Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events

Introduction: Drug-eluting stents (DESs) are replacing bare-metal stents (BMSs), but in-stent restenosis (ISR) remains a problem. Impaired endothelial function is a key event in the atherosclerosis process and a predictor of future cardiovascular events. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry (PAT) evaluates endothelial function noninvasively. Hypothesis: We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention (PCI). Methods: RHI was measured using Endo-PAT 2000 before PCI (initial RHI) and at follow-up angiography (F/U RHI) in 249 consecutive patients who had successful PCI. F/U angiography was performed at six and nine months after PCI with BMS and DES, respectively. ISR was defined as percent diameter stenosis >50% at F/U angiography assessed by quantitative coronary angiography. Results: At F/U, ISR was seen in 68 patients (27.3%). F/U ln(RHI) was significantly lower in patients with ISR than in those without (0.52 ± 0.23 vs. 0.65 ± 0.27, p < 0.01); no between-group difference in initial ln(RHI) was seen (0.60 ± 0.26 vs. 0.62 ± 0.25, p = 0.56). By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis (BMS use, total stent length, HDL-Cholesterol, HbA1c, calcium antagonist use, and post-PCI minimum lumen diameter), F/U ln(RHI) independently predicted ISR (odds ratio: 0.13; 95% confidence interval [CI]: 0.04-0.48; p = 0.002). In receiver operating-characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve [AUC]: 0.67; 95% CI: 0.60-0.75; p < 0.01; RHI < 1.73 had 67.6% sensitivity, 64.1% specificity); AUC significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors (diabetes mellitus, total stent length, minimum stent diameter) (p = 0.02). Net reclassification index was significant after addition of RHI (26.5%, p = 0.002). Conclusions: To our knowledge, this is the first study indicating that impaired RHI at F/U angiography independently predicts occurrence of ISR. The simple and noninvasive assessment of endothelial function by RH-PAT adds incremental prognostic value to ISR-risk stratification following PCI.

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Abstract 536: Poor Correlation Between FMD and PAT-Ratio in Patients With Metabolic Syndrome

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.536 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Ueda Tomohiro

Keyword(s):

Metabolic Syndrome ◽

Endothelial Function ◽

Multivariable Analysis ◽

Control Group ◽

Poor Correlation ◽

Study Group ◽

Peripheral Arterial Tonometry ◽

Arterial Tonometry ◽

Coronary Lesions ◽

Peripheral Arterial

Background: Flow mediated dilatation (FMD) and peripheral arterial tonometry (PAT) are commonly used methods for assessing endothelial function in a research setting but it is unclear how well they correlate. The aim of this study is to compare and correlate these methods in patients with metabolic syndrome. Methods: The study involved 105 subjects (mean age68±10 years) with metabolic syndrome. Based on the results of coronary angiography, they were divided into 2 groups: a study group with coronary lesions (n=68) and a control group without coronary lesions (n=37). Flow mediated vasodilatation (FMD) and nitroglycerine-induced vasodilatation (NID) in the brachial artery was measured by using UNEXEF18G (UNEX CO, Japan). At the same time, PAT ratio was measured by using Endo-PAT 2000 (Itamar Medical, Israel) Results: FMD was not correlated with PAT ratio by Spearman`s analysis. FMD was significantly impaired in the study group compared to that in the control group (3.9±1.8% vs. 2.6±1.5%, respectively; P<0.001). However, NID and PAT ratio had no deference in the two groups. Multivariable analysis revealed that FMD (odds ratio: 0.53, 95% confidence interval [CI]: 0.31-0.90) were independent variables for CAD in metabolic syndrome patients. Conclusion: This study showed that poor correlation between FMD and PAT in patients with metabolic syndrome. PAT may not be used as a substitute for FMD as a measure of endothelial function

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The relationship between peripheral arterial tonometry and classic measures of endothelial function

Vascular Medicine ◽

10.1177/1358863x12468194 ◽

2012 ◽

Vol 18 (1) ◽

pp. 13-18 ◽

Cited By ~ 12

Author(s):

Billie-Jean Martin ◽

Vikram Gurtu ◽

Sammy Chan ◽

Todd J Anderson

Keyword(s):

Endothelial Function ◽

Vascular Function ◽

Cardiac Risk ◽

Peripheral Arterial Tonometry ◽

Velocity Time Integral ◽

Time Integral ◽

Arterial Tonometry ◽

Artery Disease ◽

Peripheral Arterial ◽

The Relationship

The aim of this study was to assess the association between peripheral arterial tonometry (PAT) and two more traditional measures of endothelial function – flow-mediated dilation (FMD) and its hyperemic stimulus, hyperemic peak velocity time integral (VTI). We related three vascular function measures (natural log transformed PAT, FMD, and VTI) from 304 patients (mean age 48.9 ± 12.5 years), including 105 with coronary artery disease (CAD). Using linear regression, we studied the relationships between lnPAT, FMD, and VTI, and compared differences in these parameters in those with and without CAD. Although FMD and lnPAT both had a correlation with VTI (Pearson’s r = 0.119, p = 0.039 and r = 0.167, p = 0.004, respectively), lnPAT had no correlation with FMD ( r = −0.0471, p = 0.414). lnPAT was also lower in patients with CAD compared to controls (mean 0.51 ± 0.19 versus 0.65 ± 0.26, respectively, p < 0.0001). In multivariate analysis, VTI remained associated with lnPAT (standardized β = 0.1369, p = 0.04). Among this group of subjects with and without CAD, lnPAT was found to be unrelated to FMD but correlated with VTI. This would suggest that lnPAT is a measure of microvascular function. Although it is unrelated to FMD, lnPAT is decreased in patients with pre-existing cardiovascular disease. Further studies are required to determine if this can be used clinically as a tool for cardiac risk stratification and prediction of CAD.

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