EndoPAT – Case Studies
Dr. Steven Lamm on the Vitality of EndoPAT
Endothelial Dysfunction and the Preventative Approach to Cardiovascular Disease: An Interview with Mark C. Houston, MD, MS, ABAARM, FACP, FAHA, FASHDr Houston: The diagnosis of endothelial dysfunction is difficult to make just by looking at the patient’s phenotype. Even looking at their known risk factors, you can often be fooled. What you can say is that someone who comes in with obvious risk factors like obesity, smoking, diabetes, dyslipidemia, and/or hypertension, are likely to have endothelial dysfunction, but that does not always count when you do the test because there is a discrepancy.
We call it vascular translational medicine. What that means is two things. One, you can have a lot of risk factors and have normal endothelial function, or someone can walk in and he looks totally normal without any obvious risk factors and have very bad endothelial dysfunction.
The only way you can sort this out is to actually measure the endothelial dysfunction noninvasively. There are several machines that do it, but the one that has probably got the best sensitivity and specificity in the outcomes data is EndoPAT. EndoPAT is extremely accurate in defining ED, but also in predicting future cardiovascular events.
“EndoPAT is extremely accurate in defining ED, but also in predicting future cardiovascular events.” -Elaine M. Urbina, M.D., et alTo perform the EndoPAT test, calipers are put on both index fingers and a blood pressure cuff is placed over the arm. You occlude the brachial artery for 5 minutes, release it, and you get what is called a hyperemic response – hyperemic response to reclusion of the blood flow, That produces endogenous nitric oxide, and the artery will dilate dramatically if it is healthy.
Noninvasive Assessment of Subclinical Atherosclerosis in Children and Adolescents. A Scientific Statement From the American Heart Association (2009)
You compare the occluded arm with the control arm to see what the difference is. The more dilation you get, the healthier the artery is. but if you get a ratio that is below a certain level-we use 1.68 as a cutoff point between normal and abnormal-then you can find someone that is having endothelial dysfunction.