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Updated: Mar 26, 2026
Non-invasive Assessment of Microvascular and Endothelial Function
Published on: January 29, 2013
Clinical Phenotype and Microvascular Dynamics of Subjects with Endothelial Dysfunction as Assessed by Peripheral
Elena Venturi1, Silvia Pinnola1, Carmela Morizzo2
1Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Insights
Endothelial dysfunction (ED), measured by PAT, is not strongly linked to traditional risk factors or atherosclerosis severity in high-risk patients. Most causes of ED remain unknown, highlighting a gap in understanding cardiovascular health.
Area of Science:
- Cardiovascular Research
- Vascular Biology
- Endothelial Function
Background:
- Endothelial dysfunction (ED) is a precursor to cardiovascular disease (CVD).
- Assessing ED using peripheral arterial tonometry (PAT) offers a non-invasive method.
- Understanding ED determinants is crucial for risk stratification and management.
Purpose of the Study:
- To characterize endothelial dysfunction (ED) using PAT.
- To identify determinants of ED in a mixed outpatient population, including diabetic and non-diabetic subjects.
- To correlate ED with clinical, biochemical, and vascular parameters.
Main Methods:
- Peripheral arterial tonometry (PAT) was used to measure digital pulse amplitude (basal and post-ischemic).
- A cohort of 206 diabetic and 101 non-diabetic subjects underwent comprehensive phenotyping.
- Analysis focused on identifying factors associated with ED characteristics.
Main Results:
- Lower post-ischemic vasodilatory reserve characterized ED.
- Higher baseline pulse amplitude and delayed peak response were key ED features.
- Baseline pulse amplitude was the main determinant, influenced by age, central obesity, HDL cholesterol, and systolic blood pressure.
Conclusions:
- ED detected by PAT in high-CVD-risk individuals does not correlate with classical risk factors or atherosclerosis severity.
- Central obesity and HDL cholesterol were identified as factors, but most ED determinants remain unknown.
- Further research is needed to elucidate the multifactorial nature of ED.
Objective:
To evaluate the characteristics and the determinants of ED, as measured by PAT.
Methods:
We measured basal and post-ischemic digital pulse amplitude (EndoPAT(®)) in a mixed outpatient population of 206 diabetic and 101 non-diabetic subjects, of whom 50% with clinically manifest CVD, undergoing to an extensive clinical, biochemical, and vascular phenotype characterization.
Results:
The major characteristics of ED (tertile 1 vs 3), in addition to lower post-ischemic vasodilatory reserve (34 vs 203%), were a 3-fold higher baseline pulse amplitude and a delayed (60 second) peak response. The main determinant of this response was the baseline pulse amplitude (Stβ = -0.59), which in turn was influenced by age (Stβ = 0.13), central obesity (Stβ = 0.27) and inversely by HDL cholesterol (Stβ = -0.17), and systolic blood pressure (Stβ = -0.19). No association was observed with cardiovascular risk factors, previous cardiovascular event or extent of atherosclerosis (ABI and IMT, PWV). Most of the variability in baseline pulse amplitude remained unexplained (r(2) = 0.14).
Conclusions:
ED, as detected by PAT in a population enriched with subjects at risk for CVD neither reflects the burden of classical risk factors (under treatment) nor the severity of atherosclerosis. Aside from central obesity and HDL cholesterol, most of the factors responsible for this ED remain unknown.
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