Endopat 2000

Manufactured by Itamar Medical

Sourced in Israel, United States

The EndoPAT 2000 is a non-invasive diagnostic device designed to measure endothelial function, a key indicator of cardiovascular health. The device uses plethysmography to detect changes in arterial pulsatile volume, providing a measure of endothelial function.

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Lab products found in correlation

Computerized algorithm, by Itamar Medical (2 mentions) Computerised automated algorithm, by Itamar Medical (2 mentions) Disposable fingertip probes, by Itamar Medical (2 mentions) Sphygmocor, by AtCor Medical (1 mentions) Hem 907xl device, by Omron (1 mentions) Sphygmocor cp, by AtCor Medical (1 mentions) Sequoia 512, by Siemens (1 mentions) Endopat, by Itamar Medical (1 mentions) Sphygmocor device, by AtCor Medical (1 mentions) Elisa, by Mercodia (1 mentions)

147 protocols using endopat 2000

Comprehensive Endothelial Function Assessment

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We used a comprehensive approach to study the endothelial-function with physiological and laboratory assessments. All tests were performed blinded to mutation status:
1. The Endo-PAT2000 (Itamar Medical Ltd, Keisariya, Israel) - Endo-PAT2000 is a non-invasive device that measures changes in PAT (Peripheral Arterial Tone) before and after hyperemic response (occluding blood flow through the brachial artery for 5 minutes using an inflatable cuff) [41 ]. PAT change ratio is normalized to measurements from the contra-lateral arm, which serves as control for non-endothelial dependent systemic effects. The normalized value is termed reactive hyperemia index (RHI) [42 (link)]. RHI measure was shown to reflect NO-bioavailability and to correlate with endothelial vasodilator function in coronary artery [43 (link), 44 (link)]. RHI value is reduced in patients with established cardiovascular disease and considered to be a predictor for cardiovascular clinical outcomes [45 , 46 (link)].
2. Endothelial Progenitor Cells (EPCs) - are early stem cells that play an important role in the regeneration of the endothelial lining of blood vessels.

Witberg G., Lev E., Ber Y., Tabachnik T., Sela S., Belo I., Leshem-Lev D, & Margel D. (2019). Vascular endothelium function among male carriers of BRCA 1&2 germline mutation. Oncotarget, 10(49), 5041-5051.

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Gait Speed and Endothelial Function in ACS

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Before discharge, all patients were enrolled in a cardiac rehabilitation program during their hospitalization in accordance with the Japanese Cardiovascular Society guidelines for the rehabilitation of patients with ACS⁸⁾, as part of which their gait speed, one of the components defining frailty, was evaluated as a measure of frailty^{13
,
14)}. Patients were instructed to take a 200- or 500-m walk—at their usual pace without overexertion—in a wide hallway on a 50-m course during the daytime. Concomitantly, a trained physical therapist used a digital stopwatch to measure the patient’s gait speed. Participants who normally use canes and walkers in their daily lives were permitted to use them for the frailty evaluation. Data on gait speed was available in 83.9% of patients (n=344). Peripheral endothelial function was assessed by reactive hyperemia-peripheral arterial tonometry (RH-PAT)^{15
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17)} using EndoPAT2000 (Itamar Medical, Caesarea, Israel) just before discharge. Patients underwent RH-PAT in a fasting state, early in the morning, and prior to medication intake. RH-PAT data were automatically analyzed online in an operator-independent manner using the EndoPAT2000 software (Itamar Medical, Caesarea, Israel). The logarithmic value of the reactive hyperemia index was used in the abovementioned analyses, as previously described¹⁸⁾.

Sato R., Matsuzawa Y., Yoshii T., Akiyama E., Konishi M., Nakahashi H., Minamimoto Y., Kimura Y., Okada K., Maejima N., Iwahashi N., Kosuge M., Ebina T., Kimura K., Tamura K, & Hibi K. (2023). Impact of Low-Density Lipoprotein Cholesterol Levels at Acute Coronary Syndrome Admission on Long-Term Clinical Outcomes. Journal of Atherosclerosis and Thrombosis, 31(4), 444-460.

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Endothelial Function Evaluation via RH-PAT

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Peripheral endothelial function will be evaluated by RH-PAT using an Endo-PAT2000 device (Itamar Medical, Caesarea, Israel). RH-PAT principles and procedures have been described elsewhere [35 (link)–37 (link)]. In brief, the measurements will be performed in the mornings at baseline and at 24 wks in a quiet, light- and temperature-controlled room. The patients will be fasted and in stable condition before taking their daily medication. A BP cuff will be placed on the upper arm of the patient and the opposite arm will serve as a control. The PAT probes will be placed on one finger of each hand. The patient will be allowed to rest for ≥ 15-min on a bed in a supine position and his or her baseline pulse amplitude will be recorded from each fingertip for 6 min. The BP cuff will be inflated to 60 mmHg above systolic BP or to 200 mmHg for 5 min. The cuff will then be deflated and the pulse amplitude will be recorded for 5 min. The RHI will be automatically calculated in an operator-independent manner by a computerized algorithm. The augmentation index (AI), heart rate variability (HRV), standard deviation of the normal to normal intervals (SDNN), and the ratio of low-to high-frequency (LF/HF) will be automatically calculated using Endo-PAT2000 software (v. 3.4.4; Itamar Medical, Caesarea, Israel).

Tanaka A., Shimabukuro M., Okada Y., Sugimoto K., Kurozumi A., Torimoto K., Hirai H, & Node K. (2020). Rationale and design of an investigator-initiated, multicenter, prospective open-label, randomized trial to evaluate the effect of ipragliflozin on endothelial dysfunction in type 2 diabetes and chronic kidney disease: the PROCEED trial. Cardiovascular Diabetology, 19, 85.

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Endothelial Function Assessment with Endo-PAT

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Endo-PAT2000 was obtained from Itamar Medical Ltd, Israel. Endo-Pat was performed at baseline and at 24 hours following the clamp study. All tests were performed by the same operator, with the subject in the fasting state, and in a quiet and temperature-controlled room (23 °C) with the participant relaxed in a semi-recumbent position. Probes were placed on the index finger of each arm to measure peripheral arterial tone (PAT). PAT was recorded in both arms for the duration of the test. After 5 minutes of rest (baseline), the blood pressure cuff was inflated to 220–230 mmHg to stop the blood supply in the study arm for 5 minutes, and then deflated to release the blood supply for a further 5 minutes. A reactive hyperemic index (RHI) is a measure of the change in PAT in the study arm after occlusion compared to baseline, and adjusted for changes in the control arm. Bonetti et al.^{28 (link)} reported that a measurement of RHI lower than the cut-off value of 1.67 provides a sensitivity of 82% and a specificity of 77% in diagnosing coronary endothelial dysfunction. Endo-PAT reproducibility was within acceptable limits, ICC = 0.74, and coefficient of variation 12 ± 2.2%^{29 (link)}.

Kahal H., Halama A., Aburima A., Bhagwat A.M., Butler A.E., Graumann J., Suhre K., Sathyapalan T, & Atkin S.L. (2020). Effect of induced hypoglycemia on inflammation and oxidative stress in type 2 diabetes and control subjects. Scientific Reports, 10, 4750.

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Assessing Endothelial Function via Peripheral Arterial Tonometry

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Endothelial function was assessed via peripheral arterial tonometry, which is a non-invasive method, using the EndoPAT 2000 device (Itamar Medical Ltd., Caesarea, Israel). Two flexible probes were placed on the index fingers of both hands along with inflatable cuffs and plethysmographic biosensors. The baseline data of the two sides were collected after resting for 30 min.[12] (link) Then, cuff occlusion in the left forearm lasted for 5 min, which resulted in transitory ischemia. All data of both fingers were recorded in the process of occlusion and post-occlusion. In the course, the parameter of RHI was calculated via an automated analysis. Thus, an RHI ≥ 1.67 indicated a normal vascular endothelial function, whereas an RHI < 1.67 represented an abnormal vascular endothelial function.[13] (link)

Zhu G.H., Sun X.P., Li J., Liu R.K., Yang Z, & Hua Q. (2020). Association between serum uric acid level and endothelial dysfunction in elderly individuals with untreated mild hypertension. Journal of Geriatric Cardiology : JGC, 17(5), 264-269.

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Endothelial Function Assessment via Reactive Hyperemia

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Study members’ endothelial function was assessed in the morning in the non-fasting state after lying supine for 10 minutes in a temperature controlled room at 20°C. A PAT device was placed on the index finger of each hand (Endo-PAT2000, Itamar Medical Ltd, Caesarea, Israel). A blood pressure cuff was placed on the right upper arm and baseline measurements obtained over two minutes. The blood pressure cuff was then inflated to 200 mm Hg or 60 mm Hg above systolic blood pressure, whichever was higher and occlusion of flow was confirmed. After 5 minutes the cuff was deflated and recording continued for five minutes. Pulse amplitude was recorded from both fingers and analyzed by a computerized, automated algorithm (Itamar Medical) that provided the average pulse amplitude for each 30-second interval after forearm cuff deflation up to 5 minutes. PAT measured the digital pulse volume after reactive hyperemia induced by brachial artery occlusion and the ratio of hyperaemic to baseline pulse amplitudes was calculated as the Framingham-reactive hyperemia index (F-RHI). F-RHI was defined as F-RHI = ln(RHo/RHc), where RHo and RHc are the mean pulse amplitudes of the period between 90 and 120 seconds after cuff deflation divided by mean baseline amplitudes in the occluded arm and control arm, respectively.^{19 (link)} Lower values of the F-RHI are indicative of impaired endothelial function.

Williams M.J., Milne B.J., Ambler A., Theodore R., Ramrakha S., Caspi A., Moffitt T.E, & Poulton R. (2017). Childhood body mass index and endothelial dysfunction evaluated by peripheral arterial tonometry in early midlife: Childhood body mass index and endothelial function. International journal of obesity (2005), 41(9), 1355-1360.

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Endothelial Function Assessment by Peripheral Arterial Tonometry

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The endothelial function was measured by PAT using an EndoPAT 2000 device (Itamar Medical Ltd., Caesarea, Israel), which assessed the RHI as a measure of the microvascular endothelial function. Patients refrained from smoking, drinking caffeine-containing beverages, and eating for 12 hours before the PAT measurement. The patients also discontinued all drugs for 18 hours before the measurement and any food for 12 hours before the measurement.
The patients were placed in a supine position with a specially designed finger probe on the index finger of each hand and a pressure cuff on one upper arm in a quiet room at a constant temperature of 20°C. After continuous recording of the PAT signal from both fingers during a 10-minute baseline period, the blood pressure cuff on the study arm was inflated to suprasystolic pressure for 5 minutes. The inflated cuff was then deflated, and recording of the PAT signal continued for 10 minutes. The pressure changes reflecting the pulse amplitude both before the inflation of cuff and after the deflation were transmitted to a computer, and the RHI was calculated automatically [12 (link)].

Igari K., Kudo T., Toyofuku T, & Inoue Y. (2016). Endothelial Dysfunction of Patients with Peripheral Arterial Disease Measured by Peripheral Arterial Tonometry. International Journal of Vascular Medicine, 2016, 3805380.

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Peripheral Arterial Tonometry for Vascular Function

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Digital pulse amplitude was measured at a single visit per participant as previously described in detail.^{5 (link)} Briefly, using a peripheral arterial tonometry device on the tip of each index finger (Endo-PAT2000, Itamar Medical, Caesarea, Israel) pulse volume changes were electronically measured and expressed as pulse amplitude. Baseline pulse amplitude, or resting pulsatility, was measured in the fingertips of both hands for 2 minutes and 20 seconds. Ischemia was induced by an inflated forearm cuff on one arm for 5 minutes. The hyperemic response was determined by the ratio of the post-deflation pulse amplitude (90-120 seconds after deflation) to the baseline pulse amplitude of the same finger divided by the ratio of the pulse amplitude measured in the control finger during the same interval to the baseline pulse amplitude of the control finger. For analyses, the natural logarithm of the mean of baseline pulse amplitudes from each finger was used. Likewise the hyperemic response was transformed such that peripheral arterial tonometry ratio= log_e[(X_ht90-t120/X_ht0)/(X_ct90-t120/X_ct0)] with X denoting pulse amplitude, h denoting hyperemic finger, t denoting time interval, 0 denoting baseline, and c denoting control finger.

Ljungman P.L., Wilker E.H., Rice M.B., Austin E., Schwartz J., Gold D.R., Koutrakis P., Benjamin E.J., Vita J.A., Mitchell G.F., Vasan R.S., Hamburg N.M, & Mittleman M.A. (2016). The Impact of Multi-pollutant Clusters on the Association between Fine Particulate Air Pollution and Microvascular Function. Epidemiology (Cambridge, Mass.), 27(2), 194-201.

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Peripheral Endothelial Function Assessment

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In the sub-study, we assessed peripheral endothelial function by RH-PAT using an EndoPAT2000 (Itamar Medical, Caesarea, Israel), as described previously [13 (link)]. RH-PAT was performed at baseline and after 3 months of treatment to calculate the reactive hyperemia index (RHI), which reflects the extent of reactive hyperemia, and thereby, endothelial function. It was calculated as the ratio of the average amplitude of the PAT signal over 1 min starting at 1.5 min after cuff deflation (control arm, A; occluded arm, C) divided by the average amplitude of the PAT signal of a 2.5-min time period before cuff inflation (baseline) (control arm, B; occluded arm, D), as follows: RHI = (C/D)/(A/B).

Nakamura T., Iwanaga Y., Miyaji Y., Nohara R., Ishimura T, & Miyazaki S. (2016). Cardiovascular efficacy of sitagliptin in patients with diabetes at high risk of cardiovascular disease: a 12-month follow-up. Cardiovascular Diabetology, 15, 54.

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Vascular Function Assessment Protocol

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Arterial stiffness was investigated using noninvasive tests in a temperature-controlled room, with the subject resting in supine position. The carotid–femoral PWV was measured by specifically trained staff using applanation tonometry (SphygmoCor; AtCor Medical, Sydney, Australia) at the carotid and radial arteries to record the pressure waveforms peripherally. The correlation between PWV and arterial distensibility is based on the calculation of the speed of the propagation of transverse elastic waves. By applying the integral software, the aortic augmentation index (AIx; the quotient of amplification pressure on pulse pressure expressed as a percentage) was calculated. Quality control checks were made for all measurements to discharge measurements in which the onset of the waveform was not clearly identified.
The endothelial dysfunction was evaluated using the EndoPAT 2000 (Itamar Medical, Columbia, SC, USA), which measures the change in brachial artery diameter in response to reactive hyperaemia after an overnight fast. The hyperaemia was induced by deflating a cuff placed around the forearm that had been inflated for 5 min; the reactive hyperaemia response was calculated automatically by the instrument, thus providing the reactive hyperaemia index (RHI), which was recorded for the analysis.

Scichilone N., Tuttolomondo A., Maida C., Benfante A., Peluso J., Cirrincione A., Vassallo V, & Pinto A. (2017). Arterial stiffness in symptomatic smokers with normal lung function. ERJ Open Research, 3(3), 00037-2017.

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