In contrast to the well-defined and evidence-based limits of the ABI, the diagnostic criteria for a pathologic TBI remain ambiguous. Although several guidelines and reviews of PAD diagnostics recommend a TBI <0.70 as cutoff, it is not strictly evidence-based. The current literature is not sufficient to conclude a specific cutoff as diagnostic for PAD. The current studies in normal populations and the correlation with angiography are sparse, and additional trials are needed to further validate the limits. Large-scale trials are needed to establish the risk of morbidity and mortality for the various diagnostic limits of the TBI.

The APD showed excellent diagnostic test characteristics for detecting PAD compared to SGP. Furthermore, the APD had a good correlation in absolute toe pressures with SGP.

Strut chordal preservation was equivalent to total valve preservation during mitral valve replacement, whereas total chordal resection caused significant left ventricular slimming with compensatory increases in fractional shortening. Therefore, to preserve left ventricular geometry, special attention must be paid to maintain the valvular-ventricular continuity through the strut chordae during mitral valve replacement. This concept may have important therapeutic implications for chordal-sparing mitral valve replacement.

LDF showed a good correlation with SGP over a wide range of toe and ankle pressures, as well as substantial agreement for the diagnostic classification of PAD including CLI.