Test-retest Reliability of Pulse Amplitude Tonometry Measures of Vascular Endothelial Function: Implications for Clinical Trial Design

Overview

Journal Vasc Med

Publisher Sage Publications

Specialty Cardiology & Vascular Diseases

Date 2012 Feb 25

PMID 22363016

Citations 48

Authors

Cindy E McCrea

Ann C Skulas-Ray

Mosuk Chow

Sheila G West

Affiliations

Soon will be listed here.

Abstract

Endothelial dysfunction is an important outcome for assessing vascular health in intervention studies. However, reliability of the standard non-invasive method (flow-mediated dilation) is a significant challenge for clinical applications and multicenter trials. We evaluated the repeatability of pulse amplitude tonometry (PAT) to measure change in pulse wave amplitude during reactive hyperemia (Itamar Medical Ltd, Caesarea, Israel). Twenty healthy adults completed two PAT tests (mean interval = 19.5 days) under standardized conditions. PAT-derived measures of endothelial function (reactive hyperemia index, RHI) and arterial stiffness (augmentation index, AI) showed strong repeatability (intra-class correlations = 0.74 and 0.83, respectively). To guide future research, we also analyzed sample size requirements for a range of effect sizes. A crossover design powered at 0.90 requires 28 participants to detect a 15% change in RHI. Our study is the first to show that PAT measurements are repeatable in adults over an interval greater than 1 week.

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References

Brook R, Yalavarthi S, Myles J, Khalatbari S, Hench R, Lustig S . Determinants of vascular function in patients with chronic gout. J Clin Hypertens (Greenwich). 2011; 13(3):178-88. PMC: 3076024. DOI: 10.1111/j.1751-7176.2010.00406.x. View

Kim J, Paik J, Kim O, Park H, Lee J, Jang Y . Effects of lycopene supplementation on oxidative stress and markers of endothelial function in healthy men. Atherosclerosis. 2011; 215(1):189-95. DOI: 10.1016/j.atherosclerosis.2010.11.036. View

Maki-Petaja K, Booth A, Hall F, Wallace S, Brown J, Mceniery C . Ezetimibe and simvastatin reduce inflammation, disease activity, and aortic stiffness and improve endothelial function in rheumatoid arthritis. J Am Coll Cardiol. 2007; 50(9):852-8. DOI: 10.1016/j.jacc.2007.04.076. View

Franzini L, Ardigo D, Valtuena S, Pellegrini N, Del Rio D, Bianchi M . Food selection based on high total antioxidant capacity improves endothelial function in a low cardiovascular risk population. Nutr Metab Cardiovasc Dis. 2010; 22(1):50-7. DOI: 10.1016/j.numecd.2010.04.001. View

Heffernan K, Patvardhan E, Hession M, Ruan J, Karas R, Kuvin J . Elevated augmentation index derived from peripheral arterial tonometry is associated with abnormal ventricular-vascular coupling. Clin Physiol Funct Imaging. 2010; 30(5):313-317. PMC: 3148895. DOI: 10.1111/j.1475-097X.2010.00943.x. View

Shah A, Dolan L, Gao Z, Kimball T, Urbina E . Clustering of risk factors: a simple method of detecting cardiovascular disease in youth. Pediatrics. 2011; 127(2):e312-8. PMC: 3025419. DOI: 10.1542/peds.2010-1125. View

Haller M, Stein J, Shuster J, Theriaque D, Silverstein J, Schatz D . Peripheral artery tonometry demonstrates altered endothelial function in children with type 1 diabetes. Pediatr Diabetes. 2007; 8(4):193-8. DOI: 10.1111/j.1399-5448.2007.00246.x. View

Haller M, Silverstein J, Shuster J . Correlation between radial artery tonometry- and fingertip tonometry-derived augmentation index in children with type 1 diabetes. Diab Vasc Dis Res. 2007; 4(1):66. DOI: 10.3132/dvdr.2007.011. View

Tousoulis D, Ntarladimas I, Antoniades C, Vasiliadou C, Tentolouris C, Papageorgiou N . Acute effects of different alcoholic beverages on vascular endothelium, inflammatory markers and thrombosis fibrinolysis system. Clin Nutr. 2008; 27(4):594-600. DOI: 10.1016/j.clnu.2008.01.002. View

10.

Lantelme P, Mestre C, Lievre M, Gressard A, Milon H . Heart rate: an important confounder of pulse wave velocity assessment. Hypertension. 2002; 39(6):1083-7. DOI: 10.1161/01.hyp.0000019132.41066.95. View

11.

George J, Carr E, Davies J, Belch J, Struthers A . High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation. 2006; 114(23):2508-16. DOI: 10.1161/CIRCULATIONAHA.106.651117. View

12.

Bonetti P, Barsness G, Keelan P, Schnell T, Pumper G, Kuvin J . Enhanced external counterpulsation improves endothelial function in patients with symptomatic coronary artery disease. J Am Coll Cardiol. 2003; 41(10):1761-8. DOI: 10.1016/s0735-1097(03)00329-2. View

13.

Otto M, Svatikova A, Barretto R, Santos S, Hoffmann M, Khandheria B . Early morning attenuation of endothelial function in healthy humans. Circulation. 2004; 109(21):2507-10. DOI: 10.1161/01.CIR.0000128207.26863.C4. View

14.

Chenevard R, Hurlimann D, Bechir M, Enseleit F, Spieker L, Hermann M . Selective COX-2 inhibition improves endothelial function in coronary artery disease. Circulation. 2003; 107(3):405-9. DOI: 10.1161/01.cir.0000051361.69808.3a. View

15.

West S, Wagner P, Schoemer S, Hecker K, Hurston K, Likos Krick A . Biological correlates of day-to-day variation in flow-mediated dilation in individuals with Type 2 diabetes: a study of test-retest reliability. Diabetologia. 2004; 47(9):1625-31. DOI: 10.1007/s00125-004-1502-8. View

16.

Kuvin J, Mammen A, Mooney P, Alsheikh-Ali A, Karas R . Assessment of peripheral vascular endothelial function in the ambulatory setting. Vasc Med. 2007; 12(1):13-6. DOI: 10.1177/1358863X06076227. View

17.

Thijssen D, Black M, Pyke K, Padilla J, Atkinson G, Harris R . Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. Am J Physiol Heart Circ Physiol. 2010; 300(1):H2-12. PMC: 3023245. DOI: 10.1152/ajpheart.00471.2010. View

18.

Nohria A, Gerhard-Herman M, Creager M, Hurley S, Mitra D, Ganz P . Role of nitric oxide in the regulation of digital pulse volume amplitude in humans. J Appl Physiol (1985). 2006; 101(2):545-8. DOI: 10.1152/japplphysiol.01285.2005. View

19.

Berry S, Tucker S, Banerji R, Jiang B, Chowienczyk P, Charles S . Impaired postprandial endothelial function depends on the type of fat consumed by healthy men. J Nutr. 2008; 138(10):1910-4. DOI: 10.1093/jn/138.10.1910. View

20.

Widlansky M, Vita J, Keyes M, Larson M, Hamburg N, Levy D . Relation of season and temperature to endothelium-dependent flow-mediated vasodilation in subjects without clinical evidence of cardiovascular disease (from the Framingham Heart Study). Am J Cardiol. 2007; 100(3):518-23. PMC: 1994775. DOI: 10.1016/j.amjcard.2007.03.055. View