Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9-87.6%), with specificity 71.9% (95% CI 63.7-79.2%). ABPI sensitivity was 80.2% (95% CI 70.8-87.6%), with specificity 88.6% (95% CI 82-93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.

Assessing Automatic Plethysmographic Ankle-Brachial Index Devices in Peripheral Artery Disease Detection: A Comparative Study with Doppler Ankle-Brachial Index Measurements

BACKGROUND The ankle-brachial index (ABI) is a critical diagnostic test for peripheral artery disease (PAD), albeit requiring technical expertise and dedicated resources. The advent of automatic ABI devices proposes a more accessible approach, necessitating fewer resources and less expertise. This study was conducted to gather data on PAD prevalence and to evaluate the correlation and efficacy of automatic ABI measurements vs traditional Doppler ABI measurements to understand their potential role in primary care settings. MATERIAL AND METHODS ABI measurements were obtained using both the Doppler method and an automatic plethysmographic device (Dopplex ABility, Huntleigh Healthcare). RESULTS Of the 290 participants (mean age 67.6±7.4 years), Doppler ABI method identified 16.8% with abnormal results (<0.9), while the automatic method identified only 5.9%. The mean Doppler ABI was 1.05±0.15, and the mean automatic ABI was 1.12±0.13. The sensitivity of the automatic ABI measurements was 22.2%, and the specificity was 96.8%, with a positive predictive value of 57.1%, and a negative predictive value of 86.9%. Adjustments in the automatic assessment and inclusion of pulse wave velocity enhanced the diagnostic capabilities of the automatic ABI device. CONCLUSIONS While the automatic plethysmographic ABI device may lack the necessary diagnostic capabilities to replace the traditional Doppler ABI device as a standalone test in PAD diagnosis, it could still offer significant value in primary care settings if integrated with adjusted cut-off points and pulse wave velocity analysis.

Epidemiology of Peripheral Artery Disease: Narrative Review

Past decades have witnessed a major epidemiologic transition with a considerable increase in the disease burden associated with atherosclerotic cardiovascular diseases (CVDs), with low-income and middle-income countries (LMICs) experiencing substantial increase in CVDs. As the global population is aging and peripheral artery disease (PAD) is strongly age-related, it is estimated to become increasingly prevalent in the future. PAD shares risk factors with coronary and cerebrovascular risk factors, particularly diabetes mellitus and smoking, and is associated with significant CVD morbidity and mortality. Despite advances in therapeutic modalities, 236 million people were estimated to be suffering from PAD worldwide in 2015, and numbers have been rising since. The prevalence of asymptomatic PAD has remained high; PAD prevalence seems higher among women and is related to ethnicity. Although several epidemiological studies have been published on PAD during the past decades, data from LMICs are scarce. Besides providing up-to-date epidemiological data retrieved from the literature and the Global Burden of Disease (GBD) study database, this narrative review also intends to draw attention to the substantial disease burden of PAD manifesting in more Years of Life Lost (YLL), age-adjusted mortality and amputation rates, with a special focus on some European countries and especially Hungary, i.e., the country with the highest amputation rate in Europe.