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

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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.

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Acknowledgments

We thank Heike Bauch, Constanze Langheinrich and Kay Olischer for their technical assistance. This publication is supported by LIFE—Leipzig Research Center for Civilization Diseases, University Leipzig. LIFE is funded by the European Union, by the European Regional Development Fund (ERDF), and by the Free State of Saxony within the framework of the excellence initiative.

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Authors and Affiliations

  1. LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany

    Frank Beutner, Andrej Teren, Stephan Gielen, Gerhard Schuler, Kerstin Wirkner, Markus Loeffler & Markus Scholz

  2. Department of Medicine III, University Hospital Halle, Halle (Saale), Germany

    Stephan Gielen

  3. Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany

    Daniel Tiller

  4. Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany

    Markus Loeffler & Markus Scholz

  5. Department of Internal Medicine/Cardiology, Heart Center University Leipzig, Struempellstrasse 39, 04289, Leipzig, Germany

    Frank Beutner, Andrej Teren & Gerhard Schuler

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  1. Frank Beutner
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Correspondence to Frank Beutner.

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F. Beutner and A. Teren contributed equally.

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Beutner, F., Teren, A., Gielen, S. et al. Automated photoplethysmography-based determination of ankle-brachial index: a validation study against Doppler sonography. Clin Res Cardiol 101, 875–883 (2012). https://doi.org/10.1007/s00392-012-0471-z

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