillometric devices to be potentially feasible for use. Some note that, even though the Doppler and oscillometric methods are not fully interchangeable, the oscillometric devices could be used in screening. Significantly fewer publications are available on automatic plethysmographic devices. For photoplethysmography, most studies reported either good or moderate agreement with reference standards. For air plethysmography, poorer agreement with Doppler ABI is suggested. It is noted that pulse volume recording (PVR) function may improve the diagnostic accuracy of the devices.

scholarly journals Screening Peripheral Artery Disease using the Systolic Rise Time Measured with Photoplethysmography

2021 ◽  
pp. 1-4
Author(s):  
Hasan Obeid ◽  
◽  
Georges Leftheriotis ◽  
Keyword(s):  
Pilot Study ◽  
Lower Limb ◽  
Rise Time ◽  
Gold Standard ◽  
Pulse Wave ◽  
Ankle Brachial Index ◽  
Limiting Factor ◽  
Peripheral Artery ◽  
Peripheral Artery Occlusive Disease ◽  
Artery Disease

Screening for Peripheral Artery Occlusive Disease (PAOD) remains a challenge in the prevention and care of patients with arteriosclerosis. The Ankle Brachial Index (ABI) is currently the gold standard. However, ABI is time consuming and requires some expertise to perform which is a limiting factor for global screening. The measurement of the Systolic Rise Time (SRT) of the pulse wave of the lower limb may provide an easier alternative to detect PAOD. In a retrospective pilot study, we analyzed the possibility of detecting PAOD using the SRT of the toe waveform using the Photo-PlethysmoGraphic signal (PPG).

P947Combining the ankle-brachial index with novel waveshape-based methods improves peripheral artery disease classification

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Bachler ◽  
M Haumer ◽  
B Hametner ◽  
C C Mayer ◽  
K Glantschnig ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Univariate Analysis ◽  
Ankle Brachial Index ◽  
Disease Classification ◽  
Statistical Independence ◽  
Peripheral Artery ◽  
Discrimination Power ◽  
Asymptomatic Patients ◽  
Artery Disease ◽  
Fontaine Stage

Abstract The Ankle Brachial Index (ABI) is the most commonly used method for the investigation of peripheral artery disease (PAD) in clinical settings, but has a low sensitivity for detecting PAD in asymptomatic patients. It is calculated only based on the systolic blood pressure in the limbs and ignores the shape of the pressure waves. Therefore, we investigated a novel method focusing on waveform changes by analyzing and comparing synchronous pulse wave recordings of all four extremities. In this study, pulse waves of 44 patients (28M/16F, age 65 (SD 10) years, ABI 0.89 (SD 0.13)) measured at rest on all four limbs simultaneously using the AngE Pro 4 system (Sonotechnik Austria Angio Experience GmbH, Austria) were investigated. The patients Fontaine stage was used as a benchmark. A novel parameter based on pairwise wave shape differences, i.e., the root mean square of the differences (RMSD), was tested for its capability to correctly classify the patients Fontaine stage. Furthermore, the results were compared and combined with ABI measurements. Of the 44 patients, 7 were in Fontaine stage 0 (no PAD) and 37 in stage 2 (claudication). In univariate analysis, ABI showed significant discrimination power (AUC ROC = 0.86, p<0.01), but was surpassed by the RMSD with a discrimination power beyond ABI (AUC ROC = 0.95, p<0.001, see figure). Furthermore, logistic regression revealed statistical independence of ABI and RMSD, indicating that they reflect different aspects of the measurements. Therefore, combining these two measures, multivariate classification results in a far superior classifier (AUC ROC = 0.98, p<0.001, see figure). In this study, the novel waveshape-based method RMSD, used to classify stages of PAD, showed better discrimination power than ABI. Furthermore, statistical independence allowed for the combination of ABI and RMSD, resulting in a far superior classification of PAD Fontaine stages. Since, using the appropriate equipment, both parameters can be measured simultaneously and in an automated way, the results are promising for assisting PAD classification in the future. Acknowledgement/Funding This work was partly supported by the program “Bridge” by the Austrian Ministry for Transport, Innovation and Technology BMVIT. PWA4PAD FFG No. 858509

scholarly journals Microvascular Disease Increases Amputation in Patients With Peripheral Artery Disease

2020 ◽  
Vol 40 (3) ◽  
pp. 534-540 ◽  
Author(s):  
Adam Behroozian ◽  
Joshua A. Beckman
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Microvascular Disease ◽  
Microvascular Dysfunction ◽  
The United States ◽  
Occlusive Disease ◽  
Peripheral Artery ◽  
Capillary Bed ◽  
Artery Disease

It is estimated that >2 million patients are living with an amputation in the United States. Peripheral artery disease (PAD) and diabetes mellitus account for the majority of nontraumatic amputations. The standard measurement to diagnose PAD is the ankle-brachial index, which integrates all occlusive disease in the limb to create a summary value of limb artery occlusive disease. Despite its accuracy, ankle-brachial index fails to well predict limb outcomes. There is an emerging body of literature that implicates microvascular disease (MVD; ie, retinopathy, nephropathy, neuropathy) as a systemic phenomenon where diagnosis of MVD in one capillary bed implicates microvascular dysfunction systemically. MVD independently associates with lower limb outcomes, regardless of diabetic or PAD status. The presence of PAD and concomitant MVD phenotype reveal a synergistic, rather than simply additive, effect. The higher risk of amputation in patients with MVD, PAD, and concomitant MVD and PAD should prompt aggressive foot surveillance and diagnosis of both conditions to maintain ambulation and prevent amputation in older patients.

Occupational standing and change in the Ankle-Brachial Index: the Jackson Heart Study

2020 ◽  
pp. oemed-2020-106905
Author(s):  
Ciaran P Friel ◽  
Andrea T Duran ◽  
Marwah Abdalla ◽  
Jonathan T Unkart ◽  
John Bellettiere ◽  
...  
Keyword(s):  
African Americans ◽  
Lower Limb ◽  
Ankle Brachial Index ◽  
Significant Decline ◽  
Jackson Heart Study ◽  
Peripheral Artery ◽  
Community Based ◽  
Heart Study ◽  
Artery Disease

BackgroundA growing interest in reducing occupational sitting has resulted in public health efforts to encourage intermittent standing in workplaces. However, concerns have been raised that standing for prolonged periods may expose individuals to new health hazards, including lower limb atherosclerosis. These concerns have yet to be corroborated or refuted. The purpose of this study was to investigate the association between occupational standing and adverse changes in the Ankle-Brachial Index (ABI).MethodsWe studied 2121 participants from the Jackson Heart Study, a single-site community-based study of African-Americans residing in Jackson, MS. Occupational standing (‘never/seldom’, ‘sometimes’, ‘often/always’) was self-reported at baseline (2000–2004). ABI was measured at baseline and again at follow-up (2009–2013).ResultsOver a median follow-up of 8 years, 247 participants (11.6%) exhibited a significant decline in ABI (eg, ABI decline >0.15). In multivariable-adjusted models, higher occupational standing was not significantly associated with ABI decline (occupational standing sometimes vs never/seldom: OR 1.05; 95% CI 0.67, 1.66; occupational standing often/always vs never/seldom: OR 1.22; 95% CI 0.77, 1.94). Similarly, higher occupational standing was not associated with low ABI at follow-up reflective of peripheral artery disease (ABI <0.90) or high ABI at follow-up reflective of incompressible vessels (ABI >1.40).ConclusionsIn this community-based study of African-Americans, we found no evidence that occupational standing is deleteriously associated with adverse changes in ABI over a median follow-up of 8.0 years. These findings do not provide evidence implicating occupational standing as a risk factor for lower limb atherosclerosis.

scholarly journals Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽  
2021 ◽  
pp. 000331972110043
Author(s):  
Clemens Höbaus ◽  
Gerfried Pesau ◽  
Bernhard Zierfuss ◽  
Renate Koppensteiner ◽  
Gerit-Holger Schernthaner
Keyword(s):  
Peripheral Artery Disease ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Enzyme Linked Immunosorbent Assay ◽  
Peripheral Artery ◽  
Cross Sectional ◽  
Term Survival ◽  
Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

scholarly journals Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Yu ◽  
J Teliewubai ◽  
X Fan ◽  
C Chi ◽  
H Ji ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Peripheral Artery Disease ◽  
Wave Reflection ◽  
Pulse Wave ◽  
Ankle Brachial Index ◽  
Community Dwelling ◽  
Peripheral Artery ◽  
Cardiac Damage ◽  
Pulse Wave Reflection ◽  
Artery Disease

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P&lt;0.001) but higher AP (19 vs. 17 mmHg, P&lt;0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

scholarly journals Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study

Diabetologia ◽  
2021 ◽  
Vol 64 (3) ◽  
pp. 668-680
Author(s):  
Capucine Bertrand ◽  
◽  
Pierre-Jean Saulnier ◽  
Louis Potier ◽  
Mikaël Croyal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Plasma Concentrations ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1407
Author(s):  
Robert K. Clemens ◽  
Monika Hunjadi ◽  
Andreas Ritsch ◽  
Lucia Rohrer ◽  
Thomas O. Meier ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Cholesterol Efflux ◽  
Ankle Brachial Index ◽  
Mortality Rates ◽  
High Density Lipoproteins ◽  
Peripheral Artery ◽  
Cholesterol Efflux Capacity ◽  
Hdl Function ◽  
All Cause Mortality ◽  
Artery Disease

Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.

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