nach oben

Erschienen in:

01.11.2012 | Original Paper

Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography

verfasst von: Frank Beutner, Andrej Teren, Stephan Gielen, Gerhard Schuler, Kerstin Wirkner, Daniel Tiller, Markus Loeffler, Markus Scholz

Erschienen in: Clinical Research in Cardiology | Ausgabe 11/2012

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Determination of ankle-brachial-index (ABI) by manual Doppler is well established to screen for lower extremity arterial disease (LEAD) and to predict cardiovascular risk. A new generation of digital-controlled devices promises automated ABI determination. The aim of this study was to determine comparability of automated photoplethysmography (PPG)-derived ABI calculation with the Doppler-ABI algorithm commonly used in cohort studies.

Methods

Automated PPG-based ABI measurements [Vascular Explorer (VE) and Vicorder (VI)] were recorded from 112 limbs of healthy subjects and 22 limbs of patients with confirmed LEAD. Validity was evaluated on the basis of receiver-operating characteristic (ROC) analysis of clinical status and concordance with Doppler-ABI. Differences between cuff inflation [inf]- and deflation [def]-based method were studied in VE.

Results

PPG-based ABI values were higher compared to Doppler-ABI (VI +0.06, VEinf +0.15, VEdef +0.09, p < 0.001, respectively). The difference was pronounced in pathological (<0.9), borderline (0.9–0.99) and low normal (1.0–1.09) ABI, but less in ABI ≥1.1. However, ROC analysis revealed excellent diagnostic value for LEAD (sensitivity/specificity) and comparable area under the curve at method-adapted ABI thresholds for all methods: Doppler (95/90 %, 0.95), VI (75/96 %, 0.91), VEinf (85/89 %, 0.93) and VEdef (80/98 %, 0.94).

Conclusions

Digital-controlled PPG-based ABI determination is a useful diagnostic application for LEAD. However, the systematic higher ABI in PPG-based measurement compared to Doppler and remarkable differences between the deflationary and inflationary method are critical for the interpretation of borderline and low normal ABI values where precise reading is essential to detect mild LEAD and subclinical disease and to predict cardiovascular risk.

Nur mit Berechtigung zugänglich

Ferket BS, Spronk S, Colkesen EB, Hunink MG (2012) Systematic review of guidelines on peripheral artery disease screening. Am J med 125(2):198–199. doi:10.1016/j.amjmed.2011.06.027 PubMedCrossRef

Heald CL, Fowkes FG, Murray GD, Price JF (2006) Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis 189(1):61–69. doi:10.1016/j.atherosclerosis.2006.03.011 PubMedCrossRef

Zeymer U, Parhofer KG, Pittrow D, Binz C, Schwertfeger M, Limbourg T, Rother J (2009) Risk factor profile, management and prognosis of patients with peripheral arterial disease with or without coronary artery disease: results of the prospective German REACH registry cohort. Clin Res Cardiol Off J Ger Cardiac Soc 98(4):249–256. doi:10.1007/s00392-009-0754-1

Rastan A, Schwarzwalder U, Noory E, Taieb FH, Beschorner U, Sixt S, Burgelin K, Amantea P, Neumann FJ, Zeller T (2010) Primary use of sirolimus-eluting stents in the infrapopliteal arteries. J Endovasc Ther Off J Int Soc Endovasc Specialists 17(4):480–487. doi:10.1583/10-3073.1 CrossRef

Kalsch HI, Eggebrecht H, Mayringer S, Konorza T, Sievers B, Sack S, Erbel R, Kroeger K (2008) Randomized comparison of effects of suture-based and collagen-based vascular closure devices on post-procedural leg perfusion. Clin Res Cardiol Off J Ger Cardiac Soc 97(1):43–48. doi:10.1007/s00392-007-0575-z

Zankl AR, Ivandic B, Andrassy M, Volz HC, Krumsdorf U, Blessing E, Katus HA, Tiefenbacher CP (2010) Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease. Clin Res Cardiol Off J Ger Cardiac Soc 99(12):787–794. doi:10.1007/s00392-010-0184-0

Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, Golzarian J, Gornik HL, Halperin JL, Jaff MR, Moneta GL, Olin JW, Stanley JC, White CJ, White JV, Zierler RE (2011) 2011 ACCF/AHA Focused Update of the Guideline for the Management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 58(19):2020–2045. doi:10.1016/j.jacc.2011.08.023 PubMedCrossRef

Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Rother J, Sievert H, van Sambeek M, Zeller T, Bax J, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu B, Reiner Z, Sechtem U, Sirnes PA, Torbicki A, Vahanian A, Windecker S, Agewall S, Blinc A, Bulvas M, Cosentino F, De Backer T, Gottsater A, Gulba D, Guzik TJ, Jonsson B, Kesmarky G, Kitsiou A, Kuczmik W, Larsen ML, Madaric J, Mas JL, McMurray JJ, Micari A, Mosseri M, Muller C, Naylor R, Norrving B, Oto O, Pasierski T, Plouin PF, Ribichini F, Ricco JB, Ruilope L, Schmid JP, Schwehr U, Sol BG, Sprynger M, Tiefenbacher C, Tsioufis C, Van Damme H (2011) ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 32(22):2851–2906. doi:10.1093/eurheartj/ehr211 PubMedCrossRef

Jonsson B, Laurent C, Eneling M, Skau T, Lindberg LG (2005) Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 30(4):395–401. doi:10.1016/j.ejvs.2005.05.012 CrossRef

10.

Beutner F, Teupser D, Gielen S, Holdt LM, Scholz M, Boudriot E, Schuler G, Thiery J (2011) Rationale and design of the Leipzig (LIFE) Heart Study: phenotyping and cardiovascular characteristics of patients with coronary artery disease. PLoS One 6(12):e29070. doi:10.1371/journal.pone.0029070 PubMedCrossRef

11.

Barnhart HX, Haber M, Song J (2002) Overall concordance correlation coefficient for evaluating agreement among multiple observers. Biometrics 58(4):1020–1027PubMedCrossRef

12.

Efron B (1981) Nonparametric estimates of standard errors: the jackknife, the bootstrap and other methods. Biometrika 68(3):589–599CrossRef

13.

Alpert BS (2011) Validation of the Welch Allyn SureBP (inflation) and StepBP (deflation) algorithms by AAMI standard testing and BHS data analysis. Blood Press Monit 16(2):96–98. doi:10.1097/MBP.0b013e328345232f PubMedCrossRef

14.

Khandanpour N, Armon MP, Jennings B, Clark A, Meyer FJ (2009) Photoplethysmography, an easy and accurate method for measuring ankle brachial pressure index: can photoplethysmography replace Doppler? Vasc Endovascular Surg 43(6):578–582. doi:10.1177/1538574409334829 PubMedCrossRef

15.

Sadiq S, Chithriki M (2001) Arterial pressure measurements using infrared photosensors: comparison with CW Doppler. Clin Physiol 21(1):129–132PubMedCrossRef

16.

Diehm C, Lange S, Darius H, Pittrow D, von Stritzky B, Tepohl G, Haberl RL, Allenberg JR, Dasch B, Trampisch HJ (2006) Association of low ankle brachial index with high mortality in primary care. Eur Heart J 27(14):1743–1749. doi:10.1093/eurheartj/ehl092 PubMedCrossRef

17.

McDermott MM, Guralnik JM, Tian L, Liu K, Ferrucci L, Liao Y, Sharma L, Criqui MH (2009) Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study). J Am Coll Cardiol 53(12):1056–1062. doi:10.1016/j.jacc.2008.09.063 PubMedCrossRef

18.

Korhonen PE, Seppala T, Kautiainen H, Jarvenpaa S, Aarnio PT, Kivela SL (2011) Ankle-brachial index and health-related quality of life. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. doi:10.1177/1741826711420346

19.

Takahashi R, Imamura A, Yoshikane M, Suzuki M, Murakami R, Cheng XW, Numaguchi Y, Ikeda N, Murohara T, Okumura K (2011) High serum concentrations of pentosidine, an advanced glycation end product, are associated with low normal value of ankle-brachial index in apparently healthy men. Metab Clin Exp 60(5):649–654. doi:10.1016/j.metabol.2010.06.015 PubMedCrossRef

20.

Jobbagy A (2004) Using the photoplathysmographic signal for increasing the accuracy of indirect blood pressure measurement. Proc Estonian Acad Sci Eng 10(2):110–122

21.

Diehm C, Lawall H (2006) Diabetes, heart surgery and the peripheral arteries. Clin Res Cardiol Off J German Cardiac Soc 95(Suppl 1):i63–i69. doi:10.1007/s00392-006-1123-y

22.

Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE (1998) Peripheral arterial disease in the elderly: The Rotterdam study. Arterioscler Thromb Vasc Biol 18(2):185–192PubMedCrossRef

23.

Murabito JM, Guo CY, Fox CS, D’Agostino RB (2006) Heritability of the ankle-brachial index: the Framingham Offspring study. Am J Epidemiol 164(10):963–968. doi:10.1093/aje/kwj295 PubMedCrossRef

24.

Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, Powe NR, Siscovick D (1999) Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol 19(3):538–545PubMedCrossRef

25.

Eldrup N, Sillesen H, Prescott E, Nordestgaard BG (2006) Ankle brachial index, C-reactive protein, and central augmentation index to identify individuals with severe atherosclerosis. Eur Heart J 27(3):316–322. doi:10.1093/eurheartj/ehi644 PubMedCrossRef

26.

Lamina C, Meisinger C, Heid IM, Lowel H, Rantner B, Koenig W, Kronenberg F (2006) Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up. Eur Heart J 27(21):2580–2587. doi:10.1093/eurheartj/ehl228 PubMedCrossRef

27.

Weatherley BD, Nelson JJ, Heiss G, Chambless LE, Sharrett AR, Nieto FJ, Folsom AR, Rosamond WD (2007) The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study, 1987–2001. BMC Cardiovasc Disord 7:3. doi:10.1186/1471-2261-7-3 PubMedCrossRef

28.

Leng GC, Fowkes FG, Lee AJ, Dunbar J, Housley E, Ruckley CV (1996) Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ 313(7070):1440–1444PubMedCrossRef

29.

Smith FB, Lee AJ, Price JF, van Wijk MC, Fowkes FG (2003) Changes in ankle brachial index in symptomatic and asymptomatic subjects in the general population. J Vasc Surg 38(6):1323–1330. doi:10.1016/S0741(Official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter)PubMedCrossRef

30.

Tivesten A, Mellstrom D, Jutberger H, Fagerberg B, Lernfelt B, Orwoll E, Karlsson MK, Ljunggren O, Ohlsson C (2007) Low serum testosterone and high serum estradiol associate with lower extremity peripheral arterial disease in elderly men. The MrOS study in Sweden. J Am Coll Cardiol 50(11):1070–1076. doi:10.1016/j.jacc.2007.04.088 PubMedCrossRef

31.

Wassel CL, Loomba R, Ix JH, Allison MA, Denenberg JO, Criqui MH (2011) Family history of peripheral artery disease is associated with prevalence and severity of peripheral artery disease: the San Diego Population Study. J Am Coll Cardiol 58(13):1386–1392. doi:10.1016/j.jacc.2011.06.023 PubMedCrossRef

32.

Schroder F, Diehm N, Kareem S, Ames M, Pira A, Zwettler U, Lawall H, Diehm C (2006) A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease. J Vasc Surg 44(3):531–536. doi:10.1016/j.jvs.2006.05.016 (Official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter)PubMedCrossRef

33.

Espinola-Klein C, Rupprecht HJ, Bickel C, Lackner K, Savvidis S, Messow CM, Munzel T, Blankenberg S (2008) Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation 118(9):961–967. doi:10.1161/CIRCULATIONAHA.107.763227 PubMedCrossRef

34.

Niazi K, Khan TH, Easley KA (2006) Diagnostic utility of the two methods of ankle brachial index in the detection of peripheral arterial disease of lower extremities. Catheter Cardiovasc Interv Off J Soc Cardiac Angiogr Interv 68(5):788–792. doi:10.1002/ccd.20906 CrossRef

35.

Allison MA, Aboyans V, Granston T, McDermott MM, Kamineni A, Ni H, Criqui MH (2010) The relevance of different methods of calculating the ankle-brachial index: the multi-ethnic study of atherosclerosis. Am J Epidemiol 171(3):368–376. doi:10.1093/aje/kwp382 PubMedCrossRef

36.

Johansson K, Behre CJ, Bergstrom G, Schmidt C (2010) Ankle-brachial index should be measured in both the posterior and the anterior tibial arteries in studies of peripheral arterial disease. Angiology 61(8):780–783. doi:10.1177/0003319710366126 PubMedCrossRef

37.

Lange SF, Trampisch HJ, Pittrow D, Darius H, Mahn M, Allenberg JR, Tepohl G, Haberl RL, Diehm C (2007) Profound influence of different methods for determination of the ankle brachial index on the prevalence estimate of peripheral arterial disease. BMC Public Health 7:147PubMedCrossRef

38.

Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S (1985) The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 71(3):516–522PubMedCrossRef

39.

Yamada T, Gloviczki P, Bower TC, Naessens JM, Carmichael SW (1993) Variations of the arterial anatomy of the foot. Am J Surg 166(2):130–135 (discussion 135)PubMedCrossRef

40.

Aboyans V, Lacroix P (2007) Regarding: “A modified calculation of ankle-brachial pressure index is far more sensitive in the detection of peripheral arterial disease”. J vasc surg 46 (3):617–618) (Official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, author reply 618–619) doi:10.1016/j.jvs.2006.09.072

41.

Hasanadka R, Brown KR, Rilling WS, Rossi PJ, Hieb RA, Hohenwalter EJ, Seabrook GR, Lewis BD, Towne JB (2008) The extent of lower extremity occlusive disease predicts short- and long-term patency following endovascular infrainguinal arterial intervention. Am J Surg 196(5):629–633. doi:10.1016/j.amjsurg.2008.07.010 PubMedCrossRef

42.

Roberts AJ, Roberts EB, Sykes K, De Cossart L, Edwards P, Cotterrell D (2008) Physiological and functional impact of an unsupervised but supported exercise programme for claudicants. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 36(3):319–324. doi:10.1016/j.ejvs.2008.04.008 CrossRef

43.

Nylaende M, Kroese AJ, Morken B, Stranden E, Sandbaek G, Lindahl AK, Arnesen H, Seljeflot I (2007) Beneficial effects of 1-year optimal medical treatment with and without additional PTA on inflammatory markers of atherosclerosis in patients with PAD. Results from the Oslo Balloon Angioplasty versus Conservative Treatment (OBACT) study. Vasc Med 12(4):275–283. doi:10.1177/1358863X07082720 PubMedCrossRef

44.

Money SR, Herd JA, Isaacsohn JL, Davidson M, Cutler B, Heckman J, Forbes WP (1998) Effect of cilostazol on walking distances in patients with intermittent claudication caused by peripheral vascular disease. J Vasc Surg 27(2):267–274 (Official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, discussion 274–265)PubMedCrossRef

45.

Faglia E, Mantero M, Caminiti M, Caravaggi C, De Giglio R, Pritelli C, Clerici G, Fratino P, De Cata P, Dalla Paola L, Mariani G, Poli M, Settembrini PG, Sciangula L, Morabito A, Graziani L (2002) Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. J Intern Med 252(3):225–232PubMedCrossRef

46.

Dachun X, Jue L, Liling Z, Yawei X, Dayi H, Pagoto SL, Yunsheng M (2010) Sensitivity and specificity of the ankle-brachial index to diagnose peripheral artery disease: a structured review. Vasc Med 15(5):361–369. doi:10.1177/1358863X10378376 CrossRef

Titel: Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography
verfasst von: Frank Beutner
Andrej Teren
Stephan Gielen
Gerhard Schuler
Kerstin Wirkner
Daniel Tiller
Markus Loeffler
Markus Scholz
Publikationsdatum: 01.11.2012
Verlag: Springer-Verlag
Erschienen in: Clinical Research in Cardiology / Ausgabe 11/2012
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-012-0471-z

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

28.05.2024 Nebenwirkungen der Krebstherapie Nachrichten

Kardiotoxische Nebenwirkungen einer Therapie mit Immuncheckpointhemmern mögen selten sein – wenn sie aber auftreten, wird es für Patienten oft lebensgefährlich. Voruntersuchung und Monitoring sind daher obligat.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography

Abstract

Introduction

Methods

Results

Conclusions

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Kardiologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Introduction

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2012

Hot topics in cardiology: data from IABP-SHOCK II, TRILOGY-ACS, WOEST, ALTIDUDE, FAME II and more

Assessment of an asymmetrical coating stent with sirolimus released from ablumial matrix in porcine model

The patient’s interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment: the MONICA/KORA Myocardial Infarction Registry

A rare cause of cardiac decompensation in a patient with left ventricular hypertrophy

Fatal stress-induced cardiomyopathy in a young patient treated with adrenomimetics

Counseling reproductive health issues in women with congenital heart disease

Neu im Fachgebiet Kardiologie

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

Update Kardiologie