title: Predictive value of endothelial function by noninvasive peripheral arterial tonometry for coronary artery disease.
abstract: BACKGROUND
  Endothelial dysfunction is a key step in the initiation and progression of atherosclerosis and subsequent cardiovascular complications. We examined whether peripheral endothelial function, as assessed by fingertip reactive hyperemia-peripheral arterial tonometry (RH-PAT), can provide additional clinical value to traditional risk factors for cardiovascular diseases in predicting coronary artery disease (CAD).
  
  
  METHODS
  We included 118 stable patients who were referred for coronary angiography for chest pain evaluation or due to abnormal stress test results. A natural logarithmic value of the RH-PAT index (Ln_RHI) was obtained before cardiac catheterization by an independent operator. Significant CAD was defined as luminal stenosis of at least 70% (≥50% at left main) and/or fractional flow reserve of up to 0.80 in one or more major coronary arteries or their major branches.
  
  
  RESULTS
  Levels of Ln_RHI were significantly lower in patients with CAD (n=60) compared with patients without CAD (n=58; 0.69±0.29 vs. 0.88±0.27, P<0.001). Ln_RHI was significantly associated with CAD independent from traditional risk factors (odds ratio for a 0.1 decrease in Ln_RHI=1.25, 95% confidence interval: 1.04-1.52, P=0.01). The net reclassification index was improved when Ln_RHI was added to traditional risk factors (0.62, 95% confidence interval: 0.27-0.97, P=0.001).
  
  
  CONCLUSIONS
  Peripheral endothelial function, as assessed by RH-PAT, improved risk stratification when added to traditional risk factors. RH-PAT is potentially useful for identifying patients at high risk for CAD.
authors.affiliation: aDivision of Cardiovascular Diseases bBiomedical Statistics and Informatics cDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Aoki
authors.forename: Raviteja R
authors.initials: RR
authors.lastname: Guddeti
authors.forename: Taek-Geun
authors.initials: TG
authors.lastname: Kwon
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cilluffo
authors.forename: Robert Jay
authors.initials: RJ
authors.lastname: Widmer
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index