title: Pulse Waves in the Lower Extremities as a Diagnostic Tool of Peripheral Arterial Disease and Predictor of Mortality in Elderly Chinese.
abstract: Patients with peripheral arterial disease may have elongated upstroke time in pulse waves in the lower extremities. We investigated upstroke time as a diagnostic tool of peripheral arterial disease and predictor of mortality in an elderly (≥60 years) Chinese population. We recorded pulse waves at the left and right ankles by pneumoplethysmography and calculated the percentage of upstroke time per cardiac cycle. Diagnostic accuracy was compared with the conventional ankle-brachial index method (n=4055) and computed tomographic angiography (34 lower extremities in 17 subjects). Upstroke time per cardiac cycle at baseline (mean±SD, 16.4%±3.1%) was significantly (P<0.0001) associated with ankle-brachial index in men (n=1803; r=-0.44) and women (n=2252; r=-0.32) and had an overall sensitivity and specificity of 86% and 80%, respectively, for the diagnosis of peripheral arterial disease (upstroke time per cardiac cycle, ≥21.7%) in comparison with computed tomographic angiography. During 5.9 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 366 and 183 subjects, respectively. In adjusted Cox regression analyses, an upstroke time per cardiac cycle ≥21.7% (n=219; 5.4%) significantly (P<0.0001) predicted total and cardiovascular mortality. The corresponding hazard ratios were 1.98 (95% confidence interval, 1.48-2.65) and 2.29 (1.58-3.32), respectively, when compared with that of 2.10 (1.48-3.00) and 2.44 (1.57-3.79), respectively, associated with an ankle-brachial index of ≤0.90 (n=115; 2.8%). In conclusion, pulse waves in the lower extremities may behave as an accurate and ease of use diagnostic tool of peripheral arterial disease and predictor of mortality in the elderly.
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Sheng
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Qi-Fang
authors.initials: QF
authors.lastname: Huang
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Kang
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Fei-Ka
authors.initials: FK
authors.lastname: Li
authors.affiliation: From the Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. jiguangwang@aim.com.
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000792:Angiography / Q000379:methods; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: China; aged; ankle-brachial index; mortality; peripheral arterial disease; pulse wave transit time