Abstract 16817: Utility of Digital Assessment of Endothelial Function for Cardiovascular Risk Stratification in Patients with Diabetes Mellitus
Background: Patients with diabetes have an increased risk in developing cardiovascular complications, caused by endothelial dysfunction and accelerated atherosclerosis. However, among patients with diabetes, the degree of atherosclerosis is various. Endothelial dysfunction could provide a significant prognostic value to predict future cardiovascular events. Digital reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a noninvasive and operator-independent method to evaluate endothelial function. We examined whether the assessment of endothelial dysfunction could provide comprehensive cardiovascular risk stratification in patients with diabetes.
Methods: This study included 160 consecutive stable high-risk patients with diabetes suspected of coronary artery disease (CAD). The RH index (RHI) was measured before cardiac catheterization, and examined the presence of CAD by angiography (>50% stenosis). Coronary plaques were classified angiographically as simple or complex according to Ambrose criteria.
Results: In diabetic patients, the values of RHI were significantly attenuated in patients with CAD (n = 140) compared to those without CAD (n = 20) (non-CAD: 0.72 ± 0.23, versus CAD: 0.51 ± 0.17, p < 0.01). Furthermore, RHI values of diabetic patients with complex coronary lesion (n = 92) were significantly lower than those with simplex coronary lesion (n = 48) (simple-CAD: 0.56 ± 0.14, versus complex-CAD: 0.48 ± 0.18, p < 0.01). Multivariable logistic regression analysis among various risk factors identified lower RHI values as an independent determinant of coronary plaque complexity in patients with diabetes (the odds ratio was 0.69 [95% confidence interval: 0.56 to 0.85], p < 0.01). By receiver operating characteristics analysis, RHI had a significant prognostic value to predict complex coronary plaques (the area under the curve: 0.73 [95% confidence interval: 0.65 to 0.81], p < 0.001).
Conclusions: Advanced endothelial dysfunction significantly correlated with the presence of CAD, particularly with the coronary complex plaque in patients with diabetes. Among diabetic patients, the assessment of endothelial function can provide clinically important information to identify vulnerable patients with vulnerable plaque.
- © 2011 by American Heart Association, Inc.