Flow‐dependent, endothelium‐mediated vasodilation was assessed using Endo‐PAT (Itamar Medical, Caesarea, Israel) as previously described.25 Endo‐PAT is a novel noninvasive and reproducible technique that measures changes in pulsatile arterial volume with a fingertip probe. Analysis of the pulse waveform allows for automated calculation of endothelial function in 1 arm, while the contralateral serves as a control. Endo‐PAT has been validated in adults to identify patients with coronary endothelial dysfunction with good sensitivity and specificity,28 and has been shown to be feasible and reproducible in adolescents.29
Endopat
Manufactured by Itamar Medical
Sourced in Israel
EndoPAT is a non-invasive medical device that measures endothelial function, which is an indicator of vascular health. The device uses finger-mounted probes to detect changes in blood volume that occur in the fingertip in response to a temporary blockage of blood flow. The data collected by EndoPAT is then analyzed to provide information about the function of the endothelium, the innermost layer of the blood vessels.
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Lab products found in correlation
32 protocols using endopat
1
Endothelial Function Assessment via Endo-PAT
2
Assessing Vascular Endothelial Function Using Endo-PAT
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Vascular function was then assessed as outlined by Faizi et al.32 (link) using the Endo-PAT® (Endo-PAT®, Itamar Medical Ltd., Caesarea, Israel), which examines the vasodilatory response (measured at the finger) to 5 min of circulatory occlusion. Similar to other flow-mediated techniques, the vascular response assessed by the Endo-PAT® has been shown to be related to coronary endothelial dysfunction33 (link). Forearm occlusion was chosen to allow for consistency as the majority of patients had at least one intravenous site in the antecubital space which might be moved during hospitalization. Pulse amplitude response to hyperemia (RHI) was automatically calculated using the Endo-PAT® proprietary algorithm34 (link),35 (link). Previous research has shown an RHI score of < 1.67 represents endothelial dysfunction33 (link),35 (link).
3
Evaluation of Endothelial Function
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The EndoPAT device (EndoPAT, Itamar Medical, Israel) was used according to manufacturer’s instructions except that the occlusion cuff was placed on the forearm rather than the upper arm for concurrent measurements of FMD. This technique has been used previously by our group (Nardone et al., 2020 (link), 2021 (link)). Briefly, two tonometry finger cuffs were placed on the index finger of each hand and pulse waveforms throughout each cardiac cycle and were relayed to the device and an automated algorithm quantified the reactive hyperemia index (RHI). The EndoPAT protocol consisted of 5 min of baseline measurement, 5 min of forearm occlusion ~50 mmHg over systolic blood pressure, and 5 min of reactive hyperemia. Since the RHI is not normally distributed (Hamburg and Benjamin, 2009 (link)), the software computed the natural logarithm of the RHI (Ln-RHI). The EndoPAT 2000 also calculated the augmentation index (AI), typically used as an indirect marker of systemic arterial stiffness, and calculated the AI at a normalized HR of 75 bpm, which serves to allow for comparisons across different populations and postures.
4
Evaluating Endothelial Function via RHI
5
Endothelial function assessment by EndoPAT
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Peripheral artery tonometry (EndoPAT, Itamar Medical, Israel) was used to measure digital vasodilator function. Digital pulse volume changes during reactive hyperemia were recorded in response to a 5-minute arterial occlusion, using a blood pressure (BP) cuff as per standardized methods [5 (link)]. A 5-minute baseline recording was performed, after which the BP cuff was rapidly inflated to a predetermined level (50 mm Hg above systolic BP, minimum of 200 mm Hg in adults and 50 mm Hg above systolic BP, no minimum for children) for 5 minutes. A further postocclusion phase was timed for another 5 minutes. The EndoPAT software calculates the RHI, which is the post- to preocclusion amplitude ratio, normalized to values obtained contemporaneously in the control arm. An abnormal ratio is defined by the manufacturer as RHI <1.67 [16 (link)]. EndoPAT was performed at 3 time-points; enrollment, defervescence/hospital discharge, and follow-up.
6
Noninvasive Measurement of Microvascular Endothelial Function
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Peripheral microvascular endothelial function can be noninvasively measured at the distal phalanx of the index fingers with Endo-PAT (Itamar Medical Ltd). This involves a plethysmographic evaluation of small arterial pulsatile changes on the fingertip at rest and during reactive hyperaemia after 5 min. of forearm ischemia by means of inflating and deflating a forearm blood pressure cuff. Measurements will be done following recommendations of Bruyndonckx et al. [3 (link)].
7
Endothelial Function Assessment via RH-PAT
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Vascular endothelial function was examined using RH‐PAT (EndoPAT; Itamar Medical, Caesarea, Israel), as previously described (Kuvin et al., 2003 ). Briefly, patients could drink only water before the examination and stopped taking drugs, and did not take a bath or exercise on the morning of the test. During measurement, patients stayed in bed for 15 min under a steady environment to relax, representing no noise and comfortable temperature. The left arm was used as control, while the right arm was used as the test side. Measurement comprised a 5‐min baseline recording, 5 min of right brachial artery occlusion, and 5 min of RHI measurement. Brachial artery occlusion was performed using a sphygmomanometer cuff inflated to at least 60 mmHg over the systolic blood pressure of the patient. All analyses were performed in strict accordance with the instructions from the manufacturer.
General information and medical history of subjects such as age, sex, height, weight, blood pressure, smoking history, and serum hemoglobin (Hb) A1c level were collected from the medical records.
General information and medical history of subjects such as age, sex, height, weight, blood pressure, smoking history, and serum hemoglobin (Hb) A1c level were collected from the medical records.
8
Reactive Hyperemia Index Measurement
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A commercially available peripheral tonometer was utilized to detect changes in digital pulse volume during reactive hyperemia (EndoPAT, model 2000; Itamar Medical, Ltd., Caesarea, Israel)8 (link). Participants were fasting, and had avoided caffeine and tobacco for at least 2 h prior to the test. Tests were conducted between 07.00 and 12.00.
Testing was performed in a quiet room with participants in the supine position and covered with a light blanket. A blood pressure cuff was placed on the non-dominant upper arm while detection probes were placed on the index finger of each hand. Readings in both fingers were obtained for 10 min. The blood pressure cuff in the non-dominant arm was then inflated to 200 mmHg to occlude flow for 5 min, after which the pressure cuff was deflated and recordings continued for an additional 10 min. Only tests which were indicative of good arterial occlusion and test quality were used for analyses.
The RHI was calculated by dedicated software in the system computer as the average amplitude of the peripheral arterial tonometric signal over a 1-min interval beginning within 90 s after cuff deflation divided by the mean amplitude of the 1–3.5-min period before cuff deflation and then normalized to those values of the dominant arm8 (link). RHI was determined prior to MHT randomization (baseline) and annually thereafter for 4 years.
Testing was performed in a quiet room with participants in the supine position and covered with a light blanket. A blood pressure cuff was placed on the non-dominant upper arm while detection probes were placed on the index finger of each hand. Readings in both fingers were obtained for 10 min. The blood pressure cuff in the non-dominant arm was then inflated to 200 mmHg to occlude flow for 5 min, after which the pressure cuff was deflated and recordings continued for an additional 10 min. Only tests which were indicative of good arterial occlusion and test quality were used for analyses.
The RHI was calculated by dedicated software in the system computer as the average amplitude of the peripheral arterial tonometric signal over a 1-min interval beginning within 90 s after cuff deflation divided by the mean amplitude of the 1–3.5-min period before cuff deflation and then normalized to those values of the dominant arm8 (link). RHI was determined prior to MHT randomization (baseline) and annually thereafter for 4 years.
9
Peripheral Arterial Endothelial Function Assessment
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Pulse wave amplitude will be measured by using a finger plethysmograph (peripheral arterial tonometry) by using the EndoPAT device from Itamar Medical. Briefly explained, both index fingers of the patient are placed in the pneumatic probes. First, the device performs 5 min of baseline measurement and thereafter a blood pressure cuff occludes the arterial flow of the arm for 5 min. After a rapid deflation of the cuff, a reactive hyperaemia takes place, which is a measure for the arterial endothelial function. There is a concomitant software package. Children on growth hormone treatment will be excluded for the test with the EndoPAT, since this drug influences the test result.25 (link) If there is an infection ongoing, the examination will be postponed for 2 weeks. Since taking a blood sample can influence the test results as well, the blood sample will be done after the test with the EndoPAT device.25 (link)
10
Non-invasive Assessment of Vascular Function
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