Document Detail


Digital assessment of endothelial function and ischemic heart disease in women.
MedLine Citation:
PMID:  20394872     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We investigated the utility of digital reactive hyperemia peripheral arterial tonometry (RH-PAT) in predicting ischemic heart disease (IHD), including obstructive coronary artery disease (CAD) and nonobstructive coronary artery disease (NOCAD), in women.
BACKGROUND: IHD is the leading cause of mortality, and its pathogenesis is diverse in women. Fingertip RH-PAT is a new device that provides noninvasive, automatic, and quantitative evaluation of endothelial dysfunction.
METHODS: RH-PAT was measured using Endo-PAT2000 (Itamar Medical, Caesarea, Israel) before cardiac catheterization in 140 stable women scheduled for hospitalization to examine chest pain. NOCAD was diagnosed by angiography with measurement of coronary blood flow and cardiac lactate production during intracoronary acetylcholine provocation test and cardiac scintigraphy with stress tests.
RESULTS: Sixty-eight women (49%) had obstructive CAD and 42 women (30%) had NOCAD. RH-PAT indexes were significantly attenuated in both obstructive CAD and NOCAD as compared with non-IHD (n = 30) (obstructive CAD: median 1.57, interquartile range [IQR] 1.42 to 1.76; NOCAD: median 1.58, IQR 1.41 to 1.78; non-IHD: median 2.15, IQR 1.85 to 2.48, p < 0.001). By multivariate logistic regression analysis, only RH-PAT index was significantly associated with IHD, including obstructive CAD and NOCAD (odds ratio 0.51; 95% confidence interval: 0.38 to 0.68; p < 0.001). In receiver-operating characteristic analysis, RH-PAT index was a significant predictor of IHD (area under the curve 0.86; p < 0.001). Furthermore, only RH-PAT was useful for the prediction of NOCAD after excluding obstructive CAD (area under the curve 0.85; p < 0.001; RH-PAT index of <1.82 had 81% sensitivity and 80% specificity).
CONCLUSIONS: RH-PAT indexes were significantly attenuated in women with IHD. Digital RH-PAT can predict patients with IHD, especially NOCAD before angiography. RH-PAT is potentially useful for identifying high-risk women for IHD. (Endothelial Dysfunction and Coronary Artery Spasm; NCT00619294).
Authors:
Yasushi Matsuzawa; Seigo Sugiyama; Koichi Sugamura; Toshimitsu Nozaki; Keisuke Ohba; Masaaki Konishi; Junichi Matsubara; Hitoshi Sumida; Koichi Kaikita; Sunao Kojima; Yasuhiro Nagayoshi; Megumi Yamamuro; Yasuhiro Izumiya; Satomi Iwashita; Kunihiko Matsui; Hideaki Jinnouchi; Kazuo Kimura; Satoshi Umemura; Hisao Ogawa
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-16     Completed Date:  2010-06-15     Revised Date:  2012-06-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1688-96     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00619294
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / diagnostic use
Aged
Automatic Data Processing / methods*
Cholinergic Agents / diagnostic use
Coronary Angiography
Electrocardiography
Endothelium, Vascular / physiopathology*
Female
Fingers / blood supply*
Heart Catheterization
Humans
Hyperemia / chemically induced,  physiopathology*
Manometry / methods*
Middle Aged
Myocardial Ischemia / diagnosis,  physiopathology*
Predictive Value of Tests
Tomography, Emission-Computed, Single-Photon
Vasodilation / physiology*
Chemical
Reg. No./Substance:
0/Cholinergic Agents; 51-84-3/Acetylcholine
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Apr 20;55(16):1697-9   [PMID:  20394873 ]

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