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Updated: Jun 13, 2026
Assessing Endothelial Vasodilator Function with the Endo-PAT 2000
Published on: October 15, 2010
Digital assessment of endothelial function and ischemic heart disease in women
Yasushi Matsuzawa1, Seigo Sugiyama, Koichi Sugamura
1Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Insights
Digital reactive hyperemia peripheral arterial tonometry (RH-PAT) effectively predicts ischemic heart disease (IHD) in women, including nonobstructive coronary artery disease (NOCAD). This noninvasive method identifies high-risk patients before invasive procedures.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Ischemic heart disease (IHD) is a leading cause of mortality in women, with diverse underlying pathologies.
- Endothelial dysfunction is a key factor in IHD pathogenesis.
- Digital reactive hyperemia peripheral arterial tonometry (RH-PAT) offers a noninvasive, automated method for assessing endothelial function.
Purpose of the Study:
- To evaluate the effectiveness of digital RH-PAT in predicting IHD, encompassing both obstructive coronary artery disease (CAD) and nonobstructive coronary artery disease (NOCAD), specifically in female patients.
- To determine if RH-PAT can identify women at high risk for IHD prior to definitive diagnostic procedures.
Main Methods:
- RH-PAT measurements were taken using the Endo-PAT2000 device in 140 women undergoing cardiac catheterization for chest pain evaluation.
- Nonobstructive coronary artery disease (NOCAD) was diagnosed using angiography, coronary blood flow measurements, and provocation tests, alongside cardiac scintigraphy and stress tests.
- Statistical analyses included multivariate logistic regression and receiver-operating characteristic (ROC) analysis to assess predictive capabilities.
Main Results:
- A significant reduction in RH-PAT indexes was observed in women with obstructive CAD and NOCAD compared to those without IHD (p < 0.001).
- The RH-PAT index was the sole significant predictor of IHD (obstructive CAD and NOCAD) in multivariate analysis (OR 0.51, p < 0.001).
- RH-PAT demonstrated strong predictive power for IHD (AUC 0.86) and was particularly effective in predicting NOCAD (AUC 0.85), with an index <1.82 showing 81% sensitivity and 80% specificity.
Conclusions:
- Digital RH-PAT measurements are significantly attenuated in women with IHD.
- RH-PAT serves as a valuable noninvasive tool for predicting IHD, especially NOCAD, in women before undergoing angiography.
- This technology holds potential for identifying women at elevated risk for IHD, facilitating earlier intervention.
Objectives:
We investigated the utility of digital reactive hyperemia peripheral arterial tonometry (RH-PAT) in predicting ischemic heart disease (IHD), including obstructive coronary artery disease (CAD) and nonobstructive coronary artery disease (NOCAD), in women.
Background:
IHD is the leading cause of mortality, and its pathogenesis is diverse in women. Fingertip RH-PAT is a new device that provides noninvasive, automatic, and quantitative evaluation of endothelial dysfunction.
Methods:
RH-PAT was measured using Endo-PAT2000 (Itamar Medical, Caesarea, Israel) before cardiac catheterization in 140 stable women scheduled for hospitalization to examine chest pain. NOCAD was diagnosed by angiography with measurement of coronary blood flow and cardiac lactate production during intracoronary acetylcholine provocation test and cardiac scintigraphy with stress tests.
Results:
Sixty-eight women (49%) had obstructive CAD and 42 women (30%) had NOCAD. RH-PAT indexes were significantly attenuated in both obstructive CAD and NOCAD as compared with non-IHD (n = 30) (obstructive CAD: median 1.57, interquartile range [IQR] 1.42 to 1.76; NOCAD: median 1.58, IQR 1.41 to 1.78; non-IHD: median 2.15, IQR 1.85 to 2.48, p < 0.001). By multivariate logistic regression analysis, only RH-PAT index was significantly associated with IHD, including obstructive CAD and NOCAD (odds ratio 0.51; 95% confidence interval: 0.38 to 0.68; p < 0.001). In receiver-operating characteristic analysis, RH-PAT index was a significant predictor of IHD (area under the curve 0.86; p < 0.001). Furthermore, only RH-PAT was useful for the prediction of NOCAD after excluding obstructive CAD (area under the curve 0.85; p < 0.001; RH-PAT index of <1.82 had 81% sensitivity and 80% specificity).
Conclusions:
RH-PAT indexes were significantly attenuated in women with IHD. Digital RH-PAT can predict patients with IHD, especially NOCAD before angiography. RH-PAT is potentially useful for identifying high-risk women for IHD. (Endothelial Dysfunction and Coronary Artery Spasm; NCT00619294).
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