Microvascular Abnormalities in Chronic Heart Failure: A Cross‐Sectional Analysis

Houben, A. J. H. M.; Beljaars, Jeroen H.; Hofstra, Leo; Kroon, Abraham A.; Leeuw, Peter W. de

doi:10.1038/sj.mn.7800211

Cited by 37 publications

(12 citation statements)

References 29 publications

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“…Finally, it is conceivable that, both in SSc–PAH and in IPAH, neurohumoral activation due to compromised cardiac function causes systemic microvascular dysfunction. However, this would be at odds with recent observations showing increased rather than decreased nailfold capillary density in patients with heart failure 18. In addition, we found no association between capillary density and cardiac index or systemic vascular resistance in our patients with PAH.…”

Section: Discussioncontrasting

confidence: 99%

Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis

Hofstee

Noordegraaf

Voskuyl

et al. 2009

Annals of the Rheumatic Diseases

137

121

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Objective: The aim of this study was to investigate whether there are differences in capillary nailfold changes in patients with systemic sclerosis (SSc) with and without pulmonary arterial hypertension (PAH), and whether these changes are associated with PAH severity and disease specificity. Methods: Capillary density and loop dimensions were studied in 21 healthy controls, 20 patients with idiopathic PAH (IPAH) and 40 patients with SSc. Of the 40 patients with SSc, 19 had no PAH (SSc-nonPAH) and 21 had PAH (SSc-PAH), of whom eight had PAH during exercise. Results: Capillary density was lower in SSc-PAH compared with patients who had SSc-nonPAH (4.33/mm vs 6.56/mm respectively, p = 0.001), but loop dimensions were equal. In comparison with IPAH, patients with SSc-PAH had reduced capillary density (4.33/mm vs 7.86/mm, p,0.001) and larger loop dimensions (total width 101.05 mm vs 44.43 mm, p,0.001). Capillary density in healthy controls (9.87/mm) was significantly higher when compared with SSc-nonPAH (6.56/mm), SSc-PAH (4.33/ mm) and with IPAH (7.86/mm). No differences in capillary dimensions were present between healthy controls and IPAH. Capillary density correlated with mean pulmonary arterial pressure (PAP) at rest in SSc-PAH at rest (r = 20.58, p = 0.039) and IPAH (r = 20.67, p = 0.001). Conclusions: Reduction of nailfold capillary density, but not capillary loop dimensions is associated with PAH, and correlates with the severity of PAH in both SSc and IPAH. This suggests that either systemic microvascular changes play a part in the development of PAH, or that PAH itself contributes to systemic microvascular changes.

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Section: Discussioncontrasting

confidence: 99%

Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis

Hofstee

Noordegraaf

Voskuyl

et al. 2009

Annals of the Rheumatic Diseases

137

121

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“…During vessel paralysis -as it occurs in the early phase of the postischemic hyperemia when the arteries are dilated and the blood flow regulation is turned off [14] -a correlation between PV and vrbc in human cutaneous capillaries was demonstrated. This is thought to be an argument in favour of the hypothesis of Barras [4] that PV determines the perfusion of capillaries (capillary Hct is about 10-20%, so that blood viscosity in capillaries approaches PV [18,23,27]).…”

Section: Discussionmentioning

confidence: 99%

Influence of rheological parameters on the velocity of erythrocytes passing nailfold capillaries in humans

Jung

Mrowietz²,

Hiebl³

et al. 2011

Clinical Hemorheology and Microcirculation

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One thousand two hundred and fifty-six subjects (apparently healthy subjects and patients with cardiovascular diseases) were registered in a prospective study including demographical and clinical data, rheological parameters (hematocrit, plasma viscosity, erythrocyte aggregation, erythrocyte deformability) as well as the erythrocyte velocity in human nailfold capillaries under resting and postischemic conditions.A multivariate regression analysis showed that under resting conditions there was no correlation between rheological parameters and erythrocyte velocity in capillaries. The blood flow regulation seemed to be so effective, that pathological changes of the blood fluidity showed no effect on the velocity of an erythrocyte passing the capillaries.During vessel paralysis in the early phase of the postischemic hyperemia following a stasis of three minutes in the vasculature distal to a pressure cuff at the upper arm a very clear correlation between the plasma viscosity and the maximum postischemic erythrocyte velocity in ipsilateral cutaneous capillaries could be observed (p < 0.0001) while none of the other rheological parameters seemed to play a role. In a subgroup of diabetic patients the erythrocyte aggregation (measured during stasis) also correlated with the erythrocyte velocity (p = 0.0175) besides the plasma viscosity.This shows that a correlation of rheological parameters with the capillary perfusion could only be found during vessel paralysis. In of diabetic patients besides the plasma viscosity also the erythrocyte aggregation correlated with the mean capillary erythrocyte velocity. Theses results are in agreement with the hypothesis from Barras that plasma viscosity determines the perfusion of microvessels. Under certain conditions e.g. diabetic disorder, also the erythrocyte aggregation plays a role.

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“…Due to the requirement of special non‐invasive techniques, relatively few studies are available, however. Nevertheless without exception all show disturbed capillary recruitment, whatever the stimulus employed: low birth weight [ 173 , 357 ], obesity [ 68 , 80 ], hypertension [ 356 ], heart failure [ 164 ], hypothyroidism [ 310 ].…”

Section: Microcirculation In States Of Metabolic Syndromementioning

confidence: 99%

Microcirculation and the Metabolic Syndrome

et al. 2007

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The present review, to the authors' knowledge, is the first to specifically address the relationships between microcirculation and metabolic syndrome, a cluster of metabolic and cardiovascular modifications highly prevalent in the general population. Its close link to overweight and insulin resistance makes it the main cause of the worldwide burden of type 2 diabetes. However, metabolic syndrome is also observed in many other diseases, particularly, but not exclusively, those where insulin resistance is a main feature. Analysis of the literature reveals that this clinical situation is invariably linked to microvascular disturbances, such as abnormalities in arteriolar reactivity, capillary recruitment, permeability, and hemorheology. A particularly interesting observation is that these defects in small vessel structure and function are seen very early in life or disease. Very importantly, they further suggest that microcirculatory abnormalities may be not only secondary but also causal to the development and/or aggravation of insulin resistance and metabolic syndrome. Mechanisms responsible for these modifications remain largely unknown, but insulin's vascular effects in the microvascular network, detailed in this review, are at least one example of such connections. The existing data point to a clear, at least bidirectional, relationship between microcirculation and metabolic syndrome. Additional studies should determine the level of reciprocal causality.

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Microvascular Abnormalities in Chronic Heart Failure: A Cross‐Sectional Analysis

Abstract: In heart failure, several microvascular abnormalities occur that differ, depending on the severity of this condition.

Cited by 37 publications

References 29 publications

Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis

Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis

Influence of rheological parameters on the velocity of erythrocytes passing nailfold capillaries in humans

Microcirculation and the Metabolic Syndrome

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