Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events

Ronen Rubinshtein, Jeffrey T. Kuvin, Morgan Soffler, Ryan J. Lennon, Shahar Lavi, Rebecca E. Nelson, Geralyn M. Pumper, Lilach O. Lerman, Amir Lerman

Research output: Contribution to journalArticlepeer-review

475 Scopus citations


Aims: There is growing need for the identification of novel non-invasive methodologies for the identification of individuals at risk for adverse cardiovascular (CV) events. We examined whether endothelial dysfunction, as detected by non-invasive peripheral arterial tonometry (EndoPAT), can predict late CV events.Methods and resultsReactive hyperaemia (RH) was induced following upper arm occlusion of systolic blood pressure in 270 outpatients (54 ± 12 years, 48 female). The natural logarithmic scaled RH index (LRHI) was calculated from the ratio between the digital pulse volume during RH and at baseline. The patients were followed for CV adverse events (AE: cardiac death, myocardial infarction, revascularization or cardiac hospitalization) during a 7-year follow-up (inter-quartile range = 4.4-8). Cox models were used to estimate the association of EndoPAT results with AE adjusted for age. During the follow-up, AE occurred in 86 patients (31). Seven-year AE rate was 48 in patients with LRHI < 0.4 vs. 28 in those with LRHI ≥ 0.4 (P = 0.03). Additional univariate predictors of AE were advancing age (P = 0.02) and prior coronary bypass surgery (P = 0.01). The traditional Framingham risk score was not higher in patients with AE. Multivariate analysis identified LRHI < 0.4 as an independent predictor of AE (P = 0.03).ConclusionA low RH signal detected by EndoPAT, consistent with endothelial dysfunction, was associated with higher AE rate during follow-up. LRHI was an independent predictor of AE. Non-invasive assessment of peripheral vascular function may be useful for the identification of patients at risk for cardiac AEs.

Original languageEnglish (US)
Pages (from-to)1142-1148
Number of pages7
JournalEuropean heart journal
Issue number9
StatePublished - May 2010


  • Endothelial function
  • Outcome
  • Peripheral arterial tonometry
  • Reactive hyperaemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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