Peripheral arterial tonometry for risk stratification in men with coronary artery disease.
BACKGROUND
Coronary artery disease (CAD) risk is not fully revealed by traditional risk factors. Identification of a simple, noninvasive tool that allows for detection of high-risk CAD patients and can be applied in large populations and clinical settings would prove valuable.


OBJECTIVE
We sought to test the hypothesis that peripheral arterial tonometry (PAT) would be associated with residual risk in men with CAD.


METHODS
In this study, finger PAT was used to measure pulse wave amplitude (PWA) during reactive hyperemia (RH) and taken as a measure of microvascular endothelial function in 42 men with stable CAD and well controlled low-density lipoprotein cholesterol (LDL-C) levels. Plasma levels of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA(2)) were measured and used to reclassify men into high-risk (elevated hs-CRP and Lp-PLA(2)), moderate-risk (either elevated hs-CRP or Lp-PLA(2)), or low-risk (low hs-CRP and Lp-PLA(2)) groups.


RESULTS
PWA-RH was significantly lower in the high-risk group (1.3 +/- 0.04) compared to the moderate-risk (1.6 +/- 0.07, P < 0.05) and low-risk (2.0 +/- 0.1, P < 0.05) groups. According to binary logistic regression, PWA-RH was a significant predictor of high-risk status among men with CAD (P < 0.05).


CONCLUSIONS
Measurement of peripheral microvascular endothelial function with PAT may be able to distinguish high-risk men from moderate- and low-risk men with stable CAD and well-controlled LDL-C levels and thus aid in residual risk stratification in this at risk cohort.
Heffernan
Kevin S
KS
The Vascular Function Study Group; Division of Cardiology, Tufts Medical Center, Boston, Massachusetts 02111, USA. kheffernan@tuftsmedicalcenter.org
Karas
Richard H
RH
Patvardhan
Eshan A
EA
Jafri
Haseeb
H
Kuvin
Jeffrey T
JT
D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood; D001158:Arteries / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008833:Microcirculation; D008875:Middle Aged; D010991:Plethysmography; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D008078:Cholesterol, LDL; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase