Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease |
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Authors: | M van den Heuvel O Sorop PJ Musters RT van Domburg TW Galema DJ Duncker WJ van der Giessen K Nieman |
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Institution: | 1.Department of Cardiology, Erasmus Medical Center Rotterdam, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands ;2.Department of Radiology, Erasmus Medical Center Rotterdam, Utrecht, The Netherlands ;3.ICIN Netherlands Heart Institute, Utrecht, The Netherlands ;4.Department of Experimental Cardiology, Ee2355, Erasmus Medical Center, Dr. Molewaterplein 50–60, 3015 GE Rotterdam, The Netherlands |
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Abstract: | BackgroundEndothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic.MethodsIn 93 patients, PAT was performed resulting in reactive hyperaemia (RHI) and augmentation (AIx) indices. Patients were risk classified according to HeartScore, Diamond and Forrester pretest probability (DF), exercise testing (X-ECG), and computed tomography calcium scoring (CCS) and angiography (CTA). Correlations, risk group differences and prediction of revascularisation within 1 year were calculated.ResultsRHI correlated with HeartScore (r = − 0.21, p = 0.05), AIx with DF (r = 0.26, p = 0.01). However, both were not significantly different between normal and ischaemic X-ECG groups. In addition RHI and AIx were similar between low risk as compared with intermediate-to-high risk, based on risk algorithms (RHI: 1.98 (0.67) vs 1.94 (0.78); AIx: 0.0 (21) vs 5.0 (25); p = NS), or CCS and CTA (RHI: 1.99 (0.58) vs 1.89 (0.82); AIx: − 2.0 (24) vs 4.0 (25); p = NS). Finally, RHI and AIx failed to predict revascularisation (RHI: OR 1.42, CI 0.65–3.1; AIx: OR 1.02, CI 0.98–1.05).ConclusionsPAT cannot detect a low risk of CAD, possibly because RHI and AIx versus X-ECG, CCS and CTA represent independent processes. |
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Keywords: | Coronary artery disease Peripheral vascular function Noninvasive testing |
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