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Updated: May 22, 2026

Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Microvascular dysfunction and pulse wave reflection characterize different vascular pathologies in patients at
Ulrich Fischer-Rasokat1, Ioakim Spyridopoulos, Julia Walter
1Division of Cardiology, Department of Medicine III, Goethe University Hospital, Frankfurt/Main, Germany.
Reactive hyperemia index (RHI) and augmentation index (AI) measure distinct vascular pathologies in patients with cardiovascular risk. RHI may help identify high-risk patients after atherosclerotic disease diagnosis.
Area of Science:
- Cardiovascular research
- Vascular biology
- Biomedical engineering
Background:
- Endothelial dysfunction and arterial pulse wave reflections are key in atherosclerosis development.
- Reactive hyperemia index (RHI) reflects microvascular function.
- Increased augmentation index (AI) suggests macrovascular damage.
Purpose of the Study:
- To assess interrelationships among noninvasive measures of vascular function: RHI, radial AI (rAI), and digital AI (dAI).
- To evaluate the association of these vascular measures with cardiovascular risk factors and a modified SMART risk score.
Main Methods:
- 178 patients with cardiovascular risk factors underwent measurements of rAI and dAI via applanation tonometry.
- Digital RHI was assessed using peripheral arterial tonometry.
- A modified SMART risk score was calculated for all participants.
Main Results:
- Strong correlation observed between dAI and rAI (r = 0.63, p < 0.01), independent of age, sex, diabetes, and CAD.
- Weak correlations were found between AI parameters and RHI (microvascular function).
- AI correlated with sex, age, height, heart rate, and CAD; RHI associated with diabetes and nicotine use. Only RHI correlated with the modified SMART risk score.
Conclusions:
- RHI and increased pulse wave reflection represent distinct vascular pathologies in patients at cardiovascular risk.
- RHI may be valuable for identifying high-risk individuals once atherosclerotic disease is diagnosed.
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