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. 2023 Oct 15;12(20):6539.
doi: 10.3390/jcm12206539.

Screening for Peripheral Artery Disease Using an Automated Four-Limb Blood Pressure Monitor Equipped with Toe-Brachial Index Measurement

Krisztina Fendrik  1 , Katalin Biró  1 , Dóra Endrei  1 , Katalin Koltai  1 , Barbara Sándor  2 , Kálmán Tóth  2 , Gábor Késmárky  1
Affiliations

Screening for Peripheral Artery Disease Using an Automated Four-Limb Blood Pressure Monitor Equipped with Toe-Brachial Index Measurement

Krisztina Fendrik et al. J Clin Med. .

Abstract

Toe-brachial index (TBI) measurement helps to detect peripheral artery disease (PAD) in patients with incompressible ankle arteries due to medial arterial calcification, which is most frequently associated with diabetes. We aimed to evaluate how an automated four-limb blood pressure monitor equipped with TBI measurement could contribute to PAD screening. In 117 patients (mean age 63.2 ± 12.8 years), ankle-brachial index (ABI) measurement was performed using the Doppler-method and the MESI mTablet. TBI was obtained via photoplethysmography (MESI mTablet, SysToe) and a laser Doppler fluxmeter (PeriFlux 5000). Lower limb PAD lesions were evaluated based on vascular imaging. A significant correlation was found between Doppler and MESI ankle-brachial index values (r = 0.672), which was stronger in non-diabetic (r = 0.744) than in diabetic (r = 0.562) patients. At an ABI cut-off of 0.9, Doppler (AUC = 0.888) showed a sensitivity/specificity of 67.1%/97.4%, MESI (AUC 0.891) exhibited a sensitivity/specificity of 57.0%/100%; at a cut-off of 1.0, MESI demonstrated a sensitivity/specificity of 74.7%/94.8%. The TBI values measured using the three devices did not differ significantly (p = 0.33). At a TBI cut-off of 0.7, MESI (AUC = 0.909) revealed a sensitivity/specificity of 92.1%/67.5%. Combining MESI ABI and TBI measurements recognised 92.4% of PAD limbs. Using an ABI cut-off level of 1.0 and sequential TBI measurement increases the sensitivity of the device in detecting PAD. The precise interpretation of the obtained results requires some expertise.

Keywords: ankle–brachial index; oscillometry; peripheral artery disease; photoplethysmography; screening; toe–brachial index.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 2
Figure 2
Diagnostic efficacy of the Doppler, modified Doppler and MESI ABI measurements based on ROC curve analysis in all patients (ABI, ankle–brachial index; ROC, receiver operating characteristic; AUC, area under the curve).
Figure 6
Figure 6
Comparison of the diagnostic efficacy of the PeriFlux LD, SysToe and MESI TBI measurements based on ROC curve analysis (LD, laser Doppler; TBI, toe–brachial index; ROC, receiver operating characteristic; AUC, area under the curve).
Figure 1
Figure 1
Analysis of the intermodality agreement between the Doppler and MESI ABI measurements using the Bland–Altman method. The mean of the corresponding Doppler and MESI ABI values on the ‘x’ axis is plotted against the difference of the corresponding Doppler and MESI ABI values on the ‘y’ axis. The horizontal lines represent the mean difference with the limits of agreement (ABI, ankle–brachial index; SD, standard deviation).
Figure 3
Figure 3
Diagnostic efficacy of the Doppler, modified Doppler and MESI ABI measurements based on ROC curve analysis in diabetic patients (ABI, ankle–brachial index; ROC, receiver operating characteristic; AUC, area under the curve).
Figure 4
Figure 4
Diagnostic efficacy of the Doppler, modified Doppler and MESI ABI measurements based on ROC curve analysis in non-diabetic patients (ABI, ankle–brachial index; ROC, receiver operating characteristic; AUC, area under the curve).
Figure 5
Figure 5
Analysis of the intermodality agreement between the PeriFlux LD and MESI TBI measurements using the Bland–Altman method. The mean of the corresponding PeriFlux LD and MESI TBI values on the ‘x’ axis is plotted against the difference of the corresponding PeriFlux LD and MESI TBI values on the ‘y’ axis. The horizontal lines represent the mean difference with the limits of agreement. The circled section demonstrates 11 cases in which the PeriFlux LD measured a numerical value, but the MESI device did not detect a pulse wave on the affected toe. (LD, laser Doppler; TBI, toe–brachial index; SD, standard deviation).
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