A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease: A pilot study

Jun Tanno, Yodo Gatate, Takatoshi Kasai, Shintaro Nakano, Takaaki Senbonmatsu, Osamu Sato, Shigeru Ichioka, Makoto Kuro-O, Shigeyuki Nishimura

Research output: Contribution to journalArticle

Abstract

In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.

Original languageEnglish (US)
Article numbere0164756
JournalPLoS One
Volume11
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Peripheral Arterial Disease
Hemodynamics
hemodynamics
Ankle
signs and symptoms (animals and humans)
Blood
blood vessels
odds ratio
Ankle Brachial Index
heart rate
Lower Extremity
Stiffness
blood
ischemia
limbs (animal)
Angiography
lesions (animal)
anemia
blood flow
Vascular Stiffness

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Tanno, J., Gatate, Y., Kasai, T., Nakano, S., Senbonmatsu, T., Sato, O., ... Nishimura, S. (2016). A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease: A pilot study. PLoS One, 11(10), [e0164756]. https://doi.org/10.1371/journal.pone.0164756

A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease : A pilot study. / Tanno, Jun; Gatate, Yodo; Kasai, Takatoshi; Nakano, Shintaro; Senbonmatsu, Takaaki; Sato, Osamu; Ichioka, Shigeru; Kuro-O, Makoto; Nishimura, Shigeyuki.

In: PLoS One, Vol. 11, No. 10, e0164756, 01.10.2016.

Research output: Contribution to journalArticle

Tanno, J, Gatate, Y, Kasai, T, Nakano, S, Senbonmatsu, T, Sato, O, Ichioka, S, Kuro-O, M & Nishimura, S 2016, 'A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease: A pilot study', PLoS One, vol. 11, no. 10, e0164756. https://doi.org/10.1371/journal.pone.0164756
Tanno, Jun ; Gatate, Yodo ; Kasai, Takatoshi ; Nakano, Shintaro ; Senbonmatsu, Takaaki ; Sato, Osamu ; Ichioka, Shigeru ; Kuro-O, Makoto ; Nishimura, Shigeyuki. / A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease : A pilot study. In: PLoS One. 2016 ; Vol. 11, No. 10.
@article{2b1d4cf67ab0427f8319dbccfa66f9bc,
title = "A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease: A pilot study",
abstract = "In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50{\%} diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.",
author = "Jun Tanno and Yodo Gatate and Takatoshi Kasai and Shintaro Nakano and Takaaki Senbonmatsu and Osamu Sato and Shigeru Ichioka and Makoto Kuro-O and Shigeyuki Nishimura",
year = "2016",
month = "10",
day = "1",
doi = "10.1371/journal.pone.0164756",
language = "English (US)",
volume = "11",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

TY - JOUR

T1 - A novel index using ankle hemodynamic parameters to assess the severity of peripheral arterial disease

T2 - A pilot study

AU - Tanno, Jun

AU - Gatate, Yodo

AU - Kasai, Takatoshi

AU - Nakano, Shintaro

AU - Senbonmatsu, Takaaki

AU - Sato, Osamu

AU - Ichioka, Shigeru

AU - Kuro-O, Makoto

AU - Nishimura, Shigeyuki

PY - 2016/10/1

Y1 - 2016/10/1

N2 - In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.

AB - In peripheral arterial disease (PAD) of the lower extremities, the presence of flow-limiting stenoses can be objectively detected by the ankle-brachial index (ABI). However, the severity of ischemic symptoms is not necessarily associated with the ABI value. Atherosclerotic plaque in lower extremity PAD induces ankle arterial stiffness and reduces ankle vascular resistance, which may decrease ankle blood flow and cause ischemic symptoms. We hypothesized that the ankle hemodynamic index (AHI), defined as the ratio of ankle arterial stiffness to ankle vascular resistance, could be used to assess the blood supply deficiency in a diseased lower limb in patients with PAD. The 85 consecutive patients with PAD who were retrospectively analyzed in this study had Rutherford grade 1 to grade 6 ischemia diagnosed as PAD and significant stenotic lesions (>50% diameter stenosis) of the lower extremity on contrast angiography. The AHI was calculated as the product of the ankle pulse pressure and the ratio of heart rate to ankle mean arterial pressure (ankle pulse pressure × heart rate/ankle mean arterial pressure). The Rutherford grade was significantly correlated with the AHI (r = 0.50, P < 0.001), but not with the ABI (r = 0.07, P = 0.52). Multiple ordinal regression analysis showed that anemia (odds ratio 0.66, P = 0.002) and AHI (odds ratio 1.04, P = 0.02) were independently associated with Rutherford grade. Our study shows that AHI, a novel parameter based on the ABI measurement, is well correlated with ischemic symptoms, and may be a useful means to assess the arterial blood supply of the lower extremities of patients with PAD.

UR - http://www.scopus.com/inward/record.url?scp=84992499037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992499037&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0164756

DO - 10.1371/journal.pone.0164756

M3 - Article

C2 - 27760183

AN - SCOPUS:84992499037

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 10

M1 - e0164756

ER -