Abstract
The number of people with peripheral artery disease (PAD) has been increasing globally; therefore, it is important to explore more options to screen patients who are at a risk of developing PAD. The perfusion index (PI) represents the degree of circulation through the peripheral tissues and is measured noninvasively. We investigated the correlation between the PI and ankle-brachial index (ABI) to explore whether the PI could be used a screening tool for PAD. This cross-sectional study included 390 patients. We measured the ABI and PI for all patients. The median ABI value was 1.06 (0.92–1.13); the PI was 1.7% (0.9–3.5). The PI was higher in men than in women (P < 0.0001). The PI was positively correlated with the estimated glomerular filtration rate and ABI in both men and women. The sensitivity and specificity of the PI to predict PAD (ABI ≤0.9) were 90.0% and 80.3%, respectively, and the cutoff PI value was 1.5% in men. The sensitivity and specificity of the PI to predict PAD were 82.1% and 79.2%, respectively, and the cutoff PI value was 1.1% in women. PI could be a reliable screening tool for diagnosing PAD because it does not restrict the patient’s mobility, can be completed in a short time period, and is associated with reduced costs.
Similar content being viewed by others
References
Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UK, Williams LJ, Mensah GA, Criqui MH (2013) Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 382:1329–1340
Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group (2007) Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 45:S5–S67
Diehm C, Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, Darius H, Burghaus I, Trampisch HJ, German Epidemiological Trial on Ankle Brachial Index Study Group (2009) Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 120:2053–2061
Yamazaki T, Goto S, Shigematsu H, Shimada K, Uchiyama S, Nagai R, Yamada N, Matsumoto M, Origasa H, Bhatt DL, Steg PG, Ikeda Y, REACH Registry Investigators (2007) Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan. Circ J 71:995–1003
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FG, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RA, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME (2017) 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135:e686–e725
Lima AP, Beelen P, Bakker J (2002) Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 30:1210–1213
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26:S5–S20
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A (2009) Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992
Quinn CT, Raisis AL, Musk GC (2013) Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep. Vet Anaesth Analg 40:149–156
Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, Koji Y, Hori S, Yamamoto Y (2002) Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 25:359–364
Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D (1985) The prevalence of peripheral arterial disease in a defined population. Circulation 71:510–515
Hiatt WR, Hoag S, Hamman RF (1995) Effect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley Diabetes Study. Circulation 91:1472–1479
Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, Browner D (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386
Kobayashi M, Shindo S, Kubota K, Kojima A, Ishimoto T, Iyori K, Tada Y (2000) Causes of late mortality in patients with disabling intermittent claudication. Jpn Circ J 64:925–927
Imparato AM, Kim GE, Davidson T, Crowley JG (1975) Intermittent claudication: its natural course. Surgery 78:795–799
Dormandy J, Heeck L, Vig S (1999) The fate of patients with critical leg ischemia. Semin Vasc Surg 12:142–147
Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR (2001) Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 286:1317–1324
Davies JH, Kenkre J, Williams EM (2014) Current utility of the ankle-brachial index (ABI) in general practice: implications for its use in cardiovascular disease screening. BMC Fam Pract 15:69
Potier L, Halbron M, Bouilloud F, Dadon M, Le Doeuff J, Van Ha G, Grimaldi A, Hartemann-Heurtier A (2009) Ankle-to-brachial ratio index underestimates the prevalence of peripheral occlusive disease in diabetic patients at high risk for arterial disease. Diabetes Care 32:e44
Santoro L, Flex A, Nesci A, Ferraro PM, De Matteis G, Di Giorgio A, Giupponi B, Saviano L, Gambaro G, Franceschi F, Gasbarrini A, Landolfi R, Santoliquido A (2018) Association between peripheral arterial disease and cardiovascular risk factors: role of ultrasonography versus ankle-brachial index. Eur Rev Med Pharmacol Sci 22:3160–3165
Santoro L, Ferraro PM, Flex A, Nesci A, De Matteis G, Di Giorgio A, Zaccone V, Gambaro G, Gasbarrini A, Santoliquido A (2016) New semiquantitative ultrasonographic score for peripheral arterial disease assessment and its association with cardiovascular risk factors. Hypertens Res 39:868–873
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Michiaki Fukui received grants from the Japan Society for the Promotion of Science, AstraZeneca Plc, Astellas Pharma Inc., Nippon Boehringer Ingelheim Co., Ltd., Daiichi Sankyo Co., Ltd., Eli Lilly Japan K.K., Kyowa Hakko Kirin Company Ltd., Kissei Pharmaceutical Co., Ltd., MSD K.K., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Sanofi K.K., Ono Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd., outside the submitted work. The sponsors were not involved in the study design; the collection, analysis, and interpretation of data; the writing of this manuscript; or the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The authors declare that although they are affiliated with a department that is supported financially by a pharmaceutical company, the authors received no current funding for this study, and this does not alter their adherence to all the journal policies on sharing data and materials. The other authors have no conflict of interest to disclose.
Rights and permissions
About this article
Cite this article
Okada, H., Tanaka, M., Yasuda, T. et al. The perfusion index is a useful screening tool for peripheral artery disease. Heart Vessels 34, 583–589 (2019). https://doi.org/10.1007/s00380-018-1276-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-018-1276-4