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CLINICAL STUDY

Assessment of peripheral artery tonometry in the detection of treadmill exercise-induced myocardial ischemia

Pierre Chouraqui, MD, FACC^*,*, Robert P. Schnall, DSc, Itsik Dvir, DSc, Alan Rozanski, MD, FACC, Ehtasham Qureshi, MD, Alexander Arditti, MD, Jerold Saef, MD, FACC^||, Paul D. Feigin, PhD^¶ and Jacob Sheffy, PhD

^* Nuclear Cardiology Unit, The Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Itamar Medical Ltd., Caesarea, Israel
Department of Medicine, St. Luke’s-Roosevelt Hospital, New York, New York, USA
The Heart Institute, Kaplan Medical Center, Rehovot, Israel
^|| Batey Cardiovascular Center, Bradenton, Florida, USA
^¶ Faculty of Industrial Engineering and Management, Technion, Israel Institute of Technology, Haifa, Israel

Manuscript received December 1, 2001; revised manuscript received June 25, 2002, accepted August 30, 2002.

^* Reprint requests and correspondence: Dr. Pierre Chouraqui, Nuclear Cardiology Unit, Heart Institute, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel.
chouraq{at}post.tau.ac.il

OBJECTIVES: We sought to assess the added diagnostic value of peripheral artery tonometric (PAT) measurements, based on finger pulsatile arterial volume changes, to standard 12-lead stress electrocardiography (ECG), for detecting exercise-induced myocardial ischemia, using single-photon emission computed tomography (SPECT) as the standard of comparison in a double-blinded, multicenter protocol.

METHODS: An automated algorithm for identifying myocardial ischemia from PAT was derived from 345 training cases. The PAT outcome was combined with the ECG result (ischemic, nonischemic, or equivocal), giving a PAT-enhanced value. A threshold of normality was determined to optimize agreement with the SPECT results in the training sample. The PAT-enhanced analysis was then validated in 616 subjects, only two of whom had technically unacceptable PAT studies.

RESULTS: In the validation cohort, receiver operating characteristic curve analysis of the PAT-enhanced diagnosis yielded an area under the curve of 0.72, a sensitivity of 63.5%, compared with 44.7% for ECG alone (p < 0.0001), and a specificity of 67.8% common to both ECG and PAT-enhanced diagnoses. Similar results were found in the training sample. Although over 10% of validation subjects had equivocal ECG results, with the aid of PAT, it was possible to provide diagnostic information for all but one subject.

CONCLUSIONS: Peripheral artery tonometry may be useful for improving the diagnosis of exercise-induced myocardial ischemia by both enhancing the sensitivity without impairing the specificity and increasing the percentage of definitive test results.

Abbreviations and Acronyms   AUC   area under the curve   BP   blood pressure   ECG   electrocardiogram/electrocardiography   PAT   peripheral artery tonometer/tonometry   PWA   pulse wave amplitude   ROC   receiver operating characteristics   SPECT   single-photon emission computed tomography

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