Pulse volume recordings to identify falsely elevated ankle brachial index

2020

Cardiovasc Diabetol

Background Peripheral artery disease (PAD) in the lower extremities is a common complication of type 2 diabetes and has been shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but this method has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) in combination with the ABI would improve the prediction of mortality. Methods We retrospectively collected data from patients with type 2 diabetes who had undergone ABI and %MAP measurements at our hospital. We separated the cohort into four groups according to their ABI and %MAP values, and we examined whether these indices were associated with mortality. Results A total of 5569 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of the enrolled patients died. The combination of ABI and %MAP was significantly more effective than ABI alone for predicting mortality (C index of 0.62, 95% confidence interval [CI] of 0.57 to 0.65 vs. C index of 0.57, 95% CI of 0.53 to 0.62; P = 0.038). In multivariate analysis (with a reference group defined by ABI > 0.90 and %MAP ≤ 45%), the highest risk of mortality was seen in patients with ABI ≤ 0.90 and %MAP > 45% (hazard ratio = 2.045 [95% CI 1.420, 2.945], P < 0.001). Conclusions The use of %MAP alongside ABI appears to significantly improve the prediction of all-cause mortality in patients with type 2 diabetes.

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: an observational study

2020

Cardiovasc Diabetol

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

2020

Preprint

Background: Peripheral artery disease (PAD) in lower extremities is a common complication in type 2 diabetes and has shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) and the ABI in combination would improve prediction of mortality.Methods: We retrospectively collected the data of patients with type 2 diabetes who had undergone measurement of ABI and %MAP at our hospital. We separated the cohort into four groups according to the ABI and %MAP values, and examined these indices were associated with mortality.Results: A total of 5101 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of enrolled patients died. The combination of ABI and %MAP was significantly better at predicting mortality than ABI alone. (C index: 0.62 [95% CI: 0.57, 0.65] vs. 0.57 [95% CI: 0.53, 0.62], P = 0.038). In multivariate analysis (with ABI >0.90 and %MAP ≤45% as the reference group), the highest risk of mortality was seen in patients with ABI ≤0.90 and %MAP >45% (hazard ratio = 1.983 [95% CI: 1.380, 2.848], P < 0.001).Conclusions: Adding %MAP to ABI appears to significantly improve the predictive ability for all-cause mortality in patients with type 2 diabetes.

“…In contrast, a attened pulse volume waveform in patients with DM was more closely associated with PAD than a low ABI value was, regardless of ankle arterial stiffness [29,30]. The %MAP represents the percentage difference between the mean and maximum amplitude of the ankle pulse volume waveform [12]. A attened waveform resulting from an occluded artery will increase the %MAP value, which is not strongly affected by noncompressible arteries [11,30].…”

Section: Discussionmentioning

confidence: 99%

Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: An observational study

2020

Preprint

Background: Peripheral artery disease (PAD) in the lower extremities is a common complication of type 2 diabetes and has been shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but this method has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) in combination with the ABI would improve the prediction of mortality.Methods: We retrospectively collected data from patients with type 2 diabetes who had undergone ABI and %MAP measurements at our hospital. We separated the cohort into four groups according to their ABI and %MAP values, and we examined whether these indices were associated with mortality.Results: A total of 5569 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of the enrolled patients died. The combination of ABI and %MAP was significantly more effective than ABI alone for predicting mortality (C index of 0.62, 95% confidence interval [CI] of 0.57 to 0.65 vs. C index of 0.57, 95% CI of 0.53 to 0.62; P = 0.038). In multivariate analysis (with a reference group defined by ABI >0.90 and %MAP ≤45%), the highest risk of mortality was seen in patients with ABI ≤0.90 and %MAP >45% (hazard ratio = 2.045 [95% CI: 1.420, 2.945], P < 0.001).Conclusions: The use of %MAP alongside ABI appears to significantly improve the prediction of all-cause mortality in patients with type 2 diabetes.