title: Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease.
abstract: BACKGROUND
  Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic.
  
  
  METHODS
  In 93 patients, PAT was performed resulting in reactive hyperaemia (RHI) and augmentation (AIx) indices. Patients were risk classified according to HeartScore, Diamond and Forrester pretest probability (DF), exercise testing (X-ECG), and computed tomography calcium scoring (CCS) and angiography (CTA). Correlations, risk group differences and prediction of revascularisation within 1 year were calculated.
  
  
  RESULTS
  RHI correlated with HeartScore (r = - 0.21, p = 0.05), AIx with DF (r = 0.26, p = 0.01). However, both were not significantly different between normal and ischaemic X-ECG groups. In addition RHI and AIx were similar between low risk as compared with intermediate-to-high risk, based on risk algorithms (RHI: 1.98 (0.67) vs 1.94 (0.78); AIx: 0.0 (21) vs 5.0 (25); p = NS), or CCS and CTA (RHI: 1.99 (0.58) vs 1.89 (0.82); AIx: - 2.0 (24) vs 4.0 (25); p = NS). Finally, RHI and AIx failed to predict revascularisation (RHI: OR 1.42, CI 0.65-3.1; AIx: OR 1.02, CI 0.98-1.05).
  
  
  CONCLUSIONS
  PAT cannot detect a low risk of CAD, possibly because RHI and AIx versus X-ECG, CCS and CTA represent independent processes.
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. m.vandenheuvel.1@erasmusmc.nl.|ICIN Netherlands Heart Institute, Utrecht, The Netherlands. m.vandenheuvel.1@erasmusmc.nl.|Department of Experimental Cardiology, Ee2355, Erasmus Medical Center, Dr. Molewaterplein 50-60, 3015 GE, Rotterdam, The Netherlands. m.vandenheuvel.1@erasmusmc.nl.
authors.forename: M
authors.initials: M
authors.lastname: van den Heuvel
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|ICIN Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Sorop
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Musters
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: T W
authors.initials: TW
authors.lastname: Galema
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: Duncker
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|ICIN Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: van der Giessen
authors.affiliation: Department of Cardiology, Erasmus Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Department of Radiology, Erasmus Medical Center Rotterdam, Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Nieman
keywords: Coronary artery disease; Noninvasive testing; Peripheral vascular function