Prognostic Value of Peripheral Arterial Tonometry in Patients with Coronary Artery Disease and a High Cardiovascular Risk Profile

Abstract

Aim: Data regarding the prognostic value of peripheral endothelial function testing in patients with cardiovascular disease are conflicting. Peripheral arterial tonometry (PAT) is increasingly used to measure the peripheral endothelial function. The prognostic value of this method has not been investigated thus far in patients with cardiovascular disease and/or a high cardiovascular risk profile. Methods: In 96 patients with significant coronary artery disease (CAD) or ＜70% stenosis and ≥ three cardiovascular risk factors, reactive hyperemia was induced following upper arm occlusion and the PAT-ratio between baseline and hyperemia was calculated. The patients were followed for cardiovascular events (revascularization, acute coronary syndrome, ischemic stroke, cardiovascular death, repeat coronary angiography due to chest pain) for 44±14 months. The first event was included in the combined end point. Results: The study cohort was divided according to the median PAT-ratio (1.91). The combined end point occurred in 14 patients with a PAT-ratio below the median (1.91) and in 12 patients with a PAT-ratio of ≥ 1.91 (p= 0.65). In a subgroup of 76 patients, the PAT-ratio was reassessed after six months. No differences in the event rate were found between the patients who exhibited deterioration (n = 50) and those who exhibited an improvement in the PAT-ratio of ＞0.1 (n = 26; 22 vs. 32%, p = 0.32). The combined end point occurred earlier in the patients with a PAT-ratio within the 1st tertile than in those with a PAT-ratio within the 2nd/3rd tertile (11.3±11.0 vs. 27.5±18.6 months, p= 0.03). Conclusions: In patients with established CAD or a high cardiovascular risk profile, the PAT-ratio cannot be used to predict the risk of future cardiovascular events. However, a lower PAT-ratio may be associated with the earlier occurrence of cardiovascular events. J Atheroscler Thromb, 2014; 21:230-238.

Endothelial function as predictor in patients with coronary syndrome treated by percutaneous coronary intervention

“…The associations between RHI and coronary blood flow, coronary DEF, coronary microvascular function, heart failure, and their future events have been reported. The results above were consistent with those of previous reports, in which RHI was shown to be a risk factor in addition to the traditional risk factors [22,28], which may provide guidance for ACS risk stratification.…”

Atherosclerosis at your fingertips?

“…However, separate prediction of revascularisation could also not be demonstrated. Later, Suessenbacher et al [ 3 ] performed PAT in patients with significant coronary artery disease in at least one coronary vessel plus patients with < 70 % stenosis and a high cardiac risk profile. Average follow-up was 44 months.…”

The Relationship between Endothelial Dysfunction and Endothelial Cell Markers in Peripheral Arterial Disease

“…Several factors have been reported to be correlated with the TM level, including inflammatory disease [18], systemic disease [19], and malignant disease [20]. Some types of atherosclerotic disease, including CAD [21], CVD [22] and aneurysmal disease [23], have been reported to be positively associated with TM. Furthermore, some studies have reported a positive association between TM and PAD [11, 24].…”