{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000498,"version":"3.55.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Although ankle\u2010brachial index (ABI) and photoplethysmography (PPG) have also shown adequate sensitivity in detecting peripheral arterial disease, their diagnostic performance is less reliable in asymptomatic cases or those with high atherosclerotic cardiovascular risks.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We evaluated 130 participants using ABI, PPG, and duplex ultrasonography, diagnosing 65 with peripheral arterial disease. From the PPG, we derived 2 parameters: PPG amplitude ratio of the lower\u2010to\u2010upper extremities (PPG\n              <jats:sub>ratio<\/jats:sub>\n              ) and the PPG amplitude of the lower extremity (PPG\n              <jats:sub>amp<\/jats:sub>\n              ). Sensitivity, specificity, accuracy, and the area under receiver operating characteristic (ROC) curve were calculated for PPG parameters and ABI, and their combination of both methods. Univariate and multivariate logistic regression assessed the prognostic potential of these parameters. ROC analysis revealed optimal cutoff values in diagnosing peripheral arterial disease were 0.417 for PPG\n              <jats:sub>ratio<\/jats:sub>\n              and \u201c58\u201d for PPG\n              <jats:sub>amp<\/jats:sub>\n              . Both PPG\n              <jats:sub>ratio<\/jats:sub>\n              and PPG\n              <jats:sub>amp<\/jats:sub>\n              demonstrated significantly higher sensitivities, 78.4% and 75.7%, respectively, compared with 55.9% for ABI &lt;0.9 (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05). The areas under the ROC curves of combination models, including model 1 (ABI &lt;0.9 and PPG\n              <jats:sub>ratio<\/jats:sub>\n              ), model 2 (ABI &lt;0.9 and PPG\n              <jats:sub>amp<\/jats:sub>\n              ), and model 3 (ABI &lt;0.9, PPG\n              <jats:sub>ratio<\/jats:sub>\n              , and PPG\n              <jats:sub>amp<\/jats:sub>\n              ), exhibited improved performance with areas under the ROC curves of 0.922, 0.922, and 0.931 (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01) compared with ABI alone (area under the ROC curve, 0.822). Additionally, the PPG parameters, both alone and combined with ABI, were associated with major adverse cardiac events and all\u2010cause mortality after adjusting for other relevant factors.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">On the basis of duplex ultrasonography, combining ABI and PPG markedly improves peripheral arterial disease diagnosis in high\u2010risk individuals compared with either method alone and provides crucial insights into major adverse cardiac events and all\u2010cause mortality risks.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.034625","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T09:27:47Z","timestamp":1727688467000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic Potential of Combined Photoplethysmography and Ankle\u2010Brachial Index in Peripheral Arterial Disease: A Duplex Ultrasonography\u2010Based Comparative Study"],"prefix":"10.1161","volume":"13","author":[{"given":"Han\u2010Luen","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences and Engineering National Central University Taoyuan Taiwan"},{"name":"Section of Cardiology Hsinchu Cathay General Hospital Hsinchu Taiwan"},{"name":"College of General Education Minghsin University of Science and Technology Hsinchu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Hsiu","family":"Chang","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Cathay General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2630-4945","authenticated-orcid":false,"given":"Men\u2010Tzung","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Engineering National Central University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6261-8509","authenticated-orcid":false,"given":"Chen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Engineering National Central University Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2016.0729"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(97)06089-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016006384.x"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.37.4.624"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1969.03150230083009"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1982.01380340031008"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800560910"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.11.1317"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(00)01038-9"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000112642.63927.54"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X10378376"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526\/a000834"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/28\/3\/R01"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/26\/5\/018"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(92)90249-8"},{"key":"e_1_3_2_18_2","first-page":"67","article-title":"Sensitivity, specificity, accuracy, associated confidence interval and ROC analysis with practical SAS implementations","volume":"19","author":"Zhu W","year":"2010","unstructured":"Zhu W, Zeng N, Wang N. 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