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Pedal Acceleration Time as a Marker of Limb Perfusion : A Systematic Review and Correlation Meta-Analysis

Papatheodorou, Nikolaos ; Pavlovic, Pavle LU ; Salcedo, Jose and Maris, Mihaela Ioana (2026) In International Journal of Lower Extremity Wounds
Abstract

Pedal acceleration time (PAT) has recently attracted clinical interest for assessing peripheral arterial disease (PAD), particularly in patients in whom ankle–brachial index (ABI) or toe pressure measurements are unreliable or not feasible, yet its diagnostic worth has not been systematically evaluated. We searched MEDLINE, Embase, ScienceDirect, and the Cochrane Library from inception to January 2026 for studies that included adults with suspected or confirmed PAD and used PAT or other acceleration-based duplex measurements, aiming to synthesize evidence on the diagnostic accuracy of PAT for PAD and chronic limb-threatening ischaemia (CLTI) classification and staging, and to explore the association between PAT and established... (More)

Pedal acceleration time (PAT) has recently attracted clinical interest for assessing peripheral arterial disease (PAD), particularly in patients in whom ankle–brachial index (ABI) or toe pressure measurements are unreliable or not feasible, yet its diagnostic worth has not been systematically evaluated. We searched MEDLINE, Embase, ScienceDirect, and the Cochrane Library from inception to January 2026 for studies that included adults with suspected or confirmed PAD and used PAT or other acceleration-based duplex measurements, aiming to synthesize evidence on the diagnostic accuracy of PAT for PAD and chronic limb-threatening ischaemia (CLTI) classification and staging, and to explore the association between PAT and established hemodynamic indices via meta-analysis. Nine articles were eligible, including 1115 patients and 1748 limbs. PAT across all studies illustrated strong inverse correlations with existing haemodynamic indices, with correlation coefficients typically ranging from −0.78 to −0.89, while reported diagnostic performance differed but was typically decent (AUC=0.79–0.99). A correlation meta-analysis, based on five of the included studies, revealed significant reciprocal correlations between PAT and ABI in three studies (pooled r ≈ −0.80; I2 = 0%), whereas three studies showed a statistically significant association (pooled r ≈ −0.76) between PAT and Toe–Brachial Index (TBI), with significant heterogeneity (I2 = 97%). Two studies reported inverse correlations of PAT with toe pressure (r = −0.74 and −0.41). This study highlights that PAT consistently correlates with established perfusion indices, and appears to be a valuable measure for detecting CLTI and grading PAD.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
chronic limb- threatening ischemia, correlation meta-analysis, maximal acceleration time, pedal acceleration time, peripheral arterial disease
in
International Journal of Lower Extremity Wounds
publisher
SAGE Publications
external identifiers
  • pmid:42295166
  • scopus:105041938170
ISSN
1534-7346
DOI
10.1177/15347346261459550
language
English
LU publication?
yes
id
e8523aea-a8f6-475c-85ff-9fc2501e8d40
date added to LUP
2026-09-24 15:10:29
date last changed
2026-09-25 03:00:03
@article{e8523aea-a8f6-475c-85ff-9fc2501e8d40,
  abstract     = {{<p>Pedal acceleration time (PAT) has recently attracted clinical interest for assessing peripheral arterial disease (PAD), particularly in patients in whom ankle–brachial index (ABI) or toe pressure measurements are unreliable or not feasible, yet its diagnostic worth has not been systematically evaluated. We searched MEDLINE, Embase, ScienceDirect, and the Cochrane Library from inception to January 2026 for studies that included adults with suspected or confirmed PAD and used PAT or other acceleration-based duplex measurements, aiming to synthesize evidence on the diagnostic accuracy of PAT for PAD and chronic limb-threatening ischaemia (CLTI) classification and staging, and to explore the association between PAT and established hemodynamic indices via meta-analysis. Nine articles were eligible, including 1115 patients and 1748 limbs. PAT across all studies illustrated strong inverse correlations with existing haemodynamic indices, with correlation coefficients typically ranging from −0.78 to −0.89, while reported diagnostic performance differed but was typically decent (AUC=0.79–0.99). A correlation meta-analysis, based on five of the included studies, revealed significant reciprocal correlations between PAT and ABI in three studies (pooled r ≈ −0.80; I<sup>2</sup> = 0%), whereas three studies showed a statistically significant association (pooled r ≈ −0.76) between PAT and Toe–Brachial Index (TBI), with significant heterogeneity (I<sup>2</sup> = 97%). Two studies reported inverse correlations of PAT with toe pressure (r = −0.74 and −0.41). This study highlights that PAT consistently correlates with established perfusion indices, and appears to be a valuable measure for detecting CLTI and grading PAD.</p>}},
  author       = {{Papatheodorou, Nikolaos and Pavlovic, Pavle and Salcedo, Jose and Maris, Mihaela Ioana}},
  issn         = {{1534-7346}},
  keywords     = {{chronic limb- threatening ischemia; correlation meta-analysis; maximal acceleration time; pedal acceleration time; peripheral arterial disease}},
  language     = {{eng}},
  publisher    = {{SAGE Publications}},
  series       = {{International Journal of Lower Extremity Wounds}},
  title        = {{Pedal Acceleration Time as a Marker of Limb Perfusion : A Systematic Review and Correlation Meta-Analysis}},
  url          = {{http://dx.doi.org/10.1177/15347346261459550}},
  doi          = {{10.1177/15347346261459550}},
  year         = {{2026}},
}