Department of Surgery, Vascular Surgery Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil.
School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
Vasc Med. 2023 Feb;28(1):36-44. doi: 10.1177/1358863X221150453.
Evaluation of limb hemodynamics using the ankle-brachial index (ABI) may be difficult due to skin lesions, extensive necrosis, and obesity, such as commonly present in patients with diabetes with chronic limb-threatening ischemia (CLTI). We hypothesized that the pedal acceleration time (PAT) correlates with ABI and Wound, Ischemia, and foot Infection (WIfI) scores in patients with diabetes to serve as a new modality to accurately stage CLTI.
A single-center, cross-sectional study included patients with and without diabetes > 18 years with CLTI. Limbs were categorized in three grades of ischemia based on the ABI (ABI < 0.8, < 0.6, and < 0.4) and in two classes based on WIfI stages of amputation risk. Receiver operator characteristic (ROC) curves were used to determine PAT sensitivity, specificity, and accuracy to predict lower-limb ischemia.
A total of 141 patients (67 nondiabetic and 74 diabetic) and 198 lower limbs (94 nondiabetic and 104 diabetic) met the inclusion criteria. In patients without diabetes, the accuracy of PAT for detecting an ABI < 0.8 was 85%; for detecting an ABI < 0.6 was 85%; and for detecting an ABI < 0.4 was 87%. In patients with diabetes, the accuracy of PAT in detecting an ABI < 0.8 was 91%; for detecting an ABI < 0.6 was 79%; and for detecting an ABI < 0.4 was 88%. In patients without diabetes, the accuracy for detecting WIfI stages of moderate and high amputation risk was 77% and for patients with diabetes was also 77%.
PAT shows high correlation with the ABI as well as with the WIfI stages of amputation risk and the grades of ischemia, with high accuracy.
使用踝肱指数（ABI）评估肢体血液动力学可能因皮肤损伤、广泛坏死和肥胖而变得困难，这些情况在患有慢性肢体威胁性缺血（CLTI）的糖尿病患者中很常见。我们假设，足部加速度时间（PAT）与糖尿病患者的 ABI 和创伤、缺血和足部感染（WIfI）评分相关，可以作为一种新的方法来准确分期 CLTI。
一项单中心、横断面研究纳入了年龄>18 岁的伴有和不伴有糖尿病的 CLTI 患者。根据 ABI（ABI<0.8、<0.6 和<0.4）将肢体分为三级缺血，并根据 WIfI 截肢风险分期将肢体分为两类。使用受试者工作特征（ROC）曲线来确定 PAT 预测下肢缺血的敏感性、特异性和准确性。
共有 141 名患者（67 名非糖尿病患者和 74 名糖尿病患者）和 198 条下肢（94 名非糖尿病患者和 104 名糖尿病患者）符合纳入标准。在非糖尿病患者中，PAT 检测 ABI<0.8 的准确性为 85%；检测 ABI<0.6 的准确性为 85%；检测 ABI<0.4 的准确性为 87%。在糖尿病患者中，PAT 检测 ABI<0.8 的准确性为 91%；检测 ABI<0.6 的准确性为 79%；检测 ABI<0.4 的准确性为 88%。在非糖尿病患者中，检测 WIfI 中、高度截肢风险分期的准确性为 77%，糖尿病患者的准确性也为 77%。
PAT 与 ABI 以及截肢风险分期和缺血分级高度相关，具有较高的准确性。
