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Reproducibility of peripheral arterial tonometry for the assessment of endothelial function in adults

Brant, Luisa C.C.a,b; Barreto, Sandhi M.a,b; Passos, Valéria M.A.a,b; Ribeiro, Antônio L.P.a,b

doi: 10.1097/HJH.0b013e328362d913

Objectives: Endothelial dysfunction is associated to cardiovascular risk factors and predicts cardiovascular events. Peripheral arterial tonometry (PAT) is a novel noninvasive method to assess endothelial function. However, there is a paucity of data about its reproducibility. The aim of this study was to assess the feasibility and reproducibility of PAT in adults.

Methods: PAT exams were performed twice in the same day in 123 participants of a cohort about the determinants of diabetes and cardiovascular diseases (Brazilian Longitudinal Study of Adult Health – ELSA-Brasil). The interval between the exams was 2–6 h (mean = 4 h). Endothelial function in PAT method is measured by reactive hyperemia index (RHI), which evaluates arterial pulsatile volume changes in response to hyperemia. Agreement of RHI values was compared by Bland–Altman method, coefficient of variation and coefficient of repeatability. Reliability was assessed by intraclass correlation coefficient (ICC).

Results: Mean values of RHI did not differ significantly between the exams of each participant (1.92 ± 0.56 vs. 1.96 ± 0.58, P = 0.48). There were no systematic errors between the exams (mean of differences = −0.03 ± 0.5). Measurement error was 0.35, coefficient of variation was 18.0% and ICC was 0.61. Sex, age or the presence of obesity did not have a considerable influence on the reproducibility of PAT.

Conclusion: PAT exam is feasible and has acceptable reproducibility in adults when compared with other noninvasive methods for endothelial function assessment. This performance makes PAT a promising method for future clinical and epidemiological studies.

aBrazilian Longitudinal Study of Adult Health, ELSA-Brasil

bHospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Correspondence to Antonio L.P. Ribeiro, MD, PhD, Rua Campanha, 98/101, 30310-770, Belo Horizonte, MG, Brazil. Tel: +55 31 32879213; fax: +55 31 32847298; e-mail:

Abbreviations: BPA, baseline pulse amplitude; ELSA-Brasil, Brazilian Longitudinal Study of Adult Health; FMD, flow-mediated dilation of the brachial artery; HR, heart rate; ICC, intraclass correlation coefficient; NO, nitric oxide; PAT, peripheral arterial tonometry; RHI, reactive hyperemia index

Received 13 November, 2012

Revised 13 February, 2013

Accepted 2 May, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins