Mean Reactive Hyperemia Index Research Articles

A nutraceutical with Citrus bergamia and Cynara cardunculus improves endothelial function in adults with non-alcoholic fatty liver disease

ObjectivePolyphenol intake may prevent hepatic steatosis and cardiovascular disease by potentially improving endothelial function. The purposes of this study are to investigate the association between fatty liver disease and endothelial dysfunction and to test the effects of a nutraceutical containing extracts made from Citrus bergamia and Cynara cardunculus on peripheral vascular endothelial function in adults with liver steatosis. MethodsWe analyzed data from 32 individuals with hepatic steatosis and endothelial dysfunction (reactive hyperemia index ≤ 1.67). Sixteen subjects took 1 capsule/d (300 mg/d) containing Cynara cardunculus extract and bergamot polyphenol fraction, while the other 16 subjects matched for age, sex, and body mass index took 1 capsule/d of placebo (maltodextrin) for 12 wk. All anthropometric parameters were assessed at baseline and after 12 wk as were lipids, glucose, and reactive hyperemia index using an EndoPAT 2000. ResultsThe mean age was 52 ± 9 y. The mean reactive hyperemia index was 1.15 ± 0.4. After 12 wk, we found a greater increase in reactive hyperemia index in the participants taking the nutraceutical rather than placebo (0.58 ± 0.5 versus 0.13 ± 0.5; P = 0.02, respectively). The stepwise multivariable analysis confirmed a positive association between reactive hyperemia index change and the nutraceutical treatment (B = 0.38; P = 0.025) and negative association with reactive hyperemia index values at baseline (B = –0.81; P < 0.001). No association was found between the reduction in the amount of intrahepatic fat and the improvement of endothelial function (B = 0.002; P = 0.56). ConclusionsA nutraceutical containing bergamot and artichoke extracts improves peripheral vascular endothelial function in adults with hepatic steatosis and early phase of atherosclerosis.

Examining the association of habitual e-cigarette use with inflammation and endothelial dysfunction in young adults: The VAPORS-Endothelial function study.

Acute exposure to e-cigarette aerosol has been shown to have potentially deleterious effects on the cardiovascular system. However, the cardiovascular effects of habitual e-cigarette use have not been fully elucidated. Therefore, we aimed to assess the association of habitual e-cigarette use with endothelial dysfunction and inflammation - subclinical markers known to be associated with increased cardiovascular risk. In this cross-sectional study, we analyzed data from 46 participants (23 exclusive e-cigarette users; 23 non-users) enrolled in the VAPORS-Endothelial function study. E-cigarette users had used e-cigarettes for ≥6 consecutive months. Non-users had used e-cigarettes <5 times and had a negative urine cotinine test (<30 ng/mL). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were used to assess endothelial dysfunction, and we assayed high-sensitivity C-reactive protein, interleukin-6, fibrinogen, p-selectin, and myeloperoxidase as serum measures of inflammation. We used multivariable linear regression to assess the association of e-cigarette use with the markers of endothelial dysfunction and inflammation. Of the 46 participants with mean age of 24.3 ± 4.0 years, the majority were males (78%), non-Hispanic (89%), and White (59%). Among non-users, 6 had cotinine levels <10 ng/mL while 17 had levels 10-30 ng/mL. Conversely, among e-cigarette users, the majority (14 of 23) had cotinine ≥500 ng/mL. At baseline, the systolic blood pressure was higher among e-cigarette users than non-users (p=0.011). The mean FMD was slightly lower among e-cigarette users (6.32%) compared to non-users (6.53%). However, in the adjusted analysis, current e-cigarette users did not differ significantly from non-users in their mean FMD (Coefficient=2.05; 95% CI: -2.52-6.63) or RHI (Coefficient= -0.20; 95% CI: -0.88-0.49). Similarly, the levels of inflammatory markers were generally low and did not differ between e-cigarette users and non-users. Our findings suggest that e-cigarette use may not be significantly associated with endothelial dysfunction and systemic inflammation in relatively young and healthy individuals. Longer term studies with larger sample sizes are needed to validate these findings.

Endothelial Dysfunction in Patients With Takotsubo Syndrome and its Role in Acute and Long Terms Of the Disease

Aim To evaluate the endothelial function using an Endo-PAT2000 instrument before and after mental stress tests in patients with Tacotsubo syndrome (TS) during acute and long-term periods and to compare the obtained results with laboratory markers of endothelial dysfunction (ED).Material and methods This study included 45 patients with TS (mean age, 63.5±13.7 years) and 40 healthy volunteers (control group, CG). All patients of the main group during the acute period (first 7-14 days) and long-term period (at 1 and 2 years), as well as CG subjects, underwent evaluation of the endothelial function with an Endo-PAT 2000 instrument, and the reactive hyperemia index (RHI) was determined before and after mental stress tests. Also, concentrations of endothelin 1 (ET-1) and numbers of circulating endothelial cells (CEC) were measured after a two-year follow-up of TS patients.Results During the acute period of disease, all TS patients (n=45) had ED: RHI was below the threshold level of 1.67; furthermore, 42 (93.3 %) patients retained a lower RHI following mental stress. At one year (n=40), 16 (40%) patients showed ED at rest along with a significantly increased mean RHI. Mental stress produced at one year was associated with ED in 28 (70 %) TS patients. At two years (n=44), resting RHI was lower than normal in 19 (43.2 %) patients. Mental stress tests performed at two years were associated with ED in 29 (65.9 %) patients (RHI ≤1.67). Only 10% of CG subjects had a lower-than-normal RHI, which was significantly less than in the main group of TS patients during the acute and long-term periods (p&lt;0.05). Mean values of laboratory markers for ED also were significantly different between TS patients during the long-term period of disease (n=41) and CG subjects (n=40; p&lt;0.01).Conclusion During acute and long-term periods of disease, most of TS patients had impaired vascular reactivity both at rest and during mental stress. The laboratory markers of ED, ET-1 and CEC can be used in clinical practice for evaluation of the risk for TS.

The Effect of Artificial Pulsatility on the Peripheral Vasculature in Patients With Continuous-Flow Ventricular Assist Devices

BackgroundImplantation of left-ventricular assist systems (LVASs) has become the standard of care for advanced heart failure (HF). The absence of pulsatility in previous devices contributes to vascular and endothelial dysfunction related to atherosclerotic or vascular complications. We hypothesized that the artificial pulsatility provided by the HeartMate 3 (HM3) (Abbott, Chicago, IL) LVAS would exert a favourable effect on the vasculature. MethodsIn 32 patients implanted with HM3 (5 female patients, mean age 55 ± 13.6 years), the reactive hyperemia index (RHI) and peripheral augmentation index (AI), markers of endothelial function and arterial stiffness, were measured with an EndoPAT2000 before and in the third and sixth month after implantation. RHI and AI data from 30 HeartMate II (HM II) (Abbott) recipients in the third and sixth month after implantation, from 15 patients with advanced HF without LVASs and from 13 healthy volunteers were also analyzed. ResultsIn HM3 recipients, the mean RHI significantly decreased at 3 and 6 months after implantation. The RHI was substantially lower at baseline than that of healthy or the HF reference group. Increasing AI values, indicating worsening arterial stiffness, were also observed. Similar trends were observed in HM II recipients between the third and sixth months but with higher absolute values of RHI and AI. ConclusionsWe detected impaired vascular function in HM3 patients and provided additional evidence on the negative effect of low pulsatility on vascular function after LVAS implantation. The results suggest that the artificial pulsatility of the HM3 does not avert the progression of endothelial dysfunction.

Impaired Peripheral Microvascular Function and Risk of Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease.

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Low Vitamin D Levels are Associated with Vascular Endothelial Dysfunction in Patients with Poorly Controlled Type 2 Diabetes: A Retrospective Study.

Aim: This study aimed to determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels and vascular endothelial function in patients with type 2 diabetes (T2D). Methods: This retrospective study included 113 patients with poorly controlled T2D who were admitted for in-hospital diabetes educational program and underwent measurements of serum 25(OH)D levels and reactive hyperemia index (RHI). Results: Serum 25(OH)D levels significantly correlated with RHI in T2D patients. Receiver operating characteristic (ROC) curve analysis showed that serum 25(OH)D level of 16.5 ng/mL is the optimal cutoff level for predicting vascular endothelial dysfunction (RHI＜1.67), with a sensitivity of 68.5%, specificity of 67.9%, and area under the ROC curve of 0.668 (95% confidence interval [CI]: 0.566–0.770, p =0.002). The mean RHI was significantly lower (1.70±0.54) in patients with low 25(OH)D levels ( n =56, 25(OH)D levels ＜16.5 ng/mL) than that (1.99±0.58; p ＜0.001) in patients with high 25(OH)D levels ( n =57, 25(OH)D level ≥ 16.5 ng/mL). The proportion of patients with RHI＜1.67 was higher in the low 25(OH)D group than in the high 25(OH)D group (38% vs. 18%; p ＜0.001). Multivariate logistic regression analysis identified that serum 25(OH)D level ＜16.5 ng/mL was associated with increased odds of RHI ＜1.67 (odds ratio 4.598, 95% CI 1.961–10.783, p ＜0.001). Conclusion: The results demonstrated the association of serum 25(OH)D levels with endothelial function in poorly controlled T2D patients and identified serum 25(OH)D level of ＜16.5 ng/mL as a predictor of RHI ＜1.67. Serum 25(OH)D level is a potentially useful marker of vascular endothelial dysfunction in poorly controlled T2D patients.

288: Is endothelial function impaired among women with placenta-mediated fetal growth restriction?

To assess maternal endothelial function in pregnancies complicated by IUGR due to placental dysfunction. Prospective study assessing endothelial function using EndoPAT device in 2 populations of pregnant patients: 1. women with estimated fetal weight (EFW) below 10th percentile and abnormal uterine arteries and/or umbilical artery flow (n=15); and 2. Women with AGA fetus without placental complications matched by gestational age at testing (control group, n=22). Exclusion criteria included multifetal gestation, hypertensive diseases, diabetes mellitus, renal disease, smoking and pregnancies complicated by fetal anomalies or genetic abnormalities. EndoPAT evaluates the change in peripheral vascular tone in reaction to temporal ischemia in a process called reactive hyperemia. The ratio of the readings before and after ischemia is used to calculate the score for endothelial function and called reactive hyperemia index (RHI). Abnormal RHI indicating endothelial dysfunction is defined as RHI ≤ 1.67 in the non-pregnant population. Demographic and clinical characteristics did not differ between the two groups. The mean gestational age at endoPAT examination was comparable between the IUGR and control group (32.5 ± 2.2 vs, 31.6 ± 3.2, p=0.21). The mean RHI was significantly lower in the IUGR group compared to the control group (1.32 ± 0.16 vs 1.51 ± 0.31, p= 0.02, respectively). As expected, mean gestational age at delivery as well as neonatal birth weight were lower in the FGR group compared to the control group (35.4 ± 2.3 vs 37.3 ± 2.6 p=0.04; 1640 ± 414 grams vs 2785 ± 587 grams, p< 0.001 respectively). Pregnant women with fetal growth restriction due to placental dysfunction are characterized by endothelial dysfunction. Further studies are required in order to determine whether endothelial dysfunction is the cause or the consequence of placental dysfunction. Furthermore, delivery of IUGR has been associated with the development of cardiovascular condition later in life. Thus, the results of the present study may provide a putative explanation for this association.

The Ratio of Oxidized Lipoprotein(a) to Native Lipoprotein(a) and the Endothelial Function in Patients with Type 2 Diabetes Mellitus.

The ratio of oxidized lipoprotein(a) to native lipoprotein(a) (oxLp(a)/Lp(a)) may be a reasonable index for assessing endothelial dysfunction in type 2 diabetes mellitus (T2DM). The present study investigated whether the oxLp(a)/Lp(a) level is correlated with the endothelial function using the Endo-PATTM, a newly developed device, in patients with T2DM. A total of 63 patients with T2DM (mean age: 59 years old) were enrolled in the study. The patients’ serum Lp(a) and oxLp(a) levels were measured using an enzyme-linked immunosorbent assay. The reactive hyperemia index (RHI) level was measured using an Endo-PATTM 2000. A correlation analysis between the measured variables was conducted. Among the patients, the mean hemoglobin A1c was 7.8%. The median level of oxLp(a)/Lp(a) was 0.28 (interquartile range: 0.07–0.54), and the mean RHI was 1.8 (standard deviation: 0.4). In a multiple linear regression analysis, the oxLp(a)/Lp(a) level was an independent, significant, and inverse variable for the RHI level (β = −0.26, p < 0.05), along with male gender. A high oxLp(a)/Lp(a) level may reflect endothelial dysfunction, as assessed by the Endo-PATTM, in patients with T2DM. Further studies are warranted to confirm the observed findings.

Abstract P137: Impaired Microvascular and Endothelial Function Among African-Americans With Coronary Artery Disease

Background: African-Americans have disproportionately higher burden of mortality from coronary artery disease (CAD) compared to Caucasians even after adjusting for socioeconomic and cardiovascular risk factors. Racial differences in arterial stiffness have been described, but data on microcirculatory and endothelial vascular function are more limited and it is unknown whether they differ by race in CAD patients. Methods: We studied 313 patients with a recent history of myocardial infarction (MI). Microvascular function was assessed by digital pulse amplitude tonometry (EndoPAT) to determine reactive hyperemia index (RHI), and endothelial function as brachial artery flow mediated dilation (FMD) using ultrasound. Arterial stiffness was assessed using applanation tonometry (Sphygmocor) to determine pulse-wave velocity (PWV) and central augmentation index (C-AIx). Data on sociodemographics, cardiovascular risk factors, medication use, and CAD severity were collected. Multivariate linear regression models were used to assess the relationship between race and various vascular function measures with adjustment for risk factors. Measures of arterial stiffness were included as control factors in the adjusted model for FMD and RHI. Results: The mean age of this post-MI sample was 51 years (± 6.7 SD); 50% were African-Americans and 49% were female. Compared to Caucasians, African-Americans had worse microvascular function as indicated by lower mean (± SD) RHI (1.7±0.5 vs 2.0±0.6, p&lt;0.0001) and worse endothelial function [FMD mean (3.4±2.4 vs 4.7±3.1, p=0.0002)]. African-Americans also had greater arterial stiffness, including a higher mean C-AIx (26.5±9.0 vs 23.0±9.3, p=0.0019) and PWV (7.7±2.0 vs 7.1±1.8, p&lt;0.0267). After adjustment for cardiovascular risk factors, medications, CAD severity, and arterial stiffness (C-AIx and PWV), black race remained significantly associated with lower RHI (β=-0.30, p&lt;0.001) and FMD (β=-1.06, p=0.004). Conclusion: African-Americans with CAD have impaired microvascular and endothelial vasodilatory function compared to Caucasians, independent of CAD risk factors and arterial stiffness. Racial differences in microcirculatory and endothelial function may contribute to worse outcomes among African-Americans with CAD.

Attenuated peripheral endothelial function among women treated with aromatase inhibitors for breast cancer.

Data on long-term cardiovascular effects of aromatase inhibitors (AIs) are limited and conflicting. We sought to evaluate the effect of AIs on peripheral endothelial function in patients with breast cancer. This is an observational, prospective study of postmenopausal women with breast cancer who were enrolled at the initiation of cancer treatment. All participants underwent baseline and 6-12 months of follow-up, with peripheral endothelial function testing to measure reactive hyperemia index (RHI). The primary aim was to assess endothelial function deterioration between baseline and follow-up. The secondary aim was to assess the correlation of cardiovascular risk factors with RHI change in women treated with versus without AIs. Among 97 patients, mean (SD) age was 66 (7) years; 59 (61%) women had AI treatment, and 38 women did not (control group). There were no significant differences in baseline characteristics between the groups. Mean (SD) RHI at baseline in the treatment group did not differ significantly from that in the control group [2.2 (0.6) vs. 2.1 (0.5); P=0.15]. The mean (SD) time between baseline and follow-up studies was 262 (60) days. RHI deterioration, evaluated as a dichotomous variable with a 20% cutoff, was significantly more common in the AI group [17 (29%) vs. 4 (11%); P=0.04]. After adjusting for age, treatment with AIs was significantly associated with an RHI deterioration of at least 20% from baseline (odds ratio: 3.6; 95% confidence interval: 1.10-12.07; P=0.03). Further, in the intervention group, women with at least three traditional cardiovascular risk factors were more likely to have RHI deterioration compared to women with λ2 risk factors [10 (42%) vs. 7 (20%); P=0.04]. Amongst women with three or more cardiovascular risk factors, the percentage with RHI deterioration was higher in the AI group than the control group [10/24 (42%) vs. 3/22 (14%); P=0.04], whereas in women with up to two risk factors, the percentage with RHI deterioration was similar between the groups [7/35 (20%) vs. 1/16 (6%); P=0.21]. This study suggests that AIs may be associated with vascular injury. The effect is more pronounced among women with a higher baseline cardiovascular risk factor burden. These findings have potentially important implications, particularly among women at high risk for cardiovascular disease who are treated with AIs for hormone receptor-positive breast cancer.

Reactive hyperemia index (RHI) and cognitive performance indexes are associated with histologic markers of liver disease in subjects with non-alcoholic fatty liver disease (NAFLD): a case control study

BackgroundNo study evaluated vascular health markers in subjects with non-alcoholic fatty liver disease (NAFLD) through a combined analysis of reactive hyperemia peripheral arterial tonometry (RH-PAT) and arterial stiffness indexes.Aim of the studyWe aimed to assess whether NAFLD and its histological severity are associated with impairment of arterial stiffness and RH-PAT indexes in a mixed cohort of patients with biopsy-proven NAFLD.Materials and methodsThe Kleiner classification was used to grade NAFLD grade. Pulse wave velocity (PWV) and augmentation index (Aix) were used as markers of arterial stiffness, whereas endothelial function was assessed using reactive hyperemia index (RHI). The mini-mental state examination (MMSE) was administered to test cognitive performance.Results80 consecutive patients with biopsy-proven NAFLD and 83 controls without fatty liver disease. NAFLD subjects showed significantly lower mean RHI, higher mean arterial stiffness indexes and lower mean MMSE score. Multivariable analysis after correction for BMI, dyslipidaemia, hypertension, sex, diabetes, age and cardiovascular disease showed that BMI, diastolic blood pressure and RHI are significantly associated to NAFLD. Simple linear regression analysis showed among non-alcoholic steatohepatitis (NASH) subjects a significant negative relationship between ballooning grade and MMSE and a significant positive association between Kleiner steatosis grade and augmentation index.ConclusionsFuture research will be addressed to evaluate the relationship between inflammatory markers and arterial stiffness and endothelial function indexes in NAFLD subjects. These study will evaluate association between cardiovascular event incidence and arterial stiffness, endothelial and cognitive markers, and they will address the beneficial effects of cardiovascular drugs such as statins and ACE inhibitors on these surrogate markers in NAFLD subjects.

618: Is endothelia function impaired among women with twin gestations? Evidence from a prospective cohort study using peripheral artery tonometry

Reactive hyperemia-peripheral artery tonometry (RH-PAT, EndoPAT) has been developed as a simple method to determine endothelial function. Our aim was to determine whether endothelial function is impaired in women with twin gestations compared to singletons using EndoPAT. A prospective cohort study of 41 pregnant women who underwent endothelial function assessment using EndoPAT device between 25 and 35 weeks of gestation. Women with twin pregnancies (study group, n=19) were matched by gestational age at testing to women with singleton pregnancies (control group, n=22). Exclusion criteria included chronic hypertension, preeclampsia, gestational hypertension, diabetes mellitus, renal disease and smoking. EndoPAT evaluates the change in peripheral vascular tone in reaction to temporal ischemia in a process called reactive hyperemia. The ratio of the readings before and after ischemia is used to calculate the score for endothelial function and called reactive hyperemia index (RHI). Abnormal RHI indicating endothelial dysfunction is defined as RHI ≤ 1.67 in the non-pregnant population. All exams were undertaken between 6:00-8:00am following a 6 hour fast by two operators. Maternal age, parity, body mass index, systolic and diastolic blood pressure and gestational age at the time of testing did not differ between the two groups. Mean RHI did not differ significantly between women with twins compared to singletons (1.59±0.4 vs 1.58±0.3 respectively, p=0.45). Interestingly, most women in both twins and singleton groups exhibited an RHI of ≤1.67 indicating peripheral endothelial dysfunction (78% vs 76% respectively, p=0.5). A sub-group analysis showed no difference in RHI between women with discordant twins and women with non-discordant twins (1.64±0.56 vs 1.57±0.34 respectively, p=0.35). Peripheral endothelial function measured with EndoaPAT is similar between women with twins gestations compared to singletons. Importantly, the majority of pregnant women with either twins or singleton gestation exhibit endothelial dysfunction during pregnancy.

A Prospective Cohort Study of Endothelial Function and Its Relationship to Aspirin Responsiveness in OSA Patients

SESSION TITLE: Obstructive Sleep Apnea: Insights & Management SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 29, 2017 at 01:30 PM - 03:00 PM PURPOSE: Endothelial dysfunction is an important phenomenon implicated in cardiovascular morbidity in obstructive sleep apnea (OSA) patients. While it has been demonstrated that continuous positive airway pressure (CPAP) therapy improves endothelial function, our understanding of the pathophysiologic links between CPAP therapy and cardiovascular outcomes remains limited. We further explored endothelial function in OSA patients before and after CPAP therapy. In addition, we studied relationship between endothelial function and aspirin responsiveness, as platelet hyperactivity has been suggested as another cardiovascular risk factor in OSA patients. METHODS: In this prospective cohort study, patients with newly diagnosed moderate-to-severe OSA (apnea-hypopnea index ≥ 15) underwent modified peripheral artery tonometry and platelet aggregometry before and after initiating CPAP therapy; the results were compared using paired samples t-test. Endothelial dysfunction was defined by a reactive hyperemia index (RHI) ≤ 1.67, and aspirin resistance as ≥ 550 ARU (aspirin reaction units). RESULTS: Of the 18 patients included in this study, 94% were male. The median age was 50 (32 to 64) years. At baseline, mean RHI was 1.79 (SD = 0.3); endothelial dysfunction was present in 8/18 patients (44%). After CPAP therapy (median length - 37 days), mean RHI increased to 1.94 (SD = 0.36), one-sided p = 0.015; endothelial dysfunction was found in 5/18 patients (28%). Most patients (14/18 or 78%) were classified as aspirin resistant at baseline. Among patients with endothelial dysfunction at baseline, CPAP therapy was associated with an increase in aspirin responsiveness that trended towards significance: mean ARU decreased from 563 (SD = 73) pre-CPAP to 520 (SD = 82) post-CPAP, one-sided p = 0.09. However, this trend was absent in patients with normal endothelial function: mean ARU decreased from 574 (SD = 80) to 566 (SD = 87), one-sided p = 0.4. CONCLUSIONS: CPAP therapy is associated with improvement in endothelial function in OSA patients. Larger studies are needed to confirm the correlation between CPAP therapy and improvement in aspirin responsiveness among patients with endothelial dysfunction, suggested by our results. CLINICAL IMPLICATIONS: Patients with untreated OSA have higher risk for cardivascular events. Majority of these patients are on aspirin therapy for primary or secondary prevention. Endothelial dysfunction and aspirin resistance may be prevalent among patients with OSA. CPAP therapy has potential to improve aspirin responsiveness in those patients that also have endothelial dysfunction. DISCLOSURE: The following authors have nothing to disclose: Lirim Krveshi, Oleg Sostin, Amber Butler, Cesar Artiles, Alan Sequieros, Joann Petrini, Jose Mendez No Product/Research Disclosure Information

Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction

Introduction and ObjectivesThe role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. MethodsED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI <1.67. Infarct extension was assessed by troponin I (TnI) release and contrast-enhanced cardiac magnetic resonance (ceCMR). MVO was assessed by ceCMR and by indirect angiographic and ECG indicators. An echocardiogram was also performed in the first 12 h. ResultsWe included 38 patients (mean age 60.0±13.7 years, 29 male). Mean RHI was 1.87±0.60 and 16 patients (42.1%) had ED. Peak TnI (median 118 mg/dl, IQR 186 vs. 67/81, p=0.024) and AUC of TnI (median 2305, IQR 2486 vs. 1076/1042, p=0.012) were significantly higher in patients with ED, who also showed a trend for more transmural infarcts (63.6% vs. 22.2%, p=0.06) and larger infarct mass on ceCMR (median 17.5%, IQR 15.4 vs. 10.1/10.3, p=0.08). Left ventricular ejection fraction (LVEF) was lower and wall motion score index (WMSI) was higher on both echocardiogram and ceCMR in patients with ED. On ceCMR, MVO was more frequent in patients with RHI <1.67 (54.5% vs. 11.1%, p=0.03). ECG and angiographic indicators of MVO all showed a trend toward worse results in these patients. ConclusionsThe presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.

Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction

Introduction and ObjectivesThe role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. MethodsED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI <1.67. Infarct extension was assessed by troponin I (TnI) release and contrast-enhanced cardiac magnetic resonance (ceCMR). MVO was assessed by ceCMR and by indirect angiographic and ECG indicators. An echocardiogram was also performed in the first 12 h. ResultsWe included 38 patients (mean age 60.0±13.7 years, 29 male). Mean RHI was 1.87±0.60 and 16 patients (42.1%) had ED. Peak TnI (median 118 mg/dl, IQR 186 vs. 67/81, p=0.024) and AUC of TnI (median 2305, IQR 2486 vs. 1076/1042, p=0.012) were significantly higher in patients with ED, who also showed a trend for more transmural infarcts (63.6% vs. 22.2%, p=0.06) and larger infarct mass on ceCMR (median 17.5%, IQR 15.4 vs. 10.1/10.3, p=0.08). Left ventricular ejection fraction (LVEF) was lower and wall motion score index (WMSI) was higher on both echocardiogram and ceCMR in patients with ED. On ceCMR, MVO was more frequent in patients with RHI <1.67 (54.5% vs. 11.1%, p=0.03). ECG and angiographic indicators of MVO all showed a trend toward worse results in these patients. ConclusionsThe presence of ED assessed by PAT 24 h after P-PCI in patients with STEMI is associated with larger infarcts, lower LVEF, higher WMSI and higher prevalence of MVO.

Arterial stiffness, endothelial and cognitive function in subjects with type 2 diabetes in accordance with absence or presence of diabetic foot syndrome

BackgroundEndothelial dysfunction is an early marker of cardiovascular disease so endothelial and arterial stiffness indexes are good indicators of vascular health. We aimed to assess whether the presence of diabetic foot is associated with arterial stiffness and endothelial function impairment.MethodsWe studied 50 subjects with type 2 diabetes mellitus and diabetic foot syndrome (DFS) compared to 50 diabetic subjects without diabetic foot, and 53 patients without diabetes mellitus, by means of the mini mental state examination (MMSE) administered to evaluate cognitive performance. Carotid-femoral pulse wave velocity (PWV) and augmentation index (Aix) were also evaluated by Applanation tonometry (SphygmoCor version 7.1), and the RH-PAT data were digitally analyzed online by Endo-PAT2000 using reactive hyperemia index (RHI) values.ResultsIn comparison to diabetic subjects without diabetic foot the subjects with diabetic foot had higher mean values of PWV, lower mean values of RHI, and lower mean MMSE. At multinomial logistic regression PWV and RHI were significantly associated with diabetic foot presence, whereas ROC curve analysis had good sensitivity and specificity in arterial PWV and RHI for diabetic foot presence.ConclusionsPulse wave velocity and augmentation index, mean RHI values, and mean MMSE were effective indicators of diabetic foot. Future research could address these issues by means of longitudinal studies to evaluate cardiovascular event incidence in relation to arterial stiffness, endothelial and cognitive markers.

Improvement of endothelial function following initiation of testosterone replacement therapy.

BackgroundIsolated recent studies have suggested an increased risk of heart attack as early as 3 months following testosterone replacement therapy (TRT). Such a rapid risk increase would likely require rapid deterioration of arterial endothelial function. Our goal was to assess arterial endothelial function in hypogonadal men prior to and at least 3 months after initiation of TRT.MethodsAdult men were consented if they had symptoms of hypogonadism, a total testosterone <350 ng/dL, and planned to begin TRT. Endothelial function was non-invasively assessed using the EndoPAT-2000 machine. We measured the augmentation index (AI) (normal <3%), a measure of arterial stiffness and reactive hyperemia index (RHI), a measure of endothelial vasodilation (normal >1.69). Prior studies suggest that a 10% level of day-to-day test variability is expected. Endothelial function was reassessed at the next clinic visit, between 3 and 6 months if the patients were compliant with therapy. Changes in continuous variables were assessed with the paired t test.ResultsTwenty-three patients were consented with a mean age of 52.7 years (range, 34–68 years) and starting testosterone 196.9 ng/dL (range, 35–339 ng/dL). There was a history of diabetes in four, hypertension in ten and coronary artery disease in five. Mean RHI was 1.67±0.37 (70% were abnormal) and mean AI was 2.57%±14.0% (39% were abnormal). There were no cardiac events. At follow-up 20 patients were compliant with therapy and retested. Mean testosterone increased from 203 to 511 (P<0.0001). Mean RHI improved from 1.70 to 2.14 (P=0.01). Mean AI improved from 2.9% to −1.75% (P=0.01). In four men RHI worsened but in each case less than the 10% error of the test. No man had worsened AI.ConclusionsMen with symptomatic hypogonadism often have abnormal arterial endothelial function. Following TRT, endothelial function either remains unchanged or improves.

Endothelial function and arterial stiffness indexes in subjects with acute ischemic stroke: Relationship with TOAST subtype

Background and aimsOnly one study has examined endothelial function in subjects with acute ischemic stroke and no study has yet assessed arterial stiffness and reactive hyperemia peripheral arterial tonometry (RH-PAT) in ischemic stroke and its clinical subtypes. Our study aimed to evaluate arterial stiffness and endothelial dysfunction indexes in patients with acute ischemic stroke and the relationship between endothelial dysfunction indexes and arterial stiffness markers and stroke subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification. MethodsWe enrolled 98 patients with a diagnosis of acute ischemic stroke and 105 hospitalized patients without a diagnosis of acute ischemic stroke. Arterial stiffness analysis was conducted by applanation tonometry to record radial artery pressure waveform continuously; augmentation index (Aix) and pulse wave velocity (PWV) were calculated. The reactive hyperemia index (RHI) was assessed by peripheral arterial tonometry. ResultsIn comparison to controls, ischemic stroke subjects had higher mean levels of PWV, Aix, and significantly lower mean RHI values. Compared to subjects with lacunar and cardioembolic stroke, those with Large Artery AtheroSclerosis (LAAS) subtype of stroke had higher median levels of PWV and significantly lower median levels of RHI. On multinomial logistic regression analysis of predictive variables of stroke subtype (lacunar vs. LAAS and lacunar vs. cardioembolic), we observed a negative association between RHI value and LAAS subtype and a negative association of PWV with cardioembolic subtype. ConclusionsOur findings underline the relationship between endothelial and arterial stiffness index correlations in patients with acute ischemic stroke, also suggesting the use of a combination of PAT and arterial stiffness indexes to better categorize patients with ischemic stroke.

Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD: The iPOWER Study

ObjectivesThis study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). BackgroundCMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis and consists of multiple abnormalities of the coronary circulation. Impaired RHI is a noninvasive measure of peripheral vascular dysfunction that can identify individuals with acetylcholine induced coronary vascular dysfunction. It is largely unknown whether there is also an association between RHI and the endothelial-independent aspect of CMD assessed as a coronary flow velocity reserve (CFVR). MethodsWe included 339 women with chest pain suggestive of angina pectoris and a diagnostic invasive coronary angiogram without significant coronary artery stenosis (<50%). CFVR was measured by transthoracic pulsed wave Doppler echocardiography during dipyridamole infusion (0.84 mg/kg). RHI was assessed by digital pulse amplitude tonometry. Participants were categorized in 3 RHI and 3 CFVR groups. We examined the association between CFVR and RHI and the distribution of cardiovascular risk factors between the CFVR and RHI groups. ResultsCFVR and RHI were successfully measured in 322 participants. Median CFVR was 2.3 (interquartile range: 2.0 to 2.8) and median RHI was 2.1 (interquartile range: 1.6 to 2.6). No correlation was found between CFVR and RHI (Spearman’s rho = –0.067, p = 0.23), and mean RHI did not differ between CFVR categories (p = 0.39). Participants with low CFVR were significantly older and had a significantly greater burden of hypertension, whereas participants with an impaired RHI had a higher body mass index and were more likely to have diabetes and be current smokers. ConclusionsRHI does not identify individuals with CMD assessed as impaired CFVR by dipyridamole stress echocardiography in women with no obstructive coronary artery disease. The two methods are likely to identify different aspects of vascular pathology, as indicated by the different association with cardiovascular risk factors.

PD50-08 IMPROVEMENT OF ARTERIAL ENDOTHELIAL FUNCTION FOLLOWING INITIATION OF TESTOSTERONE REPLACEMENT THERAPY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2016PD50-08 IMPROVEMENT OF ARTERIAL ENDOTHELIAL FUNCTION FOLLOWING INITIATION OF TESTOSTERONE REPLACEMENT THERAPY Daniel Shoskes, Kathryn Dunlap, and Barbara Tucky Daniel ShoskesDaniel Shoskes More articles by this author , Kathryn DunlapKathryn Dunlap More articles by this author , and Barbara TuckyBarbara Tucky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2798AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Isolated recent studies have suggested an increased risk of heart attack as early as 3 months following testosterone replacement therapy (TRT) initiation. Such a rapid risk increase would likely require rapid deterioration of arterial endothelial function since atherosclerosis would be unlikely to develop so quickly de novo. Our goal was to assess arterial endothelial function in hypogonadal men prior to and at least 3 months after initiation of TRT METHODS Adult men were consented for the study if they had symptoms of hypogonadism, a total testosterone < 350 ng/dl, and planned to begin TRT. Endothelial function was non-invasively assessed using the Endo-PAT2000 machine, an FDA approved test of cardiac risk. We measured the Augmentation Index (AI) (normal < 3%), a measure of arterial stiffness and Reactive Hyperemia Index (RHI), a measure of endothelial vasodilation (normal > 1.69). Prior studies suggest that a 10% level of day to day test variability is expected. Topical gels or Testopel were used for TRT and target testosterone confirmed post therapy. Endothelial function was reassessed at the next clinic visit, between 3 and 6 months after treatment started if the patients were compliant with therapy. Changes in continuous variables were assessed with the paired t test and significance set at p<0.05 RESULTS 23 patients were consented with a mean age of 52.7 (range 34-68) and starting testosterone 196.9 ng/dl (range 35-339). There was a history of diabetes in 4, hypertension in 10 and coronary artery disease in 5 men. Mean RHI was 1.67+/-0.37 (70% were abnormal) and mean AI was 2.57%+/-14.0 (39% were abnormal). No patient subsequently developed a clinical cardiac event. At follow up 20 patients were compliant with therapy and retested. Mean total testosterone increased from 203 to 511 (p<0.0001). Mean RHI improved from 1.70 to 2.14 (p=0.01). Mean AI improved from 2.9% to -1.75% (p=0.01). In 4 men RHI was unchanged and any lower values were within the 10% error of the test (1.3-6.3%). No man had worsening of AI. CONCLUSIONS Men with symptomatic hypogonadism often have abnormal arterial endothelial function. Following TRT, this endothelial function either remains unchanged or improves. This improvement would be expected to reduce the risk of subsequent cardiac events. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1188 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Shoskes More articles by this author Kathryn Dunlap More articles by this author Barbara Tucky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...