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Maximum acceleration and acceleration time as markers to assess severity of peripheral artery disease

2024; Elsevier BV; Volume: 79; Issue: 6 Linguagem: Inglês

10.1016/j.jvs.2024.01.019

1097-6809

Jean-Eudes Trihan, Jeanne Hersant, Simon Lecoq, Samir Henni, Cédric Fontaine, Romain Prigent, Guillaume Mahé, Damien Lanéelle,

Venous Thromboembolism Diagnosis and Management

We were pleased to read the paper from de Willems et al entitled "Diagnostic accuracy of the maximal systolic acceleration to detect peripheral arterial disease."1Willems S.A. Dolfing S.G. Van Wissen R.C. et al.Diagnostic accuracy of the maximal systolic acceleration to detect peripheral arterial disease.J Vasc Surg. 2024; 79: 405-411Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The superiority of maximal systolic acceleration (ACCmax) and acceleration time (AT) in terms of diagnostic accuracy in peripheral arterial disease has long been recognized and has been brought back into the spotlight in recent years. We have no doubt about the high diagnostic value of ACCmax in lower extremity artery disease (LEAD),2Brouwers J.J.W.M. van Doorn L.P. Pronk L. et al.Doppler Ultrasonography derived maximal systolic acceleration: value determination with artificially induced stenosis.Vasc Endovascular Surg. 2022; 56: 472-479Crossref PubMed Scopus (4) Google Scholar,3Brouwers J.J.W.M. van Doorn L.P. van Wissen R.C. Putter H. Hamming J.F. Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study.J Vasc Surg. 2020; 71: 242-249Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar just as AT also shows high diagnostic performance in either diagnosing critical limb ischemia or excluding significant LEAD.4Trihan J.E. Mahé G. Croquette M. et al.Accuracy of acceleration time of distal arteries to diagnose severe peripheral arterial disease.Front Cardiovasc Med. 2022; 8744354Crossref Scopus (10) Google Scholar, 5de Castro-Santos G. Gonçalves P.E.O. Procópio R.J. Dardik A. Navarro T.P. Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification.Vasc Med. 2023; 28: 36-44Crossref Scopus (2) Google Scholar, 6Teso D. Sommerset J. Dally M. Feliciano B. Vea Y. Jones R.K. Pedal acceleration time (PAT): a novel predictor of limb salvage.Ann Vasc Surg. 2021; 75: 189-193Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 7Trihan J.E. Hersant J. Lecoq S. Henni S. Mahé G. Lanéelle D. Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia.Vasc Med. 2024; 79 (Accepted Manuscript): 1547Google Scholar However, a high degree of accuracy in measurement techniques is required, especially when investigating the ACCmax.8Trihan J.E. Mahé G. Laroche J.P. et al.Arterial blood-flow acceleration time on Doppler ultrasound waveforms: what are we talking about?.J Clin Med. 2023; 12: 1097Crossref Scopus (5) Google Scholar From a physics point of view, the acceleration is the first derivate of the time-velocity curve and so, acceleration is only really maximal for a tiny instant, because it is the definition of a derivate. Furthermore, the time lapse during which acceleration is truly maximal tends to decrease as the arterial duplex waveform dampens, making it increasingly difficult for nonvascular specialists to measure accurately. In this regard, the intraobserver and interobserver reproducibility of ACCmax and AT between inexperienced and experienced vascular ultrasound operators should be thoroughly addressed before any world-wide bed-side use as diagnostic tools. In their Methods section, Willems et al explained the importance of accurately adjusting the speed scale before recording the Doppler waveform ("covering at least three-quarters of the window"), but the statement "the time scale contained a maximum of 3 to 4 heartbeats" about the scrolling speed is insufficient, because it obviously depends on the heart rate, especially because this setting is important before any acceleration measurement. We think that accuracy about the scrolling speed (in mm/s) should always be stated: ≥100 mm/s and preferably, 150 to 200 mm/s. With regard to the results, we believe that it would have been preferable to publish a single cut-off value based, for example, on the highest or lowest value of ACCmax measured on either the fibular, anterior or posterior tibial arteries as the measurement ATmax previously described (highest AT value between the dorsalis pedis artery and the lateral plantar artery). This metric would facilitate the diagnostic use of ACCmax and avoid the need to remember multiple cut-off values. In this context, presence of critical limb ischemia (CLI) can often be a challenge. An analysis of ACCmax performance to detect CLI would have been of great value. All the more so because, from an analysis of Figure 3, there seems to be a significant overlap of ACCmax values between the stages claudication and CLI, which does not seem to be the case for AT. In conclusion, we would like to warmly congratulate the authors on this study. We have no doubt that both ACCmax and AT are both valuable (and perhaps the only) Doppler waveform measurements to assess the overall severity of LEAD (velocity scale and scrolling speed). For now, the acceleration measurement of the steepest systolic slope remains an rough estimate when measured on a time-velocity curve, but this problem could easily be overcome if ultrasound scanner manufacturers could find a way to also provide an acceleration-time curve, because this is only its first derivative. None. ReplyJournal of Vascular SurgeryVol. 79Issue 6PreviewWe extend our appreciation to Thiran et al. for their insightful response letter regarding our recent publication on the diagnostic efficacy of maximal systolic acceleration (ACCmax) in peripheral arterial disease (PAD) by Willems et al.1 We concur that the growing recognition of acceleration measurements, as evaluated through Doppler ultrasound examination, for diagnostic vascular applications is promising. However, we would like to address several issues raised in the response letter. Full-Text PDF