title: Low fingertip temperature rebound measured by digital thermal monitoring strongly correlates with the presence and extent of coronary artery disease diagnosed by 64-slice multi-detector computed tomography.
abstract: Previous studies showed strong correlations between low fingertip temperature rebound measured by digital thermal monitoring (DTM) during a 5 min arm-cuff induced reactive hyperemia and both the Framingham Risk Score (FRS), and coronary artery calcification (CAC) in asymptomatic populations. This study evaluates the correlation between DTM and coronary artery disease (CAD) measured by CT angiography (CTA) in symptomatic patients. It also investigates the correlation between CTA and a new index of neurovascular reactivity measured by DTM. 129 patients, age 63 +/- 9 years, 68% male, underwent DTM, CAC and CTA. Adjusted DTM indices in the occluded arm were calculated: temperature rebound: aTR and area under the temperature curve aTMP-AUC. DTM neurovascular reactivity (NVR) index was measured based on increased fingertip temperature in the non-occluded arm. Obstructive CAD was defined as >or=50% luminal stenosis, and normal as no stenosis and CAC = 0. Baseline fingertip temperature was not different across the groups. However, all DTM indices of vascular and neurovascular reactivity significantly decreased from normal to non-obstructive to obstructive CAD [(aTR 1.77 +/- 1.18 to 1.24 +/- 1.14 to 0.94 +/- 0.92) (P = 0.009), (aTMP-AUC: 355.6 +/- 242.4 to 277.4 +/- 182.4 to 184.4 +/- 171.2) (P = 0.001), (NVR: 161.5 +/- 147.4 to 77.6 +/- 88.2 to 48.8 +/- 63.8) (P = 0.015)]. After adjusting for risk factors, the odds ratio for obstructive CAD compared to normal in the lowest versus two upper tertiles of FRS, aTR, aTMP-AUC, and NVR were 2.41 (1.02-5.93), P = 0.05, 8.67 (2.6-9.4), P = 0.001, 11.62 (5.1-28.7), P = 0.001, and 3.58 (1.09-11.69), P = 0.01, respectively. DTM indices and FRS combined resulted in a ROC curve area of 0.88 for the prediction of obstructive CAD. In patients suspected of CAD, low fingertip temperature rebound measured by DTM significantly predicted CTA-diagnosed obstructive disease.
authors.affiliation: Los Angeles Biomedical Research Institute, Harbor UCLA Medical Center, Torrance, CA 90502, USA.
authors.forename: Naser
authors.initials: N
authors.lastname: Ahmadi
authors.forename: Vahid
authors.initials: V
authors.lastname: Nabavi
authors.forename: Vivek
authors.initials: V
authors.lastname: Nuguri
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Hajsadeghi
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Flores
authors.forename: Mohammad
authors.initials: M
authors.lastname: Akhtar
authors.forename: Stanley
authors.initials: S
authors.lastname: Kleis
authors.forename: Harvey
authors.initials: H
authors.lastname: Hecht
authors.forename: Morteza
authors.initials: M
authors.lastname: Naghavi
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D012881:Skin Temperature; D013817:Thermography / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed