Abstract 16295: Digital Assessment of Peripheral Endothelial Function for the Risk Stratification in Patients With Hypertension
Background: Hypertension (HT) is the major risk factor of coronary artery disease (CAD), however all HT patients were not equally predisposed to coronary aterothrombotic complications. Endothelial dysfunction has been implicated in atherogenesis and digital assessment of endothelial function by reactive hyperemia peripheral arterial tonometry (RH-PAT) is a noninvasive and operator-independent clinical examination to evaluate endothelial function. We hypothesized that peripheral endothelial dysfunction could independently associate with presence of CAD in HT patients.
Methods: In 356 stable patients with suspected CAD including 288 patients with HT, we assessed endothelial functions as RH index (RHI) by fingertip RH-PAT using Endo-PAT2000 and examined the presence of CAD by coronary angiography (>50% stenosis). Coronary lesions were classified angiographically as simple or complex according to Ambrose criteria.
Results: RHI values were significantly attenuated in HT patients (n=288) compared to non-HT patients (n=68) (RHI: HT 0.53±0.19 versus non-HT 0.59±0.22, p=0.03). In the HT patients, RHI values were significantly lower in patients with CAD (n=242) than non-CAD patients (n=46) (RHI: HT+CAD; 0.49±0.16 versus HT+non-CAD; 0.71±0.20, p<0.001). In receiver-operating characteristic analysis, RHI was a significant determinant for the presence of CAD (area under the curve 0.82, 95% confidence interval 0.75-0.89, p<0.001). Furthermore, RHI values of HT patients with coronary complex plaques (n=150) were significantly lower than those with simplex plaques (n=92) (RHI: 0.46±0.16 versus 0.55±0.15, p<0.01). By multivariate backward logistic regression analysis among various risk factors, RHI independently associated with the presence of CAD (odds ratio 0.55, 95% confidence interval 0.45-0.68; p=0.003) and coronary complex plaques (odds ratio 0.76, 95% confidence interval 0.63-0.91; p<0.001) in patients with HT.
Conclusion: RHI reflecting peripheral endothelial function significantly correlated with the presence of CAD, particularly with complex coronary lesions in stable HT patients. Identifying the high-risk HT patients with endothelial dysfunction by RH-PAT may provide clinical benefits for risk stratification.
- © 2011 by American Heart Association, Inc.