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Published in: Heart and Vessels 4/2019

01-04-2019 | Original Article

The perfusion index is a useful screening tool for peripheral artery disease

Authors: Hiroshi Okada, Muhei Tanaka, Takashi Yasuda, Tadaaki Kamitani, Hisahiro Norikae, Tetsuya Fujita, Takashi Nishi, Hirokazu Oyamada, Tetsuro Yamane, Michiaki Fukui

Published in: Heart and Vessels | Issue 4/2019

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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.
Literature
1.
go back to reference 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 382:1329–1340CrossRefPubMed 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 382:1329–1340CrossRefPubMed
2.
go back to reference 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–S67CrossRefPubMed 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–S67CrossRefPubMed
3.
go back to reference 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 120:2053–2061CrossRefPubMed 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 120:2053–2061CrossRefPubMed
4.
go back to reference 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 71:995–1003CrossRefPubMed 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 71:995–1003CrossRefPubMed
5.
go back to reference 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–e725PubMed 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–e725PubMed
6.
go back to reference 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 30:1210–1213CrossRefPubMed 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 30:1210–1213CrossRefPubMed
7.
go back to reference 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–S20CrossRef 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–S20CrossRef
8.
go back to reference 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 53:982–992CrossRefPubMed 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 53:982–992CrossRefPubMed
9.
go back to reference Quinn CT, Raisis AL, Musk GC (2013) Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep. Vet Anaesth Analg 40:149–156CrossRefPubMed Quinn CT, Raisis AL, Musk GC (2013) Evaluation of Masimo signal extraction technology pulse oximetry in anaesthetized pregnant sheep. Vet Anaesth Analg 40:149–156CrossRefPubMed
10.
go back to reference 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 25:359–364CrossRefPubMed 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 25:359–364CrossRefPubMed
11.
go back to reference 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 71:510–515CrossRefPubMed 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 71:510–515CrossRefPubMed
12.
go back to reference 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 91:1472–1479CrossRefPubMed 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 91:1472–1479CrossRefPubMed
13.
go back to reference 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 326:381–386CrossRefPubMed 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 326:381–386CrossRefPubMed
14.
go back to reference 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 64:925–927CrossRefPubMed 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 64:925–927CrossRefPubMed
15.
go back to reference Imparato AM, Kim GE, Davidson T, Crowley JG (1975) Intermittent claudication: its natural course. Surgery 78:795–799PubMed Imparato AM, Kim GE, Davidson T, Crowley JG (1975) Intermittent claudication: its natural course. Surgery 78:795–799PubMed
16.
go back to reference Dormandy J, Heeck L, Vig S (1999) The fate of patients with critical leg ischemia. Semin Vasc Surg 12:142–147PubMed Dormandy J, Heeck L, Vig S (1999) The fate of patients with critical leg ischemia. Semin Vasc Surg 12:142–147PubMed
17.
go back to reference 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 286:1317–1324CrossRefPubMed 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 286:1317–1324CrossRefPubMed
18.
go back to reference 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 15:69CrossRefPubMedPubMedCentral 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 15:69CrossRefPubMedPubMedCentral
19.
go back to reference 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:e44CrossRefPubMed 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:e44CrossRefPubMed
20.
go back to reference 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 22:3160–3165PubMed 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 22:3160–3165PubMed
21.
go back to reference 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 39:868–873CrossRefPubMedPubMedCentral 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 39:868–873CrossRefPubMedPubMedCentral
Metadata
Title
The perfusion index is a useful screening tool for peripheral artery disease
Authors
Hiroshi Okada
Muhei Tanaka
Takashi Yasuda
Tadaaki Kamitani
Hisahiro Norikae
Tetsuya Fujita
Takashi Nishi
Hirokazu Oyamada
Tetsuro Yamane
Michiaki Fukui
Publication date
01-04-2019
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 4/2019
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-018-1276-4

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