Relationship between peripheral and coronary function using laser Doppler imaging and transthoracic echocardiography

Abstract

Vascular dysfunction in the coronary and peripheral circulations is an early prognostic marker of future cardiovascular events. Measurements of coronary and peripheral vascular function in resistance vessels can be made, but rely on invasive procedures, which make them unsuitable for routine application. An assessment of the direct correlation between vascular responses in skin and coronary vessels has not been made previously. In 27 normal healthy subjects (18-55 years of age), we examined the relationship between peripheral and coronary vascular function. Cutaneous perfusion was measured using the non-invasive technique of laser Doppler imaging during iontophoresis of acetylcholine and sodium nitroprusside, and cutaneous vascular conductance was calculated (laser Doppler perfusion/mean arterial pressure). Coronary flow reserve was measured using transthoracic echocardiography during intravenous adenosine infusion. Mean diastolic velocities were measured at baseline and peak hyperaemic conditions from the Doppler signal recordings. CVR (coronary velocity reserve) was defined as the ratio of hyperaemic to basal mean diastolic velocities. There were significant positive correlations between CVR and cutaneous vascular conductance for acetylcholine (r=0.399, P=0.039) and sodium nitroprusside (r=0.446, P=0.020). These results support the idea that peripheral measurements of skin blood flow are representative of generalized microvascular function including that of the coronary circulation in normal healthy subjects.

Peripheral microvascular function is altered in young individuals at risk for hypertrophic cardiomyopathy and correlates with myocardial diastolic function

“…Cutaneous blood flow responses to endotheliumdependent and -independent agonists were assessed using a laser Doppler multifiber probe (Perimed, Stockholm, Sweden) during transdermal iontophoresis of ACh and sodium nitroprusside (SNP), respectively, on the volar side of the forearm (16,34,39). The nondominant upper extremity was chosen in all patients.…”

Transdermal iontophoresis as an in-vivo technique for studying microvascular physiology

“…As such, these models provide a more integrative assessment of microvascular function as they elicit vascular responses that involve multiple-signaling pathways. Recent studies have indicated that changes in the cutaneous microvasculature often mirror changes in vessels of different size (Debbabi et al, 2010) and in other vascular beds, such as the coronary microcirculation (Khan et al, 2008). In fact, increasing evidence indicates that the cutaneous microcirculation can serve as a representative model to examine mechanisms of vascular function and dysfunction that occur on a systemic level (Holowatz et al, 2008;IJzerman et al, 2003).…”

Exercise training improves cutaneous microvascular function in nonalcoholic fatty liver disease

“…Cutaneous vasodilator function reflects generalized microvascular function since it can be used to interrogate endothelial vasodilator pathways (19). Cutaneous microvessel dysfunction correlates with coronary artery endothelial dysfunction (4,28,35) and is associated with several CVD risk factors, including obesity (13), hypertension (10,33), hypercholesterolemia (27), and type 2 diabetes (9, 37, 44), all of which frequently manifest in NAFLD patients (15). Nevertheless, the aforementioned studies utilized iontophoresis of acetylcholine to assay cutaneous vasodilator function, a technique that has accepted limitations since the delivery method is inconsistent and the vasodilator response is not exclusively NO mediated (20).…”