Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

Abstract

Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.

The 2023 wearable photoplethysmography roadmap

“…Disease severity is likely to be different for different measurement settings, e.g. hospitals, primary care, and home-based assessments, and a ‘real-world’ device would need to account for this (Stansby et al 2022 ).…”

pyPPG: a Python toolbox for comprehensive photoplethysmography signal analysis

“…Recently, the applications of photoplethysmography-based wearables have been expanded to include atrial fibrillation detection (Perez et al 2019 ), blood pressure monitoring (Vybornova et al 2021 ), and oxygen saturation monitoring (Spaccarotella et al 2022 ). Several additional potential applications of wearable photoplethysmography devices are being researched (Charlton et al 2023 ), including sleep staging (Kotzen et al 2022 ), mental health assessment (Cakmak et al 2021 , Lyzwinski et al 2023 ), identifying obstructive sleep apnea (Behar et al 2014 , 2019 ), and detection of peripheral arterial disease (Stansby et al 2022 ). Each of these applications uses PPG signal analysis to derive physiological information from the PPG.…”