Noninvasive assessment of endothelial function and ST segment changes during exercise testing in coronary artery disease

Abstract

Endothelial function (EF) plays an important role in the onset and clinical course of atherosclerosis, although its relationship with the presence and extent of coronary artery disease (CAD) has not been well defined. We evaluated EF and the ST segment response to an exercise test in patients with a broad spectrum of CAD defined by coronary angiography. Sixty-two patients submitted to diagnostic catheterization for the evaluation of chest pain or ischemia in a provocative test were divided into three groups according to the presence and severity of atherosclerotic lesions (AL): group 1: normal coronaries (N = 19); group 2: CAD with AL <70% (N = 17); group 3: CAD with AL ≥70% (N = 26). EF was evaluated by the percentage of flow-mediated dilatation (%FMD) in the brachial artery during reactive hyperemia induced by occlusion of the forearm with a pneumatic cuff for 5 min. Fifty-four patients were subjected to an exercise test. Gender and age were not significantly correlated with %FMD. EF was markedly reduced in both groups with CAD (76.5 and 73.1% vs 31.6% in group 1) and a higher frequency of ischemic alterations in the ST segment (70.8%) was observed in the group with obstructive CAD with AL ≥70% during the exercise test. Endothelial dysfunction was observed in patients with CAD, irrespective of the severity of injury. A significantly higher frequency of ischemic alterations in the ST segment was observed in the group with obstructive CAD. EF and exercise ECG differed among the three groups and may provide complementary information for the assessment of CAD.

Prognostic Effectiveness of Blood Gas Lactate Values and Peripheral Perfusion Indices in Patients Diagnosed with Acute Coronary Syndrome in The Emergency Department

“…Contrary to expectations, PPI failed to serve as an effective marker of peripheral perfusion, hospitalization, or mortality in this study. Despite the demonstrated use of PPI as an objective indicator of peripheral circulatory disorders, our findings, consistent with previous reports [9][10][11], showed that PI was an insignificant parameter for deciding hospitalization or diagnosing outcomes of ACS in the ED. PPI has become recognized as a straightforward and noninvasive method for indicating compromised peripheral perfusion in critically ill patients [11,12].…”

“…This study should be interpreted in light of its limitations, including the sample size, which may affect the power to detect subtle differences. Furthermore, given that both PI and Blood Gas Lactate Values can be affected by sympathetic activity [9,10], a thorough examination of other relevant parameters could enhance interpretation.…”

“…Karaman et al [2] probed into the role of the Peripheral Perfusion Index in differentiating diagnoses between cardiac and pulmonary-origin dyspnea within the emergency service domain. Conversely, Chequer et al [9] embarked on an investigative journey into the noninvasive assessment of ST-segment alterations during exercise testing in coronary artery disease through the lens of PI, while Menezes et al [1] directed their investigative focus towards the exploration of endothelial functions in atherosclerosis employing PI as a critical tool in their research methodology [19].…”