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14-04-2010 | Cardiology | Article

Fingertip hyperemia test can predict ischemic heart disease in women

Abstract

Free abstract

MedWire News: Endothelial dysfunction determined by digital reactive hyperemia peripheral arterial tonometry (RH-PAT) can predict ischemic heart disease in women, Japanese researchers report.

Their study of 140 women referred for investigation of chest pain also found that RH-PAT was superior to the Reynolds Risk Score at predicting nonobstructive coronary artery disease (CAD) specifically.

“In other words, noninvasive measurement of RH-PAT can predict patients with ischemic heart disease, including nonobstructive CAD, before angiography,” comment Seigo Sugiyama, from Kumamoto University, and colleagues.

The study participants underwent RH-PAT measurement before undergoing cardiac catheterization to establish presence or absence of CAD; nonobstructive CAD was diagnosed by angiography with measurement of coronary blood flow and cardiac lactate production during acetylcholine provocation and cardiac scintigraphy during stress testing.

As reported in the Journal of the American College of Cardiology, Sugiyama and team found that RH-PAT indices were significantly attenuated in 68 women found to have obstructive CAD and in 42 with nonobstructive CAD compared with the remainder without ischemic heart disease. The respective median RH-PAT indices were 1.57 and 1.58 versus 2.15 (p<0.001).

Only RH-PAT was independently associated with ischemic heart disease in multivariable analysis including the Reynolds Risk Score (odds ratio=1.51).

Receiver-operating characteristic curve analysis showed that RH-PAT was a significant predictor of ischemic heart disease, including both obstructive and nonobstructive CAD, with an area under the curve (AUC) of 0.86 (p<0.001).

But after excluding presence of obstructive CAD, only RH-PAT index could predict nonobstructive CAD (AUC=0.85, p<0.001) whereas the Reynolds Risk Score did not (AUC=0.59, p=nonsignificant).

“RH-PAT is a potentially useful clinical test and can effectively help to identify high-risk women with chest pain,” the authors conclude.

RH-PAT has potential for wide clinical application if found to predict risk of future cardiac events, according to editorialists John Keaney and Bill Lian, from University of Massachusetts in Worcester, USA.

“Continued investigation will be needed to extend the findings of the current study to more diverse populations and provide the necessary linkage to clinical outcomes,” they wrote.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Caroline Price

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