title: Efficacy of the transfer function index using the pulse volume recording as a parameter to assess intermittent claudication.
abstract: OBJECTIVE
  The aim of this study was to elucidate whether the ankle brachial pressure index (ABPI) or transfer function index (TFI) was useful as an alternative parameter to the treadmill-walking test using near-infrared spectroscopy (NIRS) in evaluating muscle ischemia for patients with intermittent claudication (IC).
  
  
  METHODS
  In 155 claudicants, the treadmill-walking test using NIRS was performed to calculate the recovery ability index (=recovery time/walking time). The ABPI and TFI were measured at the calf (TFI(calf)) and ankle (TFI(ankle)) using pulse volume recording. The area under the curve (AUC) was calculated from the receiver operating characteristic (ROC) curve and cutoff value was determined using crossing point of the ROC curve with a diagonal line.
  
  
  RESULTS
  In the nondiabetics, AUCs were 77.3%, 80.0%, and 76.0% in the ABPI, TFI(calf), and TFI(ankle), respectively, which were not different significantly. In the diabetics, the AUC of TFI(calf) was 77.9%, which was different significantly from those of the other indices such as the ABPI or TFI(ankle) showing 66.2% or 68.1%. The cutoff value of ABPI indicating moderate or severe IC was 0.75 in the nondiabetics whereas that of TFI(calf) was 0.85 in the diabetics.
  
  
  CONCLUSIONS
  TFI(calf) was useful to distinguish moderate or severe IC from mild IC in diabetic patients even if the ABPI was sufficient in nondiabetic patients.
authors.affiliation: Department of Vascular and Applied Surgery, Tokyo Medical and Dental University Graduate School, Bunkyo-ku, Tokyo, Japan.
authors.forename: Rieko
authors.initials: R
authors.lastname: Nakashima
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Inoue
authors.forename: Norihide
authors.initials: N
authors.lastname: Sugano
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Jibiki
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Kudo
authors.forename: Takehisa
authors.initials: T
authors.lastname: Iwai
mesh_terms: D000368:Aged; D000842:Ankle / Q000503:physiopathology; D055109:Ankle Brachial Index / Q000379:methods*; D003920:Diabetes Mellitus / Q000503:physiopathology; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology*; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D007866:Leg / Q000503:physiopathology; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019265:Spectroscopy, Near-Infrared / Q000379:methods*