Artificial intelligence for the evaluation of peripheral artery disease using arterial Doppler waveforms to predict abnormal ankle-brachial index

Robert D. McBane, Dennis H. Murphree, David Liedl, Francisco Lopez-Jimenez, Itzhak Zachi Attia, Adelaide Arruda-Olson, Christopher G. Scott, Naresh Prodduturi, Steve E. Nowakowski, Thom W. Rooke, Ana I. Casanegra, Waldemar E. Wysokinski, Keith E. Swanson, Damon E. Houghton, Haraldur Bjarnason, Paul W. Wennberg

Research output: Contribution to journalArticlepeer-review


Background: Patients with peripheral artery disease (PAD) are at increased risk for major adverse limb and cardiac events including mortality. Developing screening tools capable of accurate PAD identification is a necessary first step for strategies of adverse outcome prevention. This study aimed to determine whether machine analysis of a resting Doppler waveform using deep neural networks can accurately identify patients with PAD. Methods: Consecutive patients (4/8/2015 – 12/31/2020) undergoing rest and postexercise ankle–brachial index (ABI) testing were included. Patients were randomly allocated to training, validation, and testing subsets (70%/15%/15%). Deep neural networks were trained on resting posterior tibial arterial Doppler waveforms to predict normal (> 0.9) or PAD (⩽ 0.9) using rest and postexercise ABI. A separate dataset of 151 patients who underwent testing during a period after the model had been created and validated (1/1/2021 – 3/31/2021) was used for secondary validation. Area under the receiver operating characteristic curves (AUC) were constructed to evaluate test performance. Results: Among 11,748 total patients, 3432 patients met study criteria: 1941 with PAD (mean age 69 ± 12 years) and 1491 without PAD (64 ± 14 years). The predictive model with highest performance identified PAD with an AUC 0.94 (CI = 0.92–0.96), sensitivity 0.83, specificity 0.88, accuracy 0.85, and positive predictive value (PPV) 0.90. Results were similar for the validation dataset: AUC 0.94 (CI = 0.91–0.98), sensitivity 0.91, specificity 0.85, accuracy 0.89, and PPV 0.89 (postexercise ABI comparison). Conclusion: An artificial intelligence-enabled analysis of a resting Doppler arterial waveform permits identification of PAD at a clinically relevant performance level.

Original languageEnglish (US)
Pages (from-to)333-342
Number of pages10
JournalVascular Medicine (United Kingdom)
Issue number4
StatePublished - Aug 2022


  • Doppler waveforms
  • ankle-brachial index (ABI)
  • artificial intelligence
  • exercise testing
  • peripheral artery disease (PAD)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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