Abnormal Nail Fold Capillaroscopy Findings in Patients with Chronic Total Occlusions (CTO)

Abstract

Aims: Nail fold capillaroscopy (NFC) allows a simple, non-invasive direct examination of the microvasculature. NFC abnormalities have previously been associated with a number of coronary artery disease processes, in particular microvascular dysfunction. We sought to determine the prevalence of NFC abnormalities in patients with a CTO. Methods & Results: 81 patients presenting for coronary angiography between June 2018 and January 2019 were studied. NFC was performed in 77 patients using a standardised protocol, prior to coronary angiography. An abnormal NFC was defined as the presence of microhaemorrhages, dilated capillaries or tortuous capillaries. Of those patients who underwent NFC, 27 (35.1%) had a CTO, whilst 50 (64.9%) had non-obstructive coronary artery disease (CAD). An abnormal NFC was seen more commonly in patients with a CTO as compared to those with non-obstructive CAD (33.3% vs 8%, p < 0.05). Patients with an abnormal NFC were more likely to have hypercholesterolaemia, than those without (100% vs 89.1%, p < 0.01). In patients with an abnormal NFC compared with those without, there was no difference in age, gender, presence of atrial fibrillation or other cardiovascular risk factors. In those with a CTO, there was no correlation between NFC findings and degree of collateralisation. Conclusions: An abnormal NFC is more commonly seen in patients with a CTO, which may reflect higher degree of coronary artery disease and microvascular dysfunction. NFC should be further investigated to determine its utility in routine cardiovascular screening and assessment (Fig. 1).