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Digital Peripheral Arterial Tonometry and Cardiovascular Disease Events: The Framingham Heart Study
Leroy L Cooper1, Na Wang2, Alexa S Beiser3,4,5
1Biology Department, Vassar College, Poughkeepsie, NY (L.L.C.).
Insights
Digital peripheral arterial tonometry (PAT) measures show promise as a novel, noninvasive tool for assessing cardiovascular disease risk. Specifically, the PAT ratio may serve as a valuable indicator for predicting stroke events in the general population.
Area of Science:
- Cardiovascular Research
- Vascular Function Assessment
- Biomarker Discovery
Background:
- Novel noninvasive vascular function measures are emerging as subclinical markers for cardiovascular disease (CVD).
- These measures may aid in predicting future CVD events.
- Digital peripheral arterial tonometry (PAT) offers a potential new method for CVD risk assessment.
Purpose of the Study:
- To evaluate the association between digital PAT measures and the incidence of major cardiovascular disease (CVD) events.
- To assess the predictive value of PAT measures for first-onset CVD in a community-based cohort.
- To investigate the utility of fingertip PAT in identifying individuals at risk for CVD events.
Main Methods:
- A prospective study was conducted on Framingham Heart Study (FHS) participants (n=3865).
- Digital PAT was used to measure pulse amplitude and calculate the PAT ratio during reactive hyperemia.
- Cox proportional hazards regression models were employed to analyze the relationship between PAT measures and incident CVD events.
Main Results:
- Neither baseline pulse amplitude nor PAT ratio significantly predicted composite CVD events (myocardial infarction, heart failure).
- A higher PAT ratio was significantly associated with a lower risk of incident stroke (HR, 0.76; P=0.013).
- Sensitivity analysis revealed that a higher PAT ratio was linked to a reduced risk of incident ischemic stroke (HR, 0.68; P=0.001).
Conclusions:
- Novel digital PAT measures, particularly the PAT ratio, may serve as a community-based marker for stroke risk.
- These noninvasive vascular function assessments offer potential for early identification of individuals at risk for cerebrovascular events.
- Further research into PAT measures could refine CVD risk prediction strategies.
Background And Purpose:
Novel noninvasive measures of vascular function are emerging as subclinical markers for cardiovascular disease (CVD) and may be useful to predict CVD events. The purpose of our prospective study was to assess associations between digital peripheral arterial tonometry (PAT) measures and first-onset major CVD events in a sample of FHS (Framingham Heart Study) participants.
Methods:
Using a fingertip PAT device, we assessed pulse amplitude in Framingham Offspring and Third Generation participants (n=3865; mean age, 55±14 years; 52% women) at baseline and in 30-second intervals for 4 minutes during reactive hyperemia. The PAT ratio (relative hyperemia index) was calculated as the post-to-pre occlusion pulse signal ratio in the occluded arm, relative to the same ratio in the control (nonoccluded) arm, and corrected for baseline vascular tone. Baseline pulse amplitude and PAT ratio during hyperemia are measures of pressure pulsatility and microvascular function in the finger, respectively. We used Cox proportional hazards regression to relate PAT measures in the fingertip to incident CVD events.
Results:
During follow-up (median, 9.2 years; range, 0.04–10.0 years), 270 participants (7%) experienced new-onset CVD events (n=270). In multivariable models adjusted for cardiovascular risk factors, baseline pulse amplitude (hazard ratio [HR] per 1 SD, 1.04 [95% CI, 0.90–1.21]; P=0.57) and PAT ratio (HR, 0.95 [95% CI, 0.84–1.08]; P=0.43) were not significantly related to incident composite CVD events, including myocardial infarction or heart failure. However, higher PAT ratio (HR, 0.76 [95% CI, 0.61–0.94]; P=0.013), but not baseline pulse amplitude (HR, 1.15 [95% CI, 0.89–1.49]; P=0.29), was related to lower risk for incident stroke. In a sensitivity analysis by stroke subtype, higher PAT ratio was related to lower risk of incident ischemic stroke events (HR, 0.68 [95% CI, 0.53–0.86]; P=0.001).
Conclusions:
Novel digital PAT measures may represent a marker of stroke risk in the community.
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