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

M van den Heuvel1,2,3, O Sorop4,5, P J Musters4

  • 1Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. m.vandenheuvel.1@erasmusmc.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|May 30, 2015
PubMed

Insights

Peripheral arterial tonometry (PAT) cannot reliably detect low coronary artery disease (CAD) risk. Reactive hyperaemia (RHI) and augmentation (AIx) indices did not correlate with standard risk assessments or predict revascularization needs.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Endothelial dysfunction is an early indicator of coronary artery disease (CAD).
  • Peripheral arterial tonometry (PAT) is a method to assess endothelial function.
  • This study investigates PAT's utility in identifying low CAD risk within a chest pain clinic setting.

Purpose of the Study:

  • To evaluate the effectiveness of PAT in detecting low risk for coronary artery disease (CAD).
  • To compare PAT-derived indices (RHI and AIx) with established CAD risk assessment tools.

Main Methods:

  • Peripheral arterial tonometry (PAT) was performed on 93 patients, yielding reactive hyperaemia (RHI) and augmentation (AIx) indices.
  • Patients were risk-stratified using HeartScore, Diamond and Forrester (DF) pretest probability, exercise electrocardiogram (X-ECG), computed tomography calcium scoring (CCS), and coronary computed tomography angiography (CTA).
  • Correlations between PAT indices and risk classifications, differences between risk groups, and prediction of 1-year revascularization were analyzed.

Main Results:

  • Reactive hyperaemia (RHI) showed a weak correlation with HeartScore (r = -0.21, p = 0.05), and augmentation index (AIx) with Diamond and Forrester (DF) probability (r = 0.26, p = 0.01).
  • Neither RHI nor AIx significantly differed between normal and ischemic exercise ECG groups, nor between low-risk and intermediate-to-high-risk groups based on risk algorithms, CCS, or CTA.
  • RHI and AIx failed to predict the need for revascularization within one year.

Conclusions:

  • Peripheral arterial tonometry (PAT) is not suitable for detecting low coronary artery disease (CAD) risk.
  • The study suggests that RHI and AIx indices derived from PAT may represent processes independent of established CAD risk assessment methods like X-ECG, CCS, and CTA.
Abstract

Keywords:
Coronary artery diseaseNoninvasive testingPeripheral vascular function

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