Abstract 16593: Secondary Raynaud’s Phenomenon is Associated With Microvascular Peripheral Endothelial Dysfunction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jaskanwal Deep S Sara ◽  
Riad Taher ◽  
Takumi Toya ◽  
Lilach O Lerman ◽  
Amir LERMAN
Keyword(s):  
Endothelial Dysfunction ◽  
Smoking Status ◽  
Raynaud’S Phenomenon ◽  
Reactive Hyperemia ◽  
Raynaud's Phenomenon ◽  
Control Group ◽  
Peripheral Arterial Tonometry ◽  
Cross Sectional ◽  
Peripheral Arterial ◽  
Cardiovascular Evaluation

Introduction: Previous studies in patients with Raynaud’s phenomenon (RP) have found an association between microvascular abnormalities assessed via nail fold capillaroscopy as well as macrovascular peripheral endothelial dysfunction (PED). However, the association between RP and microvascular PED is not yet established. Hypothesis: We hypothesized that patients with RP have greater microvascular PED compared to controls without RP Methods: We performed a retrospective cross-sectional analysis of patients referred to Mayo Clinic between 2006 and 2014 for routine cardiovascular evaluation, and who underwent evaluation of Reactive Hyperemia Peripheral Arterial Tonometry (index < 2 consistent with PED). Patients with RP were identified by chart review. Results: Six hundred sixty six individuals were included in this study (mean age 51.9±13.5 years, 411 (61.3%) women), 637 (95.1%) individuals did not have RP (control group), and 29 (4.3%) had secondary RP. Only 4 patients had primary RP and were excluded from the final analyses. Individuals with secondary RP had a higher frequency of microvascular PED compared to controls ( Figure ). In a multivariate analysis adjusting for age, sex, smoking status, and use of statins we found a significant association between secondary RP and microvascular PED (OR: 2.45; 95% CI 1.13-5.34; P=0.0236) that remained significant in women after stratifying by sex. In a sensitivity analysis, we compared the frequency of PED in 29 patients with secondary RP and 58 controls matched with respect to age, sex, hypertension, dyslipidemia, and diabetes mellitus. Individuals with secondary RP had a higher frequency of microvascular PED compared to the risk factor-matched controls (18/29 [62.1%] vs 18/58 [31.0%], P=0.01). Conclusions: Secondary RP is associated with microvascular PED. Early detection of microvascular PED could help identify individuals with secondary RP who are at risk for developing cardiovascular disease.

scholarly journals Comprehensive arginine metabolomics and peripheral vasodilatory capacity in rheumatoid arthritis: a monocentric cross-sectional study.

2020 ◽  
Author(s):  
Gian Luca Erre ◽  
Arduino Aleksander Mangoni ◽  
Giuseppe Passiu ◽  
Stefania Bassu ◽  
Floriana Castagna ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Endothelial Dysfunction ◽  
Reactive Hyperemia ◽  
Cross Sectional Study ◽  
Peripheral Arterial Tonometry ◽  
Cross Sectional ◽  
Bivariate Correlation ◽  
Plasma Adma ◽  
Plasma Arginine ◽  
The Relationship

Abstract Background The relationship between plasma arginine metabolites influencing vascular homeostasis and peripheral vasodilatory capacity in rheumatoid arthritis (RA) patients is not known. Methods L-arginine (Arg), monomethyl-L-arginine (MMA), L-homoarginine (hArg), asymmetric dimethyl-L-arginine (ADMA), symmetric dimethyl-L-arginine, and L-citrulline (Cit) were measured by LC-MS/MS in 164 RA patients and 100 age- and sex-matched healthy controls without previous cardiovascular events. Log-transformed reactive hyperemia index (Ln-RHI) evaluated by peripheral arterial tonometry (PAT, EndoPAT2000 device) was assessed as surrogate measure of peripheral vasodilatory capacity in RA patients. Ln-RHI values <0.51 indicated peripheral endothelial dysfunction (ED). The relationship between plasma arginine metabolite concentrations, RA descriptors and peripheral vasodilatory capacity was evaluated by bivariate correlation and regression analyses. Results Plasma ADMA concentrations were significantly higher, and plasma hArg concentrations significantly lower, in RA patients than in controls (0.53 ± 0.09 vs 0.465 ± 0.07 μmol/L and 1.50 ± 0.60 vs 1.924 ± 0.78 μmol/L, respectively; p<0.001 for both comparisons). Bivariate correlation analysis demonstrated no significant correlation between arginine metabolites and disease descriptors. In regression analysis in RA patients, higher plasma ADMA concentrations were independently associated with presence of ED [OR(95%CI) = 77.3(1.478 - 4050.005), p =0.031] and lower Ln-RHI [B coefficient(95%CI) =-0.57(-1.09 to -0.05), p =0.032]. Conclusions ADMA was significantly, albeit weakly, associated with impaired microcirculatory vasodilatory capacity and peripheral endothelial dysfunction in RA. This suggests an important pathophysiological role of this metabolite in the vascular alterations observed in this patient group.

scholarly journals Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries. A peripheral arterial tonometry study

2015 ◽  
Vol 78 (1) ◽  
Author(s):  
Donatella Ruggiero ◽  
Gianluigi Savarese ◽  
Roberto Formisano ◽  
Ada Bologna ◽  
Giacomo Mattiello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Endothelial Dysfunction ◽  
Reactive Hyperemia ◽  
Diabetic Patients ◽  
Peripheral Arterial Tonometry ◽  
Arterial Tonometry ◽  
Digital Pulse ◽  
Peripheral Arterial ◽  
The Impact

Aim: to evaluate endothelial function (EF) in diabetic and non-diabetic patients without CAD by peripheral artery tonometry (PAT) technique. Methods: a cohort of 94 patients (55 men and 39 postmenopausal women; mean age 63±9 years) undergoing coronary angiography was divided into 2 groups: 58 patients with DM and (group 1) and 36 patients without DM. Endothelial dysfunction (ED) was assessed by digital pulse amplitude, using a fingertip peripheral arterial tonometry (PAT). As a measure of ED, reactive hyperemia index (RHI) was calculated as the ratio of the digital pulse volume during reactive hyperemia following 5 min ischemia and its basal value. Results: prevalence of cardiovascular risk factors was similar between the two groups. RHI values were significantly lower in diabetic patients compared to non-diabetics (1.72±0.34 vs 2.00±0.44; p&lt;0.005) and they correlated with levels of glycosylated hemoglobin (p=0.05; r=-0.266). Conclusion: despite similar level of other risk factors, EF was much more impaired in diabetic patients than in non-diabetics. These evidences further support the impact of DM on cardiovascular risk.

scholarly journals Impact of Peripheral Microvascular Endothelial Dysfunction on White Matter Hyperintensity

2021 ◽  
Author(s):  
Takumi Toya ◽  
Jaskanwal D. Sara ◽  
Eugene L. Scharf ◽  
Ali Ahmad ◽  
Valentina Nardi ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Reactive Hyperemia ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Hyperintensity ◽  
Intracranial Volume ◽  
Resonance Imaging ◽  
Peripheral Arterial Tonometry ◽  
Arterial Tonometry ◽  
Increased Risk ◽  
Peripheral Arterial

Background White matter hyperintensity (WMH), characterized by hyperintensities on T2‐weighted fluid‐attenuated inversion recovery brain magnetic resonance imaging, has been linked to an increased risk of ischemic stroke (IS). Endothelial dysfunction is an indicator of vascular dysfunction, predicting the risk of IS. This study aimed to investigate the association between endothelial dysfunction and regional WMH, and its impact on future risk of IS. Methods and Results We enrolled 219 patients (mean age, 53.1±14.1 years; 34.7% men) who underwent peripheral endothelial function assessment using reactive hyperemia peripheral arterial tonometry and brain magnetic resonance imaging without any history of IS. Volumetric WMH segmentation was automatically extrapolated using a validated automated digital tool. Total and juxtacortical WMH volume/intracranial volume (%) increased with aging and became more prominent in patients aged >50 years (n=131) than those aged ≤50 years (n=88) (total WMH: ≤50 years, Pearson r =0.24, P =0.03; >50 years, Pearson r =0.62, P <0.0001; juxtacortical WMH: ≤50 years, Pearson r =0.09, P =0.40; >50 years, Pearson r =0.55, P <0.0001). Reactive hyperemia peripheral arterial tonometry index was negatively associated with total and juxtacortical WMH volume/intracranial volume (%) in patients aged >50 years after adjustment for other covariates (reactive hyperemia peripheral arterial tonometry index, standardized β coefficient −0.17, P =0.04). Juxtacortical WMH volume/intracranial volume (%) was associated with an increased risk of IS during median follow‐up of 6.5 years (hazard ratio, 1.47; 95% CI, 1.05–1.92; P =0.03). Conclusions Peripheral endothelial dysfunction is associated with an increased volume of juxtacortical WMH in patients aged >50 years, which is a potential marker to predict future risk of IS.

Reactive hyperemia peripheral arterial tonometry as a measure of endothelial dysfunction in COPD

2017 ◽  
Author(s):  
Desiree Schumann ◽  
Andreas Scherr ◽  
Werner Strobel ◽  
Michael Zellweger ◽  
Michael Tamm ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Reactive Hyperemia ◽  
Peripheral Arterial Tonometry ◽  
Arterial Tonometry ◽  
Peripheral Arterial

scholarly journals Assessment of peripheral endothelial function predicts future risk of solid-tumor cancer

2019 ◽  
Vol 27 (6) ◽  
pp. 608-618 ◽  
Author(s):  
Takumi Toya ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Riad Taher ◽  
Shigeo Godo ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Confidence Interval ◽  
Solid Tumor ◽  
Reactive Hyperemia ◽  
Peripheral Arterial Tonometry ◽  
Arterial Tonometry ◽  
Future Risk ◽  
Microvascular Endothelial ◽  
Peripheral Arterial

Aims Cardiovascular health metrics predict the risk not only of cardiovascular diseases but also of several types of cancers. Microvascular endothelial dysfunction can predict future cardiovascular adverse events, but the predictive value of microvascular endothelial dysfunction for future risk of solid-tumor cancer has not been characterized. Methods A total of 488 patients who underwent microvascular endothelial function assessment using reactive hyperemia peripheral arterial tonometry were included in this study. Microvascular endothelial dysfunction was defined as a reactive hyperemia peripheral arterial tonometry index ≤2.0. Results Of 221 patients with a baseline reactive hyperemia peripheral arterial tonometry index ≤2.0, 21 patients (9.5%) were diagnosed with incident solid-tumor cancer during follow-up, whereas of 267 patients with a baseline reactive hyperemia peripheral arterial tonometry index >2.0, 10 patients (3.7%) were diagnosed with incident solid-tumor cancer during follow-up ( p = 0.009). Patients with a reactive hyperemia peripheral arterial tonometry index ≤2.0 had lower solid-tumor cancer-free survival compared to patients with a reactive hyperemia peripheral arterial tonometry index >2.0 (log-rank p = 0.017) (median follow-up 6.0 (3.0–9.1) years). Cox proportional hazard analyses showed that a reactive hyperemia peripheral arterial tonometry index ≤2.0 predicted the incidence of solid-tumor cancer, with a hazard ratio of 2.52 (95% confidence interval 1.17–5.45; p = 0.019) after adjusting for age, sex, and coronary artery disease, 2.83 (95% confidence interval 1.30–6.17; p = 0.009) after adjusting for diabetes mellitus, hypertension, smoking status, and body mass index >30 kg/m2, 2.79 (95% confidence interval 1.21–6.41; p = 0.016) after adjusting for fasting plasma glucose, systolic blood pressure, smoking status (current or former), and body mass index, and 2.43 (95% confidence interval 1.10–5.34; p = 0.028) after adjusting for Framingham risk score. Conclusion Microvascular endothelial dysfunction, as defined by a reactive hyperemia peripheral arterial tonometry index ≤2.0, was associated with a greater than two-fold increased risk of solid-tumor cancer. Microvascular endothelial dysfunction may be a useful marker to predict the future risk of solid-tumor cancer, in addition to its known ability to predict cardiovascular disease. Further research is necessary to develop adequate cancer screening strategies for patients with microvascular endothelial dysfunction.

scholarly journals Endothelial Dysfunction of Patients with Peripheral Arterial Disease Measured by Peripheral Arterial Tonometry

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Kimihiro Igari ◽  
Toshifumi Kudo ◽  
Takahiro Toyofuku ◽  
Yoshinori Inoue
Keyword(s):  
Endothelial Dysfunction ◽  
Peripheral Arterial Disease ◽  
Reactive Hyperemia ◽  
Univariate Analysis ◽  
Arterial Disease ◽  
Peripheral Arterial Tonometry ◽  
Reactive Hyperemia Index ◽  
Arterial Tonometry ◽  
History Of ◽  
Peripheral Arterial

Objective. Endothelial dysfunction plays a key role in atherosclerotic disease. Several methods have been reported to be useful for evaluating the endothelial dysfunction, and we investigated the endothelial dysfunction in patients with peripheral arterial disease (PAD) using peripheral arterial tonometry (PAT) test in this study. Furthermore, we examined the factors significantly correlated with PAT test.Methods. We performed PAT tests in 67 patients with PAD. In addition, we recorded the patients’ demographics, including comorbidities, and hemodynamical status, such as ankle brachial pressure index (ABI).Results. In a univariate analysis, the ABI value (r=0.271,P=0.029) and a history of cerebrovascular disease (r=0.208,P=0.143) were found to significantly correlate with PAT test, which calculated the reactive hyperemia index (RHI). In a multivariate analysis, only the ABI value significantly and independently correlated with RHI (β=0.254,P=0.041).Conclusion. This study showed a significant correlation between RHI and ABI. The PAT test is a useful tool for evaluating not only endothelial dysfunction but also the hemodynamical state in patients with PAD.

Predicting Severity of Coronary Artery Disease in Patients With Diabetes Using Endothelial Function Measured With Peripheral Arterial Tonometry: PROCEED Study

Angiology ◽  
2019 ◽  
Vol 70 (7) ◽  
pp. 613-620 ◽  
Author(s):  
Shreenidhi Venuraju ◽  
Anand Jeevarethinam ◽  
Vishal Shahil Mehta ◽  
Sherezade Ruano ◽  
Alain Dumo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Reactive Hyperemia ◽  
Peripheral Arterial Tonometry ◽  
Arterial Tonometry ◽  
Artery Disease ◽  
Peripheral Arterial

Endothelial dysfunction is common in patients with type 2 diabetes mellitus (T2DM) and is associated with atherosclerotic disease. This study aimed to determine prognostic factors for endothelial dysfunction and identify relationships between reactive hyperemia index (RHI) score, clinically relevant coronary artery disease (>50% stenosis), and major adverse cardiovascular events (MACEs) in patients with T2DM. Endothelial function was assessed using peripheral arterial tonometry and correlated with patient characteristics and cardiovascular outcomes during a median follow-up of 22.8 months. Among 235 patients with a median duration of T2DM of 13 years, mean (standard deviation) RHI score was 2.00 (0.76). Serum low- and high-density lipoprotein cholesterol levels positively ( P = .004) and negatively ( P = .02) predicted RHI score, respectively. Median coronary artery calcium (CAC) score was 109 Agatston units, but no correlation between CAC and RHI scores was observed. The RHI score did not predict the number or severity of coronary plaques identified using computed tomography coronary angiography. Additionally, there was no association between RHI score and the risk of an MACE during follow-up. Overall, endothelial function was not predictive of CAC score, extent, and severity of coronary plaque or MACEs and did not demonstrate utility in cardiovascular risk stratifying patients with T2DM.

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