Key result
Doppler-derived estimated TBI using acceleration index shows excellent agreement with standard TBI.
Why the study?
Toe brachial index is standard for assessing distal perfusion in PAD but has limitations, making forefoot Doppler waveform characteristics a potential alternative.
Does Doppler waveform-derived estimated TBI (eTBI) accurately correlate with standard TBI in patients with peripheral arterial disease?
Observational (n=155)
No
Does Doppler waveform-derived estimated TBI (eTBI) accurately correlate with standard TBI in patients with peripheral arterial disease?
Effect estimate: R2 = 0.88
p-value: p=< 0.001
Doppler waveform-derived estimated TBI, particularly using acceleration index, provides an accurate and reproducible alternative to standard TBI for assessing distal perfusion in peripheral arterial disease.
Doppler forefoot metrics may estimate TBI in PAD; leaves open diagnostic performance and clinical adoption pending validation.
Aims The toe brachial index (TBI) is a standard diagnostic tool for assessing distal perfusion in peripheral arterial disease (PAD) but has several limitations. Doppler waveform characteristics of forefoot arteries, such as acceleration index (AccI), peak systolic velocity (PSV), and acceleration time (AT), present a potentially reliable and more accessible alternative for estimating TBI. This study evaluated the association between Doppler waveform characteristics and standard TBI, developed empirical equations for estimating TBI (eTBI), and assessed their accuracy, reproducibility, and clinical applicability. Methods and results This study presents a prospective analysis of angle-corrected Doppler AccI, PSV, and AT in forefoot metatarsal arteries together with standard automated TBI in 155 limbs of PAD patients treated at Surrey and Sussex Healthcare NHS Trust, Redhill, UK. Doppler-derived AccI, PSV, and AT were significantly associated with standard TBI (R2 = 0.88, 0.58, 0.62; each P < 0.001). Empirical equations for eTBI calculation demonstrated excellent agreement with standard TBI, with minimal average deviations [−0.01 ± 0.10 (SD) for AccI]. Multivariable analysis confirmed that eTBI derived from AccI predicted TBI largely independent of age, sex, diabetes mellitus, Fontaine stage, diastolic blood pressure, and kidney function (R2 = 0.89). After revascularization, both eTBI and standard TBI increased significantly, with strong correlation (r = 0.95, P < 0.001). Inter- and intra-observer and inter-device variability for eTBI measurements was low, outperforming standard TBI. Conclusion Doppler waveform-derived eTBI, particularly using AccI, provides a reproducible, accurate, and clinically responsive alternative to standard TBI. These findings support its integration into routine vascular diagnostics, enhancing accessibility and diagnostic precision in PAD care. Automated eTBI acquisition could enhance screening efficiency in non-specialist settings.
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Rodway et al. (2025) conducted an observational in Peripheral arterial disease (PAD) (n=155). Doppler waveform characteristics (AccI, PSV, AT) for estimating TBI vs. Standard automated TBI was evaluated on Association between Doppler-derived acceleration index (AccI) and standard TBI (R2 = 0.88, p=< 0.001). Doppler waveform-derived estimated toe brachial index using acceleration index was significantly associated with standard TBI (R2 = 0.88, P < 0.001) and demonstrated excellent agreement.
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