Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

Gorshkov, A. Yu.; Климушина, М. В.; Boytsov, S. А.; Kots, Alexander Y.; Gumanova, Nadezhda G.

doi:10.1111/micc.12454

Cited by 23 publications

(20 citation statements)

References 28 publications

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“…Here, we show that CAD is accompanied by impaired sublingual microvascular perfusion, and that women with CAD, but not men with CAD, have reductions in microvascular glycocalyx barrier function. The magnitude of impaired sublingual microvascular barrier function in our female CAD patients relative to controls was similar to that observed in patients with end‐stage renal disease (Vlahu et al, ), lacunar stroke (Martens et al, ), ischemic heart disease (Gorshkov et al, ), and systemic sclerosis (Machin et al, ). A previous study showed that PBR was larger on average in patients with CAD compared to controls (Mulders et al, ).…”

Section: Discussionsupporting

confidence: 85%

“…This RBC accessible portion of the glycocalyx is commonly termed the perfused boundary region (PBR). A variety of cardiovascular diseases or risk factors, including end‐stage renal disease (Vlahu et al, ), lacunar stroke (Martens, Vink, Oostenbrugge, & Staals, ), ischemic heart disease (Gorshkov, Klimushina, Boytsov, Kots, & Gumanova, ), and systemic sclerosis (Machin, Gates, Vink, Frech, & Donato, ), have been associated with an increase of the sublingual microvascular PBR.…”

Section: Introductionmentioning

confidence: 99%

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Noninvasive sublingual microvascular imaging reveals sex‐specific reduction in glycocalyx barrier properties in patients with coronary artery disease

et al. 2020

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Background: Risk factors for coronary artery disease (CAD) have been associated with endothelial dysfunction and degradation of the endothelial glycocalyx. This study was designed to compare sublingual microvascular perfusion and glycocalyx barrier properties in CAD patients and controls using noninvasive side stream darkfield imaging. Methods: Imaging of the sublingual microvasculature was performed in 52 case subjects (CAD confirmed by left heart catheterization) and 63 controls (low Framingham risk score). Red blood cell (RBC) filling percentage and functional microvascular density, measures of microvascular perfusion, and perfused boundary region (PBR), an index of glycocalyx barrier function, were measured in microvessels with a diameter ranging from 5-25 µm. Results: RBC filling percentage was lower in patients with CAD compared to controls (p < .001). Functional microvascular density did not differ between groups.The overall PBR was marginally greater in the CAD group compared to the control group (p = .08). PBR did not differ between male CAD cases and controls (p = .17).However, PBR was greater in females with CAD compared with female controls (p = .04), indicating reduced glycocalyx barrier function. This difference became more pronounced after adjusting for potential confounders. Conclusions: Our data suggest that patients with CAD are characterized by a reduction in percentage of time microvessels are occupied by RBCs. In addition, CAD is significantly associated with impaired sublingual microvascular glycocalyx barrier function in women but not men. More research is needed to determine the significance of peripheral microvascular dysfunction in the pathophysiology of CAD, and how this may differ by sex. K E Y W O R D Scoronary artery disease, endothelial glycocalyx, imaging, microvascular dysfunction, sex differences

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Noninvasive sublingual microvascular imaging reveals sex‐specific reduction in glycocalyx barrier properties in patients with coronary artery disease

et al. 2020

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“…Values measured in our population (both “healthy” surgical and septic patients) were much lower. Interestingly, in recently published Russian population study [ 21 ] the PBR values corresponded much more with our own measurements; median and interquartile values were 1.9 (1.75-2.04) with values above 2 pointing towards increased cardiovascular risk. To which extent these differences in absolute values are affected by different SDF camera device (KK Research technology Ltd., UK, in ours and Russian study [ 21 ] vs. MicroVision Medical Inc., Wallingford, PA, in the Dutch study [ 12 ]) version of monitoring software (mostly not given) or population is to be further elucidated.…”

Section: Discussionsupporting

confidence: 84%

“…However, amount of data regarding the PBR is still too low to allow us for separation of clinically relevant changes. In our study the highest increase observed among septic responders was 8% which lies on the borderline of the coefficient of variation measured on our population (8%) or mentioned by other authors (less than 10%) [ 21 ]. The normal values in population have also not been evaluated yet.…”

Section: Discussioncontrasting

confidence: 77%

Impact of Intravenous Fluid Challenge Infusion Time on Macrocirculation and Endothelial Glycocalyx in Surgical and Critically Ill Patients

Pouska

Tégl

Astapenko

et al. 2018

BioMed Research International

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(i) Purpose. The fluid challenge (FC) is a well-established test of preload reserve. Only limited data exist in regard to the FC efficacy based on infusion time. Slow administration may be associated with lack of effect based on fluid redistribution and external conditions changes. On the contrary, fast administration may lead to brisk fluid overload and damage to the endothelium and endothelial glycocalyx (EG). The aim of this trial was to compare the FC infusion time on its hemodynamic effects and EG. (ii) Methods. Prospective randomized single-center trial of fast (5-10 minutes) versus slow (20-30 minutes) administration of 500ml balanced crystalloid FC in spinal surgery (cohort OR) and septic shock (cohort SEP) patients. Hemodynamic response was assessed using standard monitoring and blood flow measurements; damage to EG was assessed using the perfused boundary region (PBR) via intravital microscopy monitoring in the sublingual region within relevant time points ranging up to 120 minutes. (iii) Results. Overall, 66 FCs in 50 surgical and 16 septic patients were assessed. Fluid administration was associated with increase of PBR in general (1.9 (1.8-2.1) vs. 2.0 (1.8-2.2); p= 0.008). These changes were transient in OR cohort whereas they were long-lasting in septic fluid responders. The rate of fluid responsiveness after fast versus slow administration was comparable in global population (15 (47%) vs. 17 (50%); p=0.801) as well as in both cohorts. (iv) Conclusions. Fluid challenge administration was associated with increased PBR (and presumable EG volume changes) which normalized within the next 60 minutes in surgical patients but remained impeded in septic fluid responders. The fluid responsiveness rate after fast and slow FC was comparable, but fast administration tended to induce higher, though transient, response in blood pressure.

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“…Therefore, an increased PBR may be viewed as an intermediate step between risk factors for atherosclerosis and cardiovascular events [5–7]. However, the correlations between PBR and risk factors and between PBR and cardiovascular events have not been consistently shown for the PBR: some studies have reported no clear association between the PBR and either vascular risk or vascular disease [4, 7], while others have found associations with atherosclerotic vascular disease [6, 8, 9]. These inconsistent findings might depend on the relatively small sample size of these studies and the focus on populations selected based on health status and of predominantly white ethnicity [4–6, 10].…”

Section: Introductionmentioning

confidence: 99%

Sublingual endothelial glycocalyx and atherosclerosis. A cross-sectional study

et al. 2019

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Background Damage to endothelial glycocalyx is thought to be an early marker of atherosclerosis and measuring reduced glycocalyx size clinically via the Perfused Boundary Region (PBR) may allow early detection of cardiovascular disease. However, the true value of the glycocalyx in estimating cardiovascular risk or detecting cardiovascular disease is uncertain. We therefore investigated whether small glycocalyx size is associated with cardiovascular risk or disease in a large multi-ethnic cohort. Methods In a multi-ethnic community-based sample (N = 6169, 42.4% male, mean age 43.6 ±13) we applied multiple imputation for missing data and used logistic regression and odds ratios to cross-sectionally investigate the relationship of small glycocalyx size as estimated by highest quartile of PBR with, on the one hand, classical risk factors for atherosclerosis including age, sex, diastolic and systolic blood pressure, LDL, HDL, triglycerides, BMI, diabetes, smoking status, and antihypertensive and lipid-lowering medication; on the other hand, prevalent cardiovascular disease. Analyses were additionally adjusted for ethnicity. Results With PBR divided in quartiles, the highest PBR quartile (smallest glycocalyx size) as dependent variable was independently associated with female sex (OR for male versus female: 0.61, 95% CI: 0.53, 0.70) and diabetes (OR: 1.28, 95% CI: 1.03–1.59) in a model adjusted for all classical risk factors of atherosclerosis and for ethnicity. With regard to cardiovascular disease, no association was found between the smallest glycocalyx size as independent variable and overall cardiovascular disease, coronary heart disease and revascularization procedures, or stroke. Conclusions Small glycocalyx size as estimated by highest PBR is associated with female sex and diabetes, which do not completely reflect a high cardiovascular risk profile. At the same time, glycocalyx size is not associated with prevalent cardiovascular disease.

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Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

Abstract: Thus, PBR can be considered a new highly reproducible and promising marker candidate for non-invasive diagnostics of IHD and cerebral atherosclerosis suggesting important role of microcirculation in development and progression of cardiovascular diseases.

Cited by 23 publications

References 28 publications

Noninvasive sublingual microvascular imaging reveals sex‐specific reduction in glycocalyx barrier properties in patients with coronary artery disease

Noninvasive sublingual microvascular imaging reveals sex‐specific reduction in glycocalyx barrier properties in patients with coronary artery disease

Impact of Intravenous Fluid Challenge Infusion Time on Macrocirculation and Endothelial Glycocalyx in Surgical and Critically Ill Patients

Sublingual endothelial glycocalyx and atherosclerosis. A cross-sectional study

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