title: Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia.
abstract: OBJECTIVE
  We investigated the value of reactive hyperemia peripheral arterial tonometry (RH-PAT) as a noninvasive tool to identify individuals with coronary microvascular endothelial dysfunction.
  
  
  BACKGROUND
  Coronary endothelial dysfunction, a systemic disorder, represents an early stage of atherosclerosis; RH-PAT is a technique to assess peripheral microvascular endothelial function.
  
  
  METHODS
  Using RH-PAT, digital pulse volume changes during reactive hyperemia were assessed in 94 patients without obstructive coronary artery disease and either normal (n = 39) or abnormal (n = 55) coronary microvascular endothelial function; RH-PAT index, a measure of reactive hyperemia, was calculated as the ratio of the digital pulse volume during reactive hyperemia divided by that at baseline.
  
  
  RESULTS
  Average RH-PAT index was lower in patients with coronary endothelial dysfunction compared with those with normal coronary endothelial function (1.27 +/- 0.05 vs. 1.78 +/- 0.08: p < 0.001). An RH-PAT index <1.35 was found to have a sensitivity of 80% and a specificity of 85% to identify patients with coronary endothelial dysfunction.
  
  
  CONCLUSIONS
  Digital hyperemic response, as measured by RH-PAT, is attenuated in patients with coronary microvascular endothelial dysfunction, suggesting a role for RH-PAT as a noninvasive test to identify patients with this disorder.
authors.affiliation: Center for Coronary Physiology and Imaging, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Piero O
authors.initials: PO
authors.lastname: Bonetti
authors.forename: Geralyn M
authors.initials: GM
authors.lastname: Pumper
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Higano
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kuvin
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity