title: Pulse Pressure and Upstroke Time Are Useful Parameters for the Diagnosis of Peripheral Artery Disease in Patients With Normal Ankle Brachial Index.
abstract: BACKGROUND
  Some peripheral artery disease (PAD) patients have normal ankle brachial index (ABI) (0.9 - 1.4), although ABI is a useful parameter for the diagnosis of PAD. We investigated whether other parameters of ABI report sheet are useful to detect these patients.
  
  
  METHODS
  We initially enrolled 3,912 patients (7,824 limbs) who underwent ABI for the first time. Subjects who have normal ABI were divided into the PAD group (n = 136) and the non-PAD group (n = 240) by lower extremity ultrasonography. We investigated blood pressures (BP) (systolic (SBP), diastolic (DBP), mean (mBP) and pulse pressure (PP)), heart rate, upstroke time (UT), and %mean arterial pressure (%MAP).
  
  
  RESULTS
  SBP, mBP, PP, UT, and %MAP in the PAD group were significantly higher. A multivariate analysis showed that mBP, DBP, PP, UT and %MAP were independently associated with the presence of PAD (mBP: odds ratio (OR) 2.30, 95% confidence interval (CI) 1.22 - 4.37, P = 0.010; DBP: OR 0.52, 95% CI 0.28 - 0.97, P = 0.039; PP: OR 1.30, 95% CI 0.69 - 2.46, P = 0.041; UT: OR 3.40, 95% CI 2.03 - 5.83, P < 0.001; %MAP: OR 1.77, 95% CI 1.05 - 2.98, P = 0.031). Maximal area under the curve (AUC) of BPs for associating PAD was PP. The cut-off value of PP was 53.0 mm Hg (sensitivity 0.500, specificity 0.721, AUC 0.628, 95% CI 0.569 - 0.687).
  
  
  CONCLUSIONS
  The present study demonstrated that BPs are associated with PAD in patients with normal ABI. The measurement of BPs could provide additional information for the diagnosis of PAD.
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kiuchi
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Hisatake
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Ippei
authors.initials: I
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Mikihito
authors.initials: M
authors.lastname: Toda
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kabuki
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Oka
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Dobashi
authors.affiliation: Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ikeda
keywords: Ankle brachial index; Peripheral artery disease; Pulse pressure; Upstroke time