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A controlled comparison of brachial artery flow mediated dilation (FMD) and digital pulse amplitude tonometry (PAT) in the assessment of endothelial function in systemic lupus erythematosus

Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York 10021 AizerJ{at}hss.edu

EW Karlson

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

LB Chibnik

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

KH Costenbader

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

D Post

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

MH Liang

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

V Gall

Division of Rheumatology, Immunology and Allergy, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

MD Gerhard-Herman

Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115

The utility of flow mediated dilation (FMD) a measure of endothelial function is limited by operator dependence. Pulse amplitude tonometry (PAT) is a novel, less operator-dependent technique to assess endothelial function. This study compares PAT to FMD in SLE and controls. Thirty women with SLE and 31 controls were enrolled. Medications, cardiovascular disease and risk factors, SLE activity (SLAM-R) and damage (SLICC-DI) were recorded. FMD and PAT were performed simultaneously. Endothelium-independent function was assessed with nitroglycerin. Average age was 48.3 ± 10.1 years, SLE duration 16.2 years, SLAM-R 8.3 and SLICC-DI 1.0. Framingham Risk Scores were 2% in most subjects. There were no differences between SLE cases and controls in FMD, PAT or response to nitroglycerin. This study found no association between FMD and PAT in SLE or controls. In the 17 SLE cases with a history of Raynaud’s, correlation between FMD and PAT was 0.50 (P = 0.04). There was no difference in endothelial function assessed by FMD or PAT in SLE cases versus controls. FMD did not correlate with PAT except in SLE cases with a history of Raynaud’s. Correlation between FMD and PAT may be stronger in populations with greater variation in endothelial function and more cardiovascular risk factors.

Key Words: atherosclerosis • brachial artery (ultrasonography) • endothelium • vascular (ultrasonography) • humans • systemic lupus erythematosus • vasodilation

Lupus, Vol. 18, No. 3, 235-242 (2009)
DOI: 10.1177/0961203308096663


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