title: Comparison of peripheral arterial tonometry and flow-mediated vasodilation for assessment of the severity and complexity of coronary artery disease.
abstract: OBJECTIVE
  Noninvasive flow-mediated vasodilation (FMD) is a widely used method to assess endothelial function, but its technical difficulty and problems remain obstacles for use in clinical practice. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) was developed as a simpler and more reproducible method. We compared FMD and RH-PAT in patients with stable angina. Furthermore, the differences in these two techniques according to coronary artery disease (CAD) severity and complexity were also assessed.
  
  
  METHODS
  We consecutively enrolled 80 patients who underwent elective coronary angiography. Endothelial function was assessed before angiography using brachial artery FMD and RH-PAT. The complexity and extent of the coronary lesions were assessed angiographically. The extent of CAD was defined as the number of diseased coronary arteries (>70%) and complexity of CAD was assessed by the SYNTAX score algorithm.
  
  
  RESULTS
  In the overall study group (61±9 years, 57% men), the mean FMD was 8.5±5.1% and the mean reactive hyperemia index (RHI) measured by RH-PAT was 1.7±0.4. A significant correlation was observed between FMD and RHI irrespective of sex, diabetes, or presence of CAD. FMD and RHI were significantly lower in patients with multivessel and complex CAD. A receiver-operating characteristic curve analysis showed that both techniques were comparable in terms of predicting the presence of CAD and complexity.
  
  
  CONCLUSIONS
  Assessment of RH-PAT could be a less operator-dependent and noninvasive method of evaluating vascular endothelial function in patients with stable angina.
authors.affiliation: Department of Internal Medicine, Kyung Hee University Hospital, Cardiovascular Division, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Jong Shin
authors.initials: JS
authors.lastname: Woo
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Jang
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Eun Yong
authors.initials: EY
authors.lastname: Choi
authors.forename: Jin Bae
authors.initials: JB
authors.lastname: Kim
authors.forename: Woo-Shik
authors.initials: WS
authors.lastname: Kim
authors.forename: Kwon Sam
authors.initials: KS
authors.lastname: Kim
authors.forename: Weon
authors.initials: W
authors.lastname: Kim
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D019540:Area Under Curve; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000503:physiopathology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D056910:Republic of Korea; D012720:Severity of Illness Index; D014664:Vasodilation