Format

Send to

Choose Destination
Eur J Clin Invest. 2018 Feb;48(2). doi: 10.1111/eci.12869. Epub 2017 Dec 14.

Sublingual functional capillary rarefaction in chronic heart failure.

Author information

1
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
2
Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
3
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
4
Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna, Austria.

Abstract

BACKGROUND AND OBJECTIVE:

Microcirculatory changes contribute to clinical symptoms and disease progression in chronic heart failure (CHF). A depression of coronary flow reserve is associated with a lower myocardial capillary density in biopsies. We hypothesized that changes in cardiac microcirculation might also be reflected by a systemic reduction in capillaries and visualized by sublingual videomicroscopy. The aim was to study in vivo capillary density and glycocalyx dimensions in patients with CHF vs healthy controls.

METHODS:

Fifty patients with ischaemic and nonischaemic CHF and standard treatment were compared to 35 healthy age-matched subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using a sidestream darkfield videomicroscope. Functional and perfused total capillary densities were compared between patients and controls. A reduced glycocalyx thickness was measured by an increased perfused boundary region (PBR).

RESULTS:

Median functional and total perfused capillary densities were 30% and 45% lower in patients with CHF (both P < .001). Intake of oral vitamin K antagonists was associated with significantly lower capillary densities (P < .05), but not independent of NT-proBNP. Dimensions of the glycocalyx were marginally lower in CHF patients than in healthy controls (<7% difference). However, PBR correlated significantly with inflammation markers (fibrinogen: r = .58; C-reactive protein: r = .42), platelet counts (r = .36) and inversely with measures of liver/renal function such as bilirubin (r = -.38) or estimated glomerular filtration rate (r = -.34) in CHF patients.

CONCLUSION:

CHF patients have got a markedly lower functional and total perfused capillary density in sublingual microvasculature when compared to controls, indicating a systemic decrease in microcirculation.

KEYWORDS:

capillaries; glycocalyx; heart failure; microcirculation; perfused boundary region

PMID:
29178250
DOI:
10.1111/eci.12869
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center