Reliability of peripheral arterial tonometry in patients with heart failure, diabetic nephropathy and arterial hypertension

Abstract

Endothelial dysfunction plays a major role in cardiovascular diseases and pulse amplitude tonometry (PAT) offers a non-invasive way to assess endothelial dysfunction. However, data about the reliability of PAT in cardiovascular patient populations are scarce. Thus, we evaluated the test-retest reliability of PAT using the natural logarithmic transformed reactive hyperaemia index (LnRHI). Our cohort consisted of 91 patients (mean age: 65±9.7 years, 32% female), who were divided into four groups: those with heart failure with preserved ejection fraction (HFpEF) ( n=25), heart failure with reduced ejection fraction (HFrEF) ( n=22), diabetic nephropathy ( n=21), and arterial hypertension ( n=23). All subjects underwent two separate PAT measurements at a median interval of 7 days (range 4-14 days). LnRHI derived by PAT showed good reliability in subjects with diabetic nephropathy (intra-class correlation (ICC) = 0.863) and satisfactory reliability in patients with both HFpEF (ICC = 0.557) and HFrEF (ICC = 0.576). However, in subjects with arterial hypertension, reliability was poor (ICC = 0.125). We demonstrated that PAT is a reliable technique to assess endothelial dysfunction in adults with diabetic nephropathy, HFpEF or HFrEF. However, in subjects with arterial hypertension, we did not find sufficient reliability, which can possibly be attributed to variations in heart rate and the respective time of the assessments. Clinical Trial Registration Identifier: NCT02299960.

Endothelial dysfunction is not a predictor of outcome in chronic obstructive pulmonary disease

“…However, we found no association between dysfunctional endothelium and other cardiovascular comorbidities or aspirin, a medication considered to influence endothelial function [34]. This is surprising and could point to a technical fault, yet, the RHI measured for patients with arterial hypertension (RHI = 1.8 ± 0.7) was similar to that reported by Weisrock et al (RHI = 1.7 ± 0.4 to 1.8 ± 0.4) [35]. Additionally, we confirmed the finding of van der Heijden et al [36] that BMI is associated with endothelial dysfunction.…”

“…On the other hand, more than half of the patients assessed in our study had arterial hypertension. Weisrock et al [35] indicated that PAT is not a reliable method for measuring endothelial dysfunction in patients with arterial hypertension. This could, therefore, explain why we found no association between RHI and most cardiovascular comorbidities or aspirin in our study.…”

Metabolic syndrome is associated with peripheral endothelial dysfunction amongst men

“…However, the study was based on two patient populations aged 60-79 and 70-82 which is significantly older than the age in the current study. Weisrock et al 28 found good reliability of PAT in different groups but not in subjects with hypertension, possibly due to variations in heart rate. That could explain the absence of significant association between PED and hypertension in our study.…”

Cardiac Rehabilitation and Endothelial Function

“…However, a poor correlation between RHI and FMD has been found in various settings, suggesting that the two methods explore different, although complementary, aspects of the vascular function [53,54]. The reproducibility of PAT has been reported to be rather low, which makes difficult to standardize its application in clinical practice [55,56], and has until now also precluded its inclusion in clinical guidelines [41].…”

“…In dysfunctional vessels, however, CPT may trigger sympathetic-mediated vascular constriction [63,64]. Several studies have assessed coronary microvascular endothelial function by assessing the CBF increase in response to CPT, also using non-invasive methods (e.g., positron emission tomography, cardiac magnetic resonance and transthoracic Doppler recording) [55]. The reliability of this method, however, is limited by the impossibility to exclude some direct coronary constriction in the limitation of CBF increase.…”