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. 2022 Apr 28;2(3):oeac032.
doi: 10.1093/ehjopen/oeac032. eCollection 2022 May.

Assessment of the systolic rise time by photoplethysmography in peripheral arterial diseases: a comparative study with ultrasound Doppler

Samantha Amrani  1 , Kornelia Eveilleau  2 , Verena Fassbender  1 , Hasan Obeid  2 , Imad Abi-Nasr  2 , Pascal Giordana  1 , Magid Hallab  2 , Georges Leftheriotis  1
Affiliations

Assessment of the systolic rise time by photoplethysmography in peripheral arterial diseases: a comparative study with ultrasound Doppler

Samantha Amrani et al. Eur Heart J Open. .

Abstract

Aims: Peripheral arterial disease (PAD) is a major public health burden requiring more intensive population screening. Ankle brachial index (ABI) using arm and ankle cuffs is considered as the reference method for the detection of PAD. Although it requires a rigorous methodology by trained operators, it remains time-consuming and more technically difficult in patients with diabetes due to mediacalcosis. Techniques based on the study of hemodynamic, such as the systolic rise time (SRT), appear promising but need to be validated. We retrospectively compared the reliability and accuracy of SRT using a photoplethysmography (PPG) technique to the SRT measured by ultrasound doppler (UD) in PAD patients diagnosed with the ABI (137 patients, 200 lower limbs).

Methods and results: There was a significant correlation between SRT measured with UD (SRTud) compared with that with PPG (SRTppg, r = 0.25; P = 0.001). Best correlation was found in patients without diabetes (r = 0.40; P = 0.001). Bland and Altman analysis showed a good agreement between the SRTud and SRTppg. In contrast, there was no significant correlation between UD and PPG in diabetes patients. Furthermore, patients with diabetes exhibited a significant increase of SRTppg (P = 0.02) compared with patients without diabates but not with the SRTud (P = 0.18). The SRTppg was significantly linked to the arterial velocity waveforms, the type of arterial lesion but not vascular surgery revascularization technique.

Conclusion: This monocentric pilot study shows that SRT measured with the PPG signal reliably correlates with SRT recorded with UD. The PPG is an easy to use technique in the hand of non-expert with a potential interest for general screening of PAD, especially in diabetes patients, due to its ease to use.

Keywords: Diabetes; Doppler; Peripheral arterial disease; Photoplethysmography.

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Figures

Figure 1
Figure 1
Systolic rise time measurement with pOpmètre® System
Figure 2
Figure 2
Calculation of systolic rise time by the pOpmètre® system, (a) raw photoplethysmography signal, (b) second derivative of the raw photoplethysmography signal. The max point of the second derivative is reported to the raw signal to detect the footwave of the pulse wave and calculate the systolic rise time.
Figure 3
Figure 3
Relationship between ankle brachial index and systolic rise time. (A) ABI = 1.13–0.003*SRTud; P < 0.001 for non-diabetes and ABI = 1.11–0.003*SRTud; P < 0.001 for diabetes. (B) ABI = 1.45–0.003*SRTppg; P < 0.001 for non-diabetes and ABI = 1.1–0.001*SRTppg; P < 0.05 for diabetes.
Figure 4
Figure 4
Receiver operating characteristic (ROC) curves of SRTppg and SRTud identification of ankle brachial index lower than 0.9
Figure 5
Figure 5
Bland Altman plot for SRTppg and SRTud.
Figure 6
Figure 6
SRTud and SRTppg according to the Saint-Bonnet waveform type classification of ultrasound Doppler velocity waveforms.
Figure 7
Figure 7
Receiver operating characteristic (ROC) curves of SRTppg and SRTud identification of Saint-Bonnet waveform classification.
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