Clinical investigations: interventional cardiology
Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude

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Abstract

Background

Abnormalities in pulse wave amplitude (PWA) have been described in subjects with atherosclerosis and may be a marker of future cardiac events. We evaluated the relationship between changes in PWA of the finger and peripheral endothelial function.

Methods

We performed measurements of PWA with a novel finger plethysmograph (peripheral arterial tonometry [PAT]) and compared the findings with a simultaneous noninvasive measurement of peripheral endothelial function with brachial artery ultrasound scanning (BAUS) in 89 subjects. The PAT hyperemia ratio was defined as the ratio of PWA during reactive hyperemia relative to the baseline. Flow-mediated dilation (FMD) was defined by BAUS as the ratio of the brachial artery diameter during reactive hyperemia relative to the baseline. Sixty-eight subjects underwent exercise myocardial perfusion imaging (ExMPI).

Results

Fifty-four men and 35 women were examined. There was a linear relationship between the PAT hyperemia ratio and FMD during the same episode of reactive hyperemia (r = 0.55, P < .0001). Subjects in the lowest FMD quartile had the lowest PAT hyperemia ratio, whereas subjects in the highest FMD quartile had the highest PAT hyperemia ratio (P < .001 for trend). Similar to BAUS, the PAT hyperemia ratio was more impaired in subjects with cardiovascular risk factors and in subjects with ExMPI studies that were indicative of coronary artery disease.

Conclusions

Assessment of PWA with PAT demonstrates patterns of abnormality similar to that of BAUS assessment of FMD. PWA during reactive hyperemia is influenced by factors known to affect endothelial function, including cardiovascular risk factors and coronary artery disease. These findings support the concept that analysis of PWA with PAT during reactive hyperemia may be used to study peripheral vascular endothelial function.

Section snippets

Study population

Eighty-nine subjects presenting for evaluation of chest pain gave their written informed consent to participate and underwent simultaneous testing with brachial artery ultrasound scanning (BAUS) imaging and finger plethysmography with PAT. Subjects were instructed to fast starting the night before testing and to refrain from smoking, ingesting alcohol or caffeine, and taking any vasoactive medications the day of testing. Exclusion criteria included recent myocardial infarction or unstable

Study population

Eighty-nine subjects (54 male, 35 female) an average of 54 ± 2 years of age underwent simultaneous testing with PAT and BAUS. Characteristics of this study population are listed in Table I. Subjects had normal left ventricular function (ejection fraction 61% ± 2%), and approximately one third reported a history of CAD. Forty percent of subjects had hypertension, 47% of subjects had hyperlipidemia, and 9% of subjects had diabetes mellitus.

Relation between PAT and BAUS measures

The average PAT hyperemia ratio was 1.5 ± 0.05 (range

Discussion

In this study, we evaluated the ability of changes in PWA during reactive hyperemia to reflect dynamic changes related to peripheral vascular endothelial function. In addition, we sought to determine whether PWA changes are related to factors known to affect endothelial function. These data indicate that there is a significant relationship between hyperemia-induced finger PWA changes, defined as the PAT hyperemia ratio, and brachial artery FMD. The PAT hyperemia ratio was reduced in subjects

Acknowledgements

We thank the staff of the Division of Nuclear Medicine and the Cardiovascular Imaging and Hemodynamics Laboratories at the Tufts-New England Medical Center.

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    Supported in part by Itamar Medical Ltd.

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