Noninvasive Assessment of Endothelial Function: The Classic Methods and the New Peripheral Arterial Tonometry

Abstract

The combination of risk stratification by assessment of conventional risk factors for cardiovascular disease (CVD) with not only a morphological assessment of vascular damage (such as carotid ultrasound examination) but also vascular function tests may be a useful strategy for the management of CVD and its related risk factors. Endothelial dysfunction is present in a great variety of pathological conditions: it is considered the first alteration of vascular function in atherosclerosis and one of the phenomena involved in the progression of heart failure. Assessing endothelial function with noninvasive methods could have a central role for evaluation of treatment, prognostic stratification, and pharmacological studies in CVD. In this review, we focus on noninvasive techniques that have recently become available to assess endothelial function and express the possible clinical role in different clinical settings.

Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in Patients with Periprocedural Myocardial Injury

“…However, these methods are limited by availability, cost, or exposure to radiation. RHI assessment by PAT has been validated as a noninvasive way to evaluate peripheral and coronary microvascular endothelial function [ 12 , 14 , 15 ]. Herein, we designed this prospective study to determine if preprocedural RHI is a risk factor and predictor of PMI.…”

“…CMD is a crucial pathophysiologic damage caused by PMI, which, in turn, could be an important risk factor that predisposes patients to PMI. PAT, which detects the reactive hyperemia-induced changes in digital peripheral pulse amplitude to evaluate peripheral endothelial function [ 12 ], was not only closely related with cardiovascular risk factors [ 13 ] but also considered as a valuable noninvasive way to evaluate coronary microvascular function [ 14 , 15 ]. Hence, PAT could be a useful method to identify patients at high risk of PMI before the procedure.…”

Reproducibility of a New Method to Assess Endothelial Function According to Peripheral Arterial Volume

“…The ICC, reflecting the consistency between two measurements, demonstrated the good reproducibility of PAV in this clinical study in adults, thus highlighting the inherent advantages of this technique. Grounded in PAT theory [13][14][15], PAV is a reliable fingertip technique for evaluating endothelial function in the adult population. Although few studies have assessed PAV's repeatability, several findings support its application.…”

A new peripheral endothelial function measurement improves prediction of symptomatic coronary artery disease

“…10,11 In the current clinical setting, measurement of endothelial function is often used daily or in large patient populations, and thus should be noninvasive and easy to perform. 12 In recent years, several noninvasive methods have been developed based on the same principle of reactive hyperemia. [13][14][15][16] The PAT technique is an automatic and operator-independent method, and this technique has gained increasing attention.…”