Hyperemia Peripheral Arterial Tonometry Research Articles

Utility of both carotid intima–media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms

BackgroundMyocardial perfusion scintigraphy (MPS) is used widely to assess cardiovascular risk in patients with chest pain. The utility of carotid intima–media thickness (CIMT) and endothelial function as assessed by reactive hyperemia-peripheral arterial tonometry index (RHI) in risk stratifying patients with angina-like symptoms needs to be defined. We investigated whether the addition of CIMT and RHI to Framingham Cardiovascular Risk Score (FCVRS) and MPS improves comprehensive cardiovascular risk prediction in patients presenting with angina-like symptoms. MethodsWe enrolled 343 consecutive patients with angina-like symptoms suspected of having stable angina. MPS, CIMT, and RHI were performed and patients were followed for cardiovascular events for a median of 5.3years (range 4.4–6.2). Patients were stratified by FCVRS and MPS. ResultsDuring the follow-up, 57 patients (16.6%) had cardiovascular events. Among patients without perfusion defect, low RHI was significantly associated with cardiovascular events in the intermediate and high FCVRS groups (hazard ratio (HR) [95% confidence interval (CI)] of RHI≤2.11 was 6.99 [1.34–128] in the intermediate FCVRS group and 6.08 [1.08–114] in the high FCVRS group). Furthermore, although MPS did not predict, only RHI predicted hard cardiovascular events (cardiovascular death, myocardial infarction, and stroke) independent from FCVRS, and adding RHI to FCVRS improved net reclassification index (20.9%, 95% CI 0.8–41.1, p=0.04). Especially, RHI was significantly associated with hard cardiovascular events in the high FCVRS group (HR [95% CI] of RHI≤1.93 was 5.66 [1.54–36.4], p=0.007). ConclusionsPeripheral endothelial function may improve discrimination in identifying at-risk patients for future cardiovascular events when added to FCVRS–MPS-based risk stratification.

Patients with both CYP2C19 loss-of-function allele and peripheral endothelial dysfunction are significantly correlated with adverse cardiovascular events following coronary stent implantation

BackgroundThere is some controversy regarding the effect of CYP2C19 polymorphism on clinical outcome in patients receiving dual antiplatelet therapy (DAPT). Peripheral endothelial dysfunction has recently been reported to predict adverse cardiovascular events. We hypothesized that CYP2C19 loss-of-function (LOF) allele carriers with peripheral endothelial dysfunction had worse prognosis. The aim of this study was to evaluate an additive effect of peripheral endothelial dysfunction on clinical outcome following percutaneous coronary intervention (PCI) in patients with a CYP2C19 variant. MethodsWe enrolled 434 patients on DAPT following PCI. CYP2C19 genotype was examined, and we divided patients into two groups: carriers, who had at least one CYP2C19 LOF allele, and non-carriers. Peripheral endothelial dysfunction was examined using reactive hyperemia-peripheral arterial tonometry index (RHI), and we divided patients into low and high RHI. Thus, subjects were divided into four groups, and clinical events were followed up. ResultsA total of 55 patients had a cardiovascular event. Kaplan–Meier analysis demonstrated a significantly higher probability of cardiovascular events in carriers with low RHI (log-rank test: p=0.007). Multivariate Cox proportional hazards analysis identified both CYP2C19 LOF allele possession (hazard ratio (HR): 1.94; 95% confidence interval (CI): 1.1–3.69; p=0.045) and low RHI (HR: 2.15; 95% CI: 1.22–3.78; p=0.008) as independent and significant predictors of future cardiovascular events. ConclusionsCYP2C19 LOF allele carriers with peripheral endothelial dysfunction were significantly correlated with cardiovascular events. The additional evaluation of peripheral endothelial function along with CYP2C19 polymorphism might improve risk stratification after coronary stent implantation.

Circulating level of microRNA-126 may be a potential biomarker for recovery from smoking-related vascular damage in middle-aged habitual smokers

BackgroundCigarette smoking promotes vascular endothelial damage and accelerates progression of atherosclerosis. The purpose of this study was to examine whether the circulating level of vascular endothelium-enriched microRNA-126 (miR-126), which is highlighted as a regulator of gene expression, would serve as a novel biomarker for recovery from smoking-related vascular damage. MethodsMiddle-aged male smokers (n=30) were enrolled and instructed to stop smoking. Their clinical profiles and laboratory findings including expression of miR-126 were investigated before and after 8weeks of smoking cessation. Serum levels of cotinine, metabolites of nicotine, were measured to confirm smoking cessation. Endothelial function for peripheral small vessels was assessed and expressed as reactive hyperemia peripheral arterial tonometry (RH-PAT) index. The expression of miR-126 in plasma was analyzed by quantitative real-time PCR. ResultsAt baseline, serum cotinine levels were inversely correlated with RH-PAT index (r=−0.48, P<0.01) and positively correlated with levels of metabolic parameters such as non-HDL cholesterol (r=0.53, P<0.01) and HOMA-IR (r=0.52, P<0.01). The RH-PAT index was not significantly changed after 8weeks in all subjects, because only 13 subjects could attain smoking cessation. However, changes in the RH-PAT index showed a significant correlation with those in systolic blood pressure (r=−0.54, P<0.01). In smokers who completely attained smoking cessation (n=13), RH-PAT index and plasma levels of miR-126 were significantly increased (P<0.05, respectively). ConclusionsEndothelial damage was improved and plasma levels of circulating miR-126 were increased after 8weeks of smoking cessation. These findings suggested a potential use of miR-126 as a biomarker for recovery from smoking-induced vascular damage.

Gender differences in the risk factors for endothelial dysfunction in Chinese hypertensive patients: homocysteine is an independent risk factor in females.

ObjectivesEndothelial dysfunction plays a key role in the pathogenesis of cardiovascular disease. However, the gender-related differences in risk factors for endothelial dysfunction are controversial. We investigated the gender differences in the risk factor profiles for endothelial dysfunction in Chinese hypertensive patients.MethodsVascular endothelial functions in 213 hypertensive patients were measured by digital reactive hyperemia peripheral arterial tonometry (RH-PAT). Peripheral blood samples were collected, and the self-reported smoking and alcohol consumption status, age, body mass index, heart rate, blood pressure and drug administrations were recorded.ResultsRH-PAT indexes were attenuated in both male and female hypertensive patients [1.60 (1.38-2.02) vs. 1.63 (1.44-1.98)]. Multivariate logistic regression analysis identified plasma creatinine (p < 0.001), total cholesterol (p = 0.001), homocysteine (p = 0.002) and smoking (p < 0.001) as the independent factors correlated with gender (male). Multivariate linear regression analysis further identified homocysteine as the factor that is significantly and independently correlated with the decrease in the RH-PAT indexes in female patients (odds ratio: -0.166, 95% confidence interval: -0.292 to -0.040, p = 0.01). However, none of these four factors were correlated with the RH-PAT indexes in male patients.ConclusionsThere are gender-related differences in the risk factors for endothelial dysfunction in Chinese hypertensive patients. Homocysteine is an independent factor for endothelial dysfunction in female hypertensive patients.

Adolescents and young adults with type 1 diabetes display a high prevalence of endothelial dysfunction.

Little is known about endothelial function in adolescents with type 1 diabetes, and we evaluated endothelial dysfunction, using reactive hyperaemia peripheral arterial tonometry (RH-PAT). This prospective, observational, 1-year study focused on 73 adolescents with type 1 diabetes, using multiple daily injections or continuous subcutaneous insulin infusion. The subjects were assessed using RH-PAT, body mass index, blood pressure, fasting lipid profile, glycated haemoglobin, insulin requirements and hours of physical exercise per week. Endothelial dysfunction was observed in 56 patients (76.7%), with lower mean RH-PAT scores (1.26±0.22 versus 2.24±0.48, p<0.0001) and higher glycated haemoglobin values at baseline (8.27±1.24% versus 7.37±0.54%, p=0.006) and as a mean of the whole period since diagnosis (8.25±1.22% versus 7.72±0.82%, p=0.034). A higher percentage of patients with endothelial dysfunction showed abnormal cardiac autonomic tests (p=0.02) and were more sedentary, exercising <4 hours a week, than patients with normal endothelial function. After follow-up in 64/73 patients, we observed endothelial dysfunction in 81.8% of patients, despite a modest improvement in glycated haemoglobin. Adolescents with type 1 diabetes displayed evidence of endothelial dysfunction. Good metabolic control (glycated haemoglobin ≤7.5%, 58mmol/mol) and regular physical activity of at least 4h a week might be protective.

Association between endothelial function (assessed on reactive hyperemia peripheral arterial tonometry) and obstructive sleep apnea, visceral fat accumulation, and serum adiponectin.

Visceral obesity, low adiponectin, and severe obstructive sleep apnea (OSA) are associated with cardiovascular diseases, but the interactions among these factors on endothelial dysfunction are not well known. Endothelial function in 133 patients after polysomnography was evaluated as reactive hyperemia index (RHI) on reactive hyperemia peripheral arterial tonometry. Visceral obesity was defined as visceral fat area ≥100 cm(2)on computed tomography. RHI was significantly correlated with apnea hypopnea index (AHI), visceral fat area, and serum adiponectin (r=-0.24, P=0.0055, r=-0.19, P=0.031, and r=0.20, P=0.019, respectively). RHI in patients with visceral obesity was significantly decreased in the presence of severe OSA (AHI ≥30; P=0.042). On multivariate regression analysis, only severe OSA remained as an independent predictive factor of RHI (P=0.024, R(2)=5.4%). RHI in patients with severe OSA (n=44) was significantly improved after 3 months of continuous positive airway pressure (CPAP) treatment (1.78±0.40 before CPAP vs. 2.00±0.53 after CPAP, P=0.013), similarly to those with AHI <30 (P=0.45). Severe OSA, but not visceral fat area or serum adiponectin, was independently associated with endothelial function according to RHI. In addition, impaired endothelial function was reversible following 3 months of CPAP treatment.

Impact of Catheter Sheath Insertion into the Radial Artery on Vascular Endothelial Function Assessed by Reactive Hyperemia Peripheral Arterial Tonometry.

The transradial approach has been used for coronary procedures, but this procedure carries a risk of injury to the endothelium of the radial artery. In this study, the vascular dysfunction caused by transradial catheterization was examined using reactive hyperemia peripheral arterial tonometry (RH-PAT), a recently developed technique for assessing endothelial function in digits, and the differences in injuries were compared according to the size of sheath.Forty-three patients undergoing transradial catheterization with 6-Fr sheaths (n = 17) or 4-Fr/5-Fr (non-6-Fr; n = 26) sheaths underwent RH-PAT using an Endo-PAT2000 before, the day after, and 6 months after catheterization. RH-PAT was assessed in the arm of sheath placement and in the other arm as a control.RH-PAT values decreased from 2.42 ± 0.67 before catheterization to 2.08 ± 0.41 the day after catheterization in the 6-Fr group (P = 0.031); this was more evident in patients with a longer procedure time (> 91 minutes). In contrast, the change in the non-6-Fr group was not significant. RH-PAT of the non-catheterized arm was unchanged in both groups. At 6 months after catheterization, RH-PAT values in the 6-Fr group had not completely returned to baseline.In conclusion, the insertion of a 6-Fr catheter sheath into the radial artery, especially with a longer procedure time, impaired vascular endothelial function assessed by RH-PAT the day after the procedure and was sustained for 6 months. Thus, the use of smaller size sheaths (< 6-Fr) with a shorter procedure should be considered when performing transradial catheterization.

Assessment of endothelial function. History, methodological aspects, and clinical perspectives.

In 1986, endothelial function was measured for the first time in patients with atherosclerotic coronary arteries. Since then, several methods for assessment of endothelial function, such as endothelium-dependent vasodilation induced by intra-arterial infusion of vasoactive agents using coronary angiography, Doppler flow guide wire, mercury-filled Silastic strain-gauge plethysmography, flow-mediated vasodilation, reactive hyperemia-peripheral arterial tonometry, and vascular response using an oscillometric method have been performed in humans. This review focuses on the assessment of endothelial function, including measurement history, methodological issues, and clinical perspectives.

Relationship of systemic endothelial function and peripheral arterial stiffness with diabetic retinopathy

BackgroundTo investigate possible associations between diabetic retinopathy (DR) and systemic vascular endothelial function and arterial stiffness measured using reactive hyperaemia peripheral arterial tonometry.MethodsThis was a cross-sectional observational clinical study. Subjects...

Abstract 13172: Gender Differences in Impact of Vascular Endothelial Dysfunction or CYP2C19 Polymorphism on Clinical Outcome Following Coronary Stenting in Patients with Coronary Heart Disease

Background: Vascular endothelial dysfunction and CYP2C19 polymorphism are associated with increased risk of cardiovascular event in patients with coronary heart disease (CHD). The aim was to examine the gender differences in vascular endothelial dysfunction or CYP2C19 genotype on clinical outcomes following stent implantation. Methods: We enrolled 600 patients following stent implantation, taking dual antiplatelet therapy. Patients were divided into male (n=426) and female (n=174) groups. Platelet reactivity (PR) by a light transmission aggregometry, reactive hyperemia index (RHI) using reactive hyperemia peripheral arterial tonometry as an index of endothelial dysfunction, and CYP2C19 polymorphism were examined. CYP2C19 genotype was classified into carrier (at least one CYP2C19 loss-of function allele carriage) and non-carrier. Cardiovascular event (cardiovascular death, myocardial infarction (MI), stroke, unstable angina, revascularization, intraprocedural thrombotic event and heart failure) was assessed according to male or female over 18 months follow-up. Results: There were no significant differences in distribution of CYP2C19 carrier and non-carrier (78.9 vs. 64.3%, P=0.126), PR (4474 vs. 4223 AU*min, P=0.485) and clinical outcomes (17.8 vs. 16.7%, P=0.731) between male and female. In male group alone, the incidence of cardiovascular event was significantly associated with CYP2C19 carrier, renal failure, high PR, previous MI, and peripheral artery disease. While in female group alone, low RHI was significant (0.47 vs. 0.61, P=0.015). Multivariate analysis identified CYP2C19 carrier (HR, 1.908, 95% CI, 1.043-3.489; P=0.032), previous MI (HR, 1.918, 95% CI, 1.125-3.269, P=0.017), and peripheral artery disease (HR, 1.872, 95% CI, 1.079-3.247, P=0.026) as predictors of cardiovascular events in male group, while low RHI alone was a predictor in female (HR, 0.129, 95% CI, 0.021-0.811, P=0.029). Conclusions: The impact of CYP2C19 polymorphism on clinical outcome is more significant in male, not female, while effect of endothelial dysfunction is more significant in female, not male, respectively. There are gender differences in impact of CYP2C19 genotype or endothelial dysfunction on clinical outcome in CHD patients.

Abstract 11845: Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In-Stent Restenosis

Introduction: Drug-eluting stents (DESs) are replacing bare-metal stents (BMSs), but in-stent restenosis (ISR) remains a problem. Impaired endothelial function is a key event in the atherosclerosis process and a predictor of future cardiovascular events. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry (PAT) evaluates endothelial function noninvasively. Hypothesis: We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention (PCI). Methods: RHI was measured using Endo-PAT 2000 before PCI (initial RHI) and at follow-up angiography (F/U RHI) in 249 consecutive patients who had successful PCI. F/U angiography was performed at six and nine months after PCI with BMS and DES, respectively. ISR was defined as percent diameter stenosis &gt;50% at F/U angiography assessed by quantitative coronary angiography. Results: At F/U, ISR was seen in 68 patients (27.3%). F/U ln(RHI) was significantly lower in patients with ISR than in those without (0.52 ± 0.23 vs. 0.65 ± 0.27, p &lt; 0.01); no between-group difference in initial ln(RHI) was seen (0.60 ± 0.26 vs. 0.62 ± 0.25, p = 0.56). By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis (BMS use, total stent length, HDL-Cholesterol, HbA1c, calcium antagonist use, and post-PCI minimum lumen diameter), F/U ln(RHI) independently predicted ISR (odds ratio: 0.13; 95% confidence interval [CI]: 0.04-0.48; p = 0.002). In receiver operating-characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve [AUC]: 0.67; 95% CI: 0.60-0.75; p &lt; 0.01; RHI &lt; 1.73 had 67.6% sensitivity, 64.1% specificity); AUC significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors (diabetes mellitus, total stent length, minimum stent diameter) (p = 0.02). Net reclassification index was significant after addition of RHI (26.5%, p = 0.002). Conclusions: To our knowledge, this is the first study indicating that impaired RHI at F/U angiography independently predicts occurrence of ISR. The simple and noninvasive assessment of endothelial function by RH-PAT adds incremental prognostic value to ISR-risk stratification following PCI.

Abstract 14815: Impact of Fluctuations in Glucose Levels on Vascular Endothelial Dysfunction in Non Diabetes Mellitus (DM) Patients with Coronary Artery Disease (CAD)

Background: Fluctuations in glucose levels give rise to inflammation and endothelial dysfunction by increasing oxidative stress. Mean amplitude of glycemic excursions (MAGE) is commonly used as a degree of fluctuations in glucose levels, and plays a significant role in vascular endothelial dysfunction in patient with diabetes mellitus (DM). Vascular endothelial dysfunction is associated with cardiovascular event risk. Thus, we examined the impact of MAGE on vascular endothelial dysfunction and clinical outcomes in non DM patients with CAD. Methods: We analyzed 22 non DM patients with CAD following percutaneous coronary intervention (PCI) during 12 months follow up, and assessed the relationship among MAGE, the level of high-sensitivity CRP (hs-CRP), and reactive hyperemia index (RHI) measured from RH-PAT (reactive hyperemia peripheral arterial tonometry). Cardiovascular events were cardiovascular death, myocardial infarction, stroke, unstable angina,and revascularization. Results: In clinical characteristics of total patients, age, HbA1c, average of blood glucose for 24 hour, and MAGE were 73ys, 5.93%, 121.5mg/dl, and 55.5mg/dl. MAGE correlated with hs-CRP (r=0.610; P=0.004) and RHI (r=–0.485; P=0.047), but not correlated with HbA1c, LDL cholesterol, HDL cholesterol, triglyceride, and systolic blood pressures. In short, high glycemic excursions (high MAGE) is associated with high inflammation (high hs-CRP) and vascular endothelial dysfunction (low RHI). When patients were classified into MAGE&lt;60mg/dl (normal glycemic excursions) and MAGE&gt;60mg/dl (high glycemic excursions), group of MAGE&gt;60mg/dl were significant higher in hs-CRP (0.251±0.301 vs 0.072±0.067mg/dl, P=0.048) and lower in RHI (0.392±0.193 vs 0.834±0.316, P=0.008) than group of MAGE&lt;60mg/dl. Multivariate analysis for vascular endothelial dysfunction identified MAGE as a predictive factor (OR13.3, 95%RI 1.069-166.4, P=0.044). Moreover, MAGE was an independent predictive factor for cardiovascular events (OR11.0, 95%RI 1.42-85.20, P=0.022) Conclusions: Fluctuations in glucose levels are associated with inflammation, endothelial dysfunction, and cardiovascular events risk in non DM patients with CAD.

Abstract 12027: Peripheral Endothelial Dysfunction Independently Correlated With Cardiovascular Events in Patients Following Coronary Stent Implantation

Introduction: Percutaneous coronary intervention (PCI) is performed in patients with coronary heart disease to improve symptoms and clinical prognosis. Despite optimal therapies after PCI, some patients experience one or more adverse outcome. Therefore, to evaluate the determinants of the residual risk of cardiovascular events is still important. Endothelial dysfunction has been reported to correlate with adverse cardiovascular events in coronary heart disease. Hypothesis: We hypothesized that endothelial dysfunction could predict future cardiovascular events in patients following coronary stent implantation. Methods: We conducted a prospective cohort study of 435 patients after coronary stent implantation. All patients received aspirin and clopidogrel in addition to other optimal medications. Peripheral endothelial dysfunction was expressed as reactive hyperemia index (RHI) using reactive hyperemia peripheral arterial tonometry, and we used the median value of the RHI (0.54) to divide patients into low (n=218, male 70.2%) and high (n=217, male 70%) RHI groups. We followed cardiovascular events after coronary stent implantation. Results: There was no significant difference in clinical characteristics between the low and high group. A total of 64 patients had a cardiovascular event. The incidence of cardiovascular event was significantly higher in the low RHI group (20.2% versus 9.2%; P=0.007). Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in the low RHI group than in the high RHI group (mean follow-up: 70 months; log-rank test: P=0.002). Multivariate Cox hazard analysis among various clinical factors demonstrated that body mass index (hazard ratio [HR]: 0.906; 95% confidence interval [CI]: 0.838 to 0.980; P=0.014), peripheral arterial disease (HR: 1.834; 95% CI: 1.003 to 3.351; P=0.049), Cytochrome P450 loss-of-function allele carriage (HR: 2.005; 95% CI: 1.101 to 3.651; P=0.023), and RHI (HR: 0.149; 95% CI: 0.044 to 0.502; P=0.002) as independent and significant determinants of clinical outcome. Conclusions: Peripheral endothelial dysfunction independently correlated with future cardiovascular events in patients following coronary stent implantation.

Abstract 18400: Distinct Endothelial Function in Patients With Chronic Total Occlusion With Preserved Myocardial Viability

Backgrounds: Coronary collateral vessels work as a detour and ameliorate ischemic myocardial damage. Induction or enhancement of the collateral growth is a novel therapeutic strategy for the ischemic heart disease, however their mechanisms are almost unknown. Patients with chronic total occlusion (CTO) who keep the intact myocardium maintain rich collateral sources, which perfuse the area of the occluded artery. We tried to assess the characteristics of patients with CTO compared with non-occlusive patients with ischemic heart disease and those with old myocardial infarction (OMI). Methods: Consecutive 264 patients from January 2010 to February 2014 were enrolled this study. First we assessed the myocardial viability using summed rest score (SRS) of thallium perfusion scintigraphy and divided into OMI patients (SRS greater than or equal to 4, OMI group, n=99) and the others with almost normal myocardial viabilities (n=165). Next we divided into CTO group (n=51) and Stenosis group (n=114) from the coronary angiographic findings. We also measured their peripheral endothelial function by reactive hyperemia peripheral arterial tonometry index (RHI). Results: There were no significant differences between CTO group and Stenosis group in clinical characteristics. Ln-RHI was lowest in the OMI group (OMI 0.53±0.21), furthermore, CTO group showed higher endothelial function than Stenosis group (CTO 0.71±0.21 vs Stenosis 0.63±0.23, p&lt;0.05). Multivariate logistic regression analysis identified high Ln-RHI as an independent factor associated with the presence of CTO (OR 2.523, 95% CI 1.119-5.687, p&lt;0.05) among preserved myocardial patients. Other factors did not show the statistical significance. Conclusion: Patient with CTO showed paradoxically high Ln-RHI values in spite of the existence of the total occlusion vessel. Enhanced endothelial function might promote the collateral vessel growth and protect myocardium from the irreversible damage.

Abstract 19340: Advanced Peripheral Endothelial Dysfunction Correlates with Left Ventricular Diastolic Dysfunction and Heart Failure with Preserved Left Ventricular Ejection Fraction in Hypertensive Patients

Background: Left ventricular (LV) diastolic dysfunction (DD) and vascular functions including peripheral endothelial function play an important role in the pathogenesis of heart failure (HF) with preserved LV ejection fraction (EF) (HFPEF). Hypertension is the most important risk factor in HFPEF and the increased workload caused by hypertension results in LV pathological hypertrophy and LVDD. However, the importance of endothelial function in hypertensive patients with LVDD or HFPEF remains yet undetermined. We investigated the association between peripheral endothelial function, LVDD, and HFPEF in hypertensive patients. Methods and Results: We evaluated cardiac function by echocardiography measuring the ratio of early transmitral flow velocity to tissue Doppler early diastolic mitral annular velocity (E/e’) and LVEF. We also noninvasively assessed peripheral endothelial function by reactive hyperemia-peripheral arterial tonometry (RH-PAT) as the RH-PAT index(RHI) in 405 hypertensive patients with preserved LVEF (LVEF&gt;50%), comprising 180 HFPEF and 225 non-HF patients (LVDD; E/e’&gt;15, non-HF with LVDD; n=98, non-HF without LVDD; n=127). RHI negatively correlated with E/e’ (r=-0.24, P&lt;0.001) and B-type natriuretic peptide (r=-0.19, P&lt;0.001). RHI was significantly lower in hypertensive patients with HFPEF than in non-HF hypertensive patients (0.49±0.17 vs. 0.62±0.20, P&lt;0.001). Furthermore, RHI was significantly lower in non-HF hypertensive patients with LVDD than those without LVDD (0.58±0.19 vs. 0.65±0.21, P=0.01). Multivariate logistic regression analysis identified that lower RHI independently correlated with the presence of HFPEF in hypertensive patients with preserved LVEF (odds ratio: 0.65, 95% confidence interval: 0.55-0.77, P&lt;0.001) and with the presence of LVDD in non-HF hypertensive patients (odds ratio: 0.65, 95% confidence interval: 0.71-0.95, P=0.01). Conclusions: RHI was independently associated with the presence of HFPEF and LVDD in hypertensive patients with preserved LVEF. Endothelial dysfunction in microcirculation could play a crucial role in the pathogenesis of LVDD and HFPEF in hypertensive patients.

Abstract 17516: Improvement of the Endothelial Function in Patients with Atrial Fibrillation: Effect of Sinus Rhythm Restoration by Catheter Ablation

Background: Endothelial dysfunction has been shown to be correlated significantly with the presence of atrial fibrillation (AF). However, it is not clear to what extent restoration of sinus rhythm by catheter ablation (CA) can improve the endothelial function in patients with AF. Objectives: The purpose of this study was to examine the serial change in the endothelial function for 6 months periods following CA in AF patients in whom the AF recurrence was not observed. Furthermore, we compared the endothelial functions of these AF patients obtained before and, 3 and 6 months after CA with that of normal control subjects. Methods: Forty-three normal control patients (control group) and 61 consecutive AF patients who underwent CA of AF and showed no AF recurrence for 6 months after the procedure (AF group) were included. AF group consisted of patients without structural heart disease and the history of AF was 4.7±4.9 years. Endothelial function of these two groups were assessed. All patients assessed their endothelial function by the reactive hyperemia-peripheral arterial tonometry (RH-PAT) and the RH-PAT index (RHI) was measured. The RHI was measured before and 3 month and 6 months after CA in AF group. Then the serial change in the RHI was elucidated in AF group. All measurement of RHI was performed during sinus rhythm both in control and AF groups. Results: The RHI in control group was 2.21±0.46. The RHI in the AF group before CA was significantly lower than that in control group (2.06±0.49 vs. 2.22±0.46, p=0.036). The RHI in AF group 3 months after CA was significantly improved compared with that before CA (2.40±0.59 vs. 2.06±0.49, p&lt;0.001). The RHI 6 months after CA in AF group was also significantly higher than that before CA (2.24±0.53, vs. 2.06±0.49, p=0.048). The RHI at 3 and 6 months after CA in AF group were not different from that of control group (3 months; 2.40±0.59 vs. 2.21±0.46, p=NS, 6 months; 2.24±0.53, vs. 2.21±0.46, p=NS). Conclusions: The endothelial dysfunction was present in AF patients even if the sinus rhythm was observed during measurement of RHI before CA. However, the endothelial function in AF patients was improved to the similar level of the normal control subjects when the sinus rhythm was maintained after CA.

O-051 Impaired Endothelial Function In Adolescents With Type 1 Diabetes Or Overweight, Measured By Peripheral Artery Tonometry

<h3>Background and aims</h3> Reactive hyperemia-peripheral artery tonometry (RH–PAT) is a non-invasive method for endothelial function assessment. The goal of this study is to investigate endothelial function as assessed with the RH-PAT in control adolescents and adolescents with type 1 diabetes (T1D) or overweight. <h3>Methods</h3> RH-PAT score and baseline pulse amplitude was measured after an overnight fast in 25 control subjects (age 12–20 years), 34 adolescents with T1D and 27 adolescents with overweight or obesity. <h3>Results</h3> RH-PAT score was lower in adolescents with T1D compared to healthy controls (1.6 [1.3–2.0] versus 1.9 [1.7–2.4], p = 0.0154). The same trend was seen in adolescents with overweight or obesity (1.5 [1.3–2.0] versus 1.9 [1.7–2.4], p = 0.027). Similarly, the baseline pulse amplitude was higher in the group of patients with T1D (373.0 [208.3–522.0] versus 145.3 [52.3–300.2], p = 0.0033) and in adolescents with overweight or obesity compared to healthy controls (416.3 [360.3–675.7] versus 145.3 [52.3­300.2], p &lt; 0.0001). Within the group with overweight, a significantly positive correlation was seen between baseline pulse amplitude and body mass index (BMI) standard deviation score (SDS) (<i>r = 0</i>.39 [0.006–0.67], p = 0.047). <h3>Conclusions</h3> Endothelial dysfunction, quantified by lower RH-PAT score or higher baseline pulse amplitude, was observed in both adolescents with T1D and with overweight. Early detection of vascular changes in these high-risk patient groups may allow targeted interventions to reduce cardiovascular disease in adulthood.

Comparison of peripheral arterial tonometry and flow-mediated vasodilation for assessment of the severity and complexity of coronary artery disease

Noninvasive flow-mediated vasodilation (FMD) is a widely used method to assess endothelial function, but its technical difficulty and problems remain obstacles for use in clinical practice. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) was developed as a simpler and more reproducible method. We compared FMD and RH-PAT in patients with stable angina. Furthermore, the differences in these two techniques according to coronary artery disease (CAD) severity and complexity were also assessed. We consecutively enrolled 80 patients who underwent elective coronary angiography. Endothelial function was assessed before angiography using brachial artery FMD and RH-PAT. The complexity and extent of the coronary lesions were assessed angiographically. The extent of CAD was defined as the number of diseased coronary arteries (>70%) and complexity of CAD was assessed by the SYNTAX score algorithm. In the overall study group (61±9 years, 57% men), the mean FMD was 8.5±5.1% and the mean reactive hyperemia index (RHI) measured by RH-PAT was 1.7±0.4. A significant correlation was observed between FMD and RHI irrespective of sex, diabetes, or presence of CAD. FMD and RHI were significantly lower in patients with multivessel and complex CAD. A receiver-operating characteristic curve analysis showed that both techniques were comparable in terms of predicting the presence of CAD and complexity. Assessment of RH-PAT could be a less operator-dependent and noninvasive method of evaluating vascular endothelial function in patients with stable angina.

Impaired endothelial function in adolescents with overweight or obesity measured by peripheral artery tonometry

Overweight and obesity in adolescents are associated with a subsequent increased mortality due to cardiovascular disease in adulthood. The reactive hyperemia-peripheral artery tonometry (RH-PAT) is a non-invasive method for endothelial function assessment. The goal of this study is to investigate endothelial function as assessed with the RH-PAT in adolescents with overweight or obesity. In 27 adolescents with overweight or obesity (16 males, 11 females) and 25 control subjects (12 males, 13 females) (age 12-20 yr) RH-PAT score and baseline pulse amplitude were measured after an overnight fast. Confounding risk factors for endothelial dysfunction, including smoking and diabetes mellitus were excluded. RH-PAT score was lower in adolescents with overweight or obesity compared to healthy controls, whereas their baseline pulse amplitude was higher (p = 0.027 and p < 0.0001, respectively). A significantly positive correlation was seen between baseline pulse amplitude and body mass index standard deviation score in the group with overweight or obese subjects. Endothelial dysfunction, measured by lower RH-PAT score and higher baseline pulse amplitude, was present in overweight adolescents. Interestingly, we also report for the first time in the literature a significant difference in baseline pulse amplitude between overweight adolescents compared to their peers.

PREDICTIVE VALUE OF ENDOTHELIAL FUNCTION BY NON-INVASIVE PERIPHERAL ARTERIAL TONOMETRY FOR CORONARY ARTERY DISEASE

Endothelial dysfunction is an early stage of atherosclerosis and is associated with cardiovascular events. We examined whether peripheral endothelial function, as assessed by fingertip reactive hyperemia-peripheral arterial tonometry (RH-PAT) can provide an additional clinical value to Framingham