Ankle brachial index and brachial-ankle pulse wave velocity as predictor for major adverse limb events and all-cause mortality in diabetes.

Background: Ankle-brachial index (ABI) is not a reliable index predicting cardiovascular events, as a significant number of patients with normal ABI do have cardiovascular events. Brachial-ankle pulse wave velocity (BaPWV), a non-invasive vascular assessment index for predicting CV events in normal ABI is not studied in type 2 diabetes (T2D).

Methods: This prospective study included people with T2D from year 2013 until December 2022 or death. Demographics and T2D related complications were recorded. All participants had ABI and BaPWV measured at study entry and grouped based on initial ABI (group A: ABI 0.7-0.9, group B: ABI 0.9-1.2, and group C: ABI >1.2) and sub-categorised based on BaPWV quartiles. The primary objective was to identify BaPWV cut-offs for prediction of all-cause mortality despite normal ABI.

Results: A total of 16000 patients with T2D were screened and 2186 individuals with first incident diabetic foot ulcer (DFU) were evaluated. The median age of participants was 61 (53-67) years, duration of T2D 10 (6-15) years, and follow-up of 6 (2-8) years. Overall, BaPWV>1882 cm/s was associated with reduced survival [HR 0.750 (0.622-0.904); p = 0.003]. Participants with BaPWV >2210 cm/s (HR = 0.48, 95 % CI: 0.33-0.70, p < 0.001) and BaPWV<1642 cm/s (HR = 0.75, 95 % CI: 0.56-1.002, p = 0.051) had higher mortality risk compared to BaPWV 1642-2210 cm/s, despite normal ABI.

Conclusions: A BaPWV>1882 cm/s is associated with reduced survival in people of diabetes. Despite a normal ABI, a BaPWV>2210 cm/s or <1642 cm/s are associated with increased all-cause mortality in people with T2D.