Abstract 10034: Digital Assessment of Peripheral Vascular Endothelial Function is Useful for the Risk Stratification in Patients With Hypertension
Introduction: Hypertension (HT) is the major risk factor of coronary artery disease (CAD), however all HT patients were not equally predisposed to CAD. Endothelial dysfunction has been implicated in atherogenesis, and digital assessment by reactive hyperemia peripheral arterial tonometry (RH-PAT) is a novel examination to evaluate endothelial function.
Methods: In 1323 stable patients with suspected CAD including 1057 HT patients, we assessed peripheral endothelial function as fingertip RH-PAT index (RHI) and examined the presence and severity of CAD by coronary angiography.
Results: Ln-RHI was significantly attenuated in HT patients (n=215) compared to risk-factor-matched non-HT patients (n=215) (0.538±0.224 vs. 0.664±0.248, p<0.001) after matching number of patients and coronary risk factors (CRFs). In HT patients, ln-RHI was further lower in CAD (n=786) than in non-CAD (n=271) (0.514±0.185 vs. 0.634±0.219, p<0.001). By multivariate-logistic-regression analysis, ln-RHI was independently associated with the presence of CAD in HT (per 0.1; odds ratio [OR]: 6.15, 95% confidence interval [CI]: 1.87-20.3, p<0.001). CAD with high-ln-RHI was significantly associated with the complication of multi-vessel disease (MVD) and B-type natriuretic peptide (both p<0.001). In receiver-operating-characteristic analysis, ln-RHI was a significant determinant for the presence of CAD (area under curve [AUC]: 0.650, 95% CI: 0.646-0.721, p<0.001), and adding ln-RHI to CRFs improved predictive values of CAD (AUC: 0.737, 95% CI: 0.701-0.773, p<0.001). The net reclassification index was significant with the inclusion of ln-RHI (13.8%, p<0.005).
Furthermore, ln-RHI was significantly lower in CAD with MVD (n=464) than in those with single-vessel disease (n=322) (0.46 vs. 0.57, p<0.001). Multivariate-logistic-regression analysis suggested that ln-RHI was independently associated also with the presence of MVD in CAD (per 0.1; OR: 0.66, 95% CI: 0.60-0.73, p<0.001).
Conclusions: Ln-RHI significantly correlated with the presence and severity of CAD in HT, and the combination with CRFs may be more powerful at predicting CAD. Identifying high-risk HT patients by RH-PAT might provide clinical benefits for risk stratification.
Author Disclosures: E. Yamamoto: None. S. Sugiyama: None. Y. Matsuzawa: None. Y. Hirata: None. E. Akiyama: None. K. Fujisue: None. T. Tokitsu: None. K. Sugamura: None. K. Kaikita: None. S. Hokimoto: None. H. Ogawa: None.
- © 2015 by American Heart Association, Inc.