Combination of pulse volume recording (PVR) parameters and ankle–brachial index (ABI) improves diagnostic accuracy for peripheral arterial disease compared with ABI alone

Abstract

The ankle-brachial index (ABI) measurement is widely used as a screening tool to detect peripheral arterial disease (PAD). With the advent of the oscillometric ABI device incorporating a system for the measurement of pulse volume recording (PVR), not only ABI but also other parameters, such as the percentage of mean arterial pressure (%MAP) and the upstroke time (UT), can be obtained automatically. The purpose of the present study was to compare the diagnostic accuracy for PAD with ABI alone with that of a combination of ABI, %MAP and UT. This study included 108 consecutive patients on whom 216 limb measurements were performed. The sensitivity, specificity and positive and negative predictive values of ABI, %MAP, UT and their combination were evaluated and compared with CT angiography that was used as a gold standard for the detection of PAD. The diagnostic accuracy as well as the optimal cutoff values of %MAP and UT were evaluated using receiver operating characteristic (ROC) curve analysis. The combination of ABI, %MAP and UT achieved higher sensitivity, negative predictive value and accuracy than ABI alone, particularly for mild stenosis. The areas under the ROC curve for the detection of 50% stenosis with UT and %MAP were 0.798 and 0.916, respectively. The optimal UT and %MAP values to detect ≧50% stenosis artery were 183 ms and 45%, respectively. The combination of ABI, %MAP and UT contributed to the improvement of the diagnostic accuracy for PAD. Consideration of the values of %MAP and UT in addition to ABI may have a significant impact on the detection of early PAD lesions.

Comparison of Diagnostic Accuracy between Pulse Volume Recording Parameters and Exercise-Ankle-Brachial Pressure Index in Patients with Ankle-Brachial Pressure Index above 0.91

“…%MAP indicates the presence of stenosis lesions in the region with 0.9 or lower ABI, but this ability may not be expected for regions with 0.91 or higher ABI. In the study reported by Hashimoto et al, 6) AUC of UT was 0.798, being almost consistent with that (0.810) in our study. These studies suggest that the diagnostic ability of UT is constantly high regardless of ABI being 0.9 or lower or 0.91 or higher.…”

“…Hashimoto et al 6) evaluated the diagnostic abilities of %MAP and UT using CTA as a reference in a group including many patients with 0.9 or lower ABI (range: 0.63-1.11), in which AUC of %MAP was 0.916. In contrast, in our study limiting patients to those with 0.91 or higher ABI, the diagnostic ability of %MAP decreased (AUC = 0.700).…”

“…Solving these problems was tried by concomitant use of pulse volume recoding (PVR) for measurement of ABI in some studies. [4][5][6] Using oscillometric methods, PVR parameters can be measured simultaneously with ABI, being easy to introduce it into clinical sites. However, it is unclear whether or not these PVR parameters have screening capability equivalent to Ex-ABI.…”

Use of the Combination of Ankle-brachial Index and Percentage of Mean Arterial Pressure at Ankle for Improving Prediction of All-cause Mortality in type 2 Diabetes Mellitus

“…The %MAP represents the percentage difference between the mean and maximum amplitude of the ankle pulse volume waveform [11]. An occluded artery with a atted waveform will result in an increased in %MAP value [10]. Therefore, the pulse volume recording at the ankle might be a sensitive indicator of an occlusive artery with a non-compressible pattern, which is frequently observed in patients with DM [21].…”

Noninvasive Arterial Testing: What and When to Use

“…Unlike ABIs, vascular calcification and poor compressibility do not degrade PVRs. 12,16 As such, PVRs are considered a useful adjunct to segmental pressures in the vascular laboratory. 17,18 When combined with segmental pressures, PVRs have a reported diagnostic accuracy as high as 97%.…”