Digital Peripheral Arterial Tonometry and Cardiovascular Disease Events: The Framingham Heart Study

Abstract

Background and Purpose: Novel noninvasive measures of vascular function are emerging as subclinical markers for cardiovascular disease (CVD) and may be useful to predict CVD events. The purpose of our prospective study was to assess associations between digital peripheral arterial tonometry (PAT) measures and first-onset major CVD events in a sample of FHS (Framingham Heart Study) participants. Methods: Using a fingertip PAT device, we assessed pulse amplitude in Framingham Offspring and Third Generation participants (n=3865; mean age, 55±14 years; 52% women) at baseline and in 30-second intervals for 4 minutes during reactive hyperemia. The PAT ratio (relative hyperemia index) was calculated as the post-to-pre occlusion pulse signal ratio in the occluded arm, relative to the same ratio in the control (nonoccluded) arm, and corrected for baseline vascular tone. Baseline pulse amplitude and PAT ratio during hyperemia are measures of pressure pulsatility and microvascular function in the finger, respectively. We used Cox proportional hazards regression to relate PAT measures in the fingertip to incident CVD events. Results: During follow-up (median, 9.2 years; range, 0.04–10.0 years), 270 participants (7%) experienced new-onset CVD events (n=270). In multivariable models adjusted for cardiovascular risk factors, baseline pulse amplitude (hazard ratio [HR] per 1 SD, 1.04 [95% CI, 0.90–1.21]; P =0.57) and PAT ratio (HR, 0.95 [95% CI, 0.84–1.08]; P =0.43) were not significantly related to incident composite CVD events, including myocardial infarction or heart failure. However, higher PAT ratio (HR, 0.76 [95% CI, 0.61–0.94]; P =0.013), but not baseline pulse amplitude (HR, 1.15 [95% CI, 0.89–1.49]; P =0.29), was related to lower risk for incident stroke. In a sensitivity analysis by stroke subtype, higher PAT ratio was related to lower risk of incident ischemic stroke events (HR, 0.68 [95% CI, 0.53–0.86]; P =0.001). Conclusions: Novel digital PAT measures may represent a marker of stroke risk in the community.

New Noninvasive Methods to Evaluate Microvascular Structure and Function

“…A , Illustration of a standardized EndoPAT protocol, Adapted from Masi et al 75 B , Postocclusion reactive hyperemia is associated with microcirculatory endothelial function. It is an independent prognostic marker of cardiovascular events such as stroke, 87 ( C ) cardiac death/myocardial infarction/coronary revascularization and cardiac hospitalization. 91…”

“…82 EndoPAT has proven reliable in patients with HF, diabetic nephropathy, and hypertension. 83 More importantly, a reduced RHI has been associated with an increased risk of adverse CV outcomes in patients with CAD 84 and diabetic nephropathy 85 and is an independent predictor of ischemic stroke in a nonhigh CV risk population 86,87 (Figure 2B). It also predicts CV events in patients with HF with preserved ejection fraction, 88 angina, [89][90][91] (Figure 2C) and undergoing CV surgery.…”

“…107 Moreover, LDF may be easily combined with an oxygen-to-see spectrophotometer 107 to measure peripheral oxygen extraction, as well as with EndoPAT, given that the 2 techniques assess noninvasively different components of the endothelial vasodilator response. 78 It is an independent prognostic marker of cardiovascular events such as stroke, 87 (C) cardiac death/ myocardial infarction/coronary revascularization and cardiac hospitalization. 91…”

Emerging Medical Therapies for the Treatment of Obesity in Women with Cardiovascular Diseases

“…Sex hormones, including estrogen, regulate adipose tissue biology, leading to a more unhealthy phenotype in the postmenopausal period [ 35 ]. Age-related arterial stiffening is greater in women as is insulin-resistance driven microvascular dysfunction [ 36 – 40 ]. Sex hormones also contribute to endothelial function with a greater decline in vasomotor function in women following menopause [ 41 , 42 ].…”

Effect of high‐intensity interval walking on microvascular endothelial function among community‐dwelling older people

“…In a meta‐analysis, FMD has been reported to predict the risk of cardiovascular events in patients with a history of cardiovascular diseases 6 . However, some cohort studies in community‐dwelling people that measured both FMD and microvascular function, measured as RHI or hyperemia velocity, reported that microvascular function, but not FMD, predicted the risk of cardiovascular events 7,8 . As the RHI reflects various physiological changes that lead to the development of atherosclerosis, 9,10 its decrease would be associated with cardiovascular risk among community‐dwelling people.…”