Abstract
BackgroundCardiovascular risk assessment is usually based on traditional risk factors and risk assessment algorithms. However, a number of risk markers that might provide additional predictive power have been identified. Endothelial function determined by digital reactive hyperemia peripheral arterial tonometry (RH-PAT) and carotid artery intima-media thickness (IMT) have both been proposed as surrogate markers for coronary artery disease (CAD). We aimed to examine the ability of RH-PAT and IMT to predict coronary computed tomography angiography (CTA) plaque burden in clinically healthy subjects.MethodsFifty-eight clinically healthy volunteers (50–73 years old) underwent testing for RH-PAT and IMT as well as coronary CTA, including coronary artery calcium (CAC) scoring. Coronary CTA was analyzed with respect to any atheromatous plaques, stenotic as well as non-stenotic. The Mann–Whitney U-test was used to compare the groups with and without CAD and the Spearman test was used to test for correlation between variables.ResultsTwenty-five (43 %) subjects had normal coronary arteries, without any signs of atherosclerosis. The median (range) number of diseased segments was 1 (0–10), RH-PAT index 2.2 (1.4-4.9), IMT 0.70 (0.49-0.99) mm and CAC 4 (0–1882). There was no association between presence or extent of CAD and RH-PAT index (Spearman correlation coefficient rs = 0.13) or IMT (rs = 0.098). As expected, CAC was strongly correlated to presence and extent of CAD by coronary CTA (rs =0.86; p < 0.0001).ConclusionsNeither evaluation of endothelial function by RH-PAT nor assessment of carotid artery IMT can reliably be used to predict coronary CTA plaque burden in clinically healthy subjects.
Highlights
Cardiovascular risk assessment is usually based on traditional risk factors and risk assessment algorithms
Cardiovascular risk assessment, which is of great importance for guiding early preventive interventions and treatment, is usually based on traditional risk factors and risk assessment algorithms, such as the Framingham, the SCORE or the Reynolds risk scores [1,2,3]
Even fewer have focused on clinically healthy subjects, with predominantly low to intermediate risk profiles [22]. To clarify whether these non-invasive tests can reliably be used to predict coronary plaque burden in clinically healthy subjects, we studied the correlation of endothelial function and intimamedia thickness (IMT) respectively with plaque burden, as assessed by coronary computed tomography angiography (CTA)
Summary
Cardiovascular risk assessment is usually based on traditional risk factors and risk assessment algorithms. A number of risk markers that might provide additional predictive power have been identified. Endothelial function determined by digital reactive hyperemia peripheral arterial tonometry (RH-PAT) and carotid artery intimamedia thickness (IMT) have both been proposed as surrogate markers for coronary artery disease (CAD). In the search for accessible non-invasive tests that might provide additional predictive power, a number of novel risk markers have been identified [4]. A quite recently developed method for assessing peripheral endothelial function is measuring digital reactive hyperemia peripheral arterial tonometry (RH-PAT), which has the advantage of being an accessible, largely operator-independent and highly reproducible method [9, 10]. A recent study demonstrated an association between endothelial function determined by RH-PAT and several cardio-metabolic risk factors, in particular male sex, overweight, smoking and low levels of HDL cholesterol [11]
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