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. 2015 Sep;23(10):468-474.
doi: 10.1007/s12471-015-0715-4.

Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

M van den Heuvel  1   2   3 , O Sorop  4   5 , P J Musters  4 , R T van Domburg  4 , T W Galema  4 , D J Duncker  4 , W J van der Giessen  4   5 , K Nieman  4   6
Affiliations

Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

M van den Heuvel et al. Neth Heart J. 2015 Sep.

Abstract

Background: Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic.

Methods: In 93 patients, PAT was performed resulting in reactive hyperaemia (RHI) and augmentation (AIx) indices. Patients were risk classified according to HeartScore, Diamond and Forrester pretest probability (DF), exercise testing (X-ECG), and computed tomography calcium scoring (CCS) and angiography (CTA). Correlations, risk group differences and prediction of revascularisation within 1 year were calculated.

Results: RHI correlated with HeartScore (r = - 0.21, p = 0.05), AIx with DF (r = 0.26, p = 0.01). However, both were not significantly different between normal and ischaemic X-ECG groups. In addition RHI and AIx were similar between low risk as compared with intermediate-to-high risk, based on risk algorithms (RHI: 1.98 (0.67) vs 1.94 (0.78); AIx: 0.0 (21) vs 5.0 (25); p = NS), or CCS and CTA (RHI: 1.99 (0.58) vs 1.89 (0.82); AIx: - 2.0 (24) vs 4.0 (25); p = NS). Finally, RHI and AIx failed to predict revascularisation (RHI: OR 1.42, CI 0.65-3.1; AIx: OR 1.02, CI 0.98-1.05).

Conclusions: PAT cannot detect a low risk of CAD, possibly because RHI and AIx versus X-ECG, CCS and CTA represent independent processes.

Keywords: Coronary artery disease; Noninvasive testing; Peripheral vascular function.

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Figures

Fig. 1
Fig. 1
Correlation graphs of reactive hyperaemia index (RHI) (panels a, c, e) and augmentation index (AIx) (panels b, d, f) with HeartScore (panels a, b), Diamond and Forrester pretest probability (DF) (panels c, d) and total amount of plaque assessed by computed tomographic angiography (CTA) (panels e, f). Regression equation and R2 correlation coefficient are depicted per panel. Significant associations were observed between RHI and HeartScore as well as between AIx and DF, *P ≤ 0.05
Fig. 2
Fig. 2
Differences of reactive hyperaemia index (RHI) (panels a, c) and augmentation index (AIx) (panels b, d) between patients at low and intermediate-to-high risk of clinically relevant CAD based on the combined outcome of risk scores (a, b), and CCS and CTA assessed plaque and stenosis (c, d). Horizontal bars depict the median value. No significant differences between the groups were observed. RF risk factors, X-ECG exercise ECG, CT computed tomography, low low risk, int-hi intermediate-to-high risk
Fig. 3
Fig. 3
Differences of reactive hyperaemia index (RHI) (panel a) and augmentation index (AIx) (panel b) between patients with and without revascularisation up to 1 year after PAT measurement. Horizontal bars depict the median value. No significant differences between the groups were observed. Revasc − no revascularisation; Revasc + revascularisation
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