OBJECTIVE: To identify an analog waveform characteristic of smokers by Doppler sonography, which reflects their atherogenic state, and to determine if the presence of this aberrant waveform will increase the sensitivity of the ankle pressure index (API) peripheral Doppler examination. Also, to examine the relationship between pac-yr smoked and arterial compliance.

DESIGN: A cross-sectional design was used to examine the diastolic component of the triphasic arterial analog waveform. A comparison between the Doppler studies of smokers and nonsmokers was constructed.

SETTING: A university-based study from the Department of Applied Physiology, Teachers College, Columbia University.

PARTICIPANTS: Studied were a total of 140 sedentary subjects consisting of 70 controls and 70 smokers. Control subjects were sedentary and never smoked. Each group consisted of an equal number of male and female subjects. Smoking subjects had smoked 37.8 +/- 21.4 mean pac-yr and were sedentary. No subject had hypertension, diabetes, hyperlipidemia or cardiac disease. They had no evidence of myocardial infarction, arrhythmia, aortic coarctation, cardiac valve disease or peripheral arterial disease. Anthropometric measurements and percent body fat were recorded. A predictive, oxygen-consumption, bike ergometer test was performed to determine aerobic capacity. The standard API Doppler examination and arterial diastolic flow analysis were performed with A-mode Doppler ultrasound on all subjects.

MAIN OUTCOME MEASURE: The amplitude of the diastolic component of the triphasic arterial analog waveform was examined by diastolic flow analysis. This method has been shown to quantify arterial compliance, which is a correlate of arteriosclerotic disease.

RESULTS: A statistically significant difference (p < .001) existed between the mean arterial compliance values of the control and smoking groups. The mean arterial compliance value for the control group was 21.3 +/- 3.7% and 4.9 +/- 4.7% for the smoking group. The mean quantity of arterial compliance in the control group was 4.3 times greater than that observed in the smoking group. A significant inverse-linear relationship was observed between pac-yr smoked and arterial compliance (p < .001).

CONCLUSION: When utilizing Doppler to identify lower-extremity occlusive disease, these results demonstrate that smokers display a distinctive analog waveform. The morphology of the waveform is characterized by an attenuated diastolic component of the analog triphasic complex. This finding reflects an advanced state of arterial disease. In our study, this characteristic waveform was identified when API remained negative. When examining the results of a Doppler peripheral arterial study in a claudication patient, the identification of this waveform suggests that advanced atherogenic changes have occurred.

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