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

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 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.