Sublingual functional capillary rarefaction in chronic heart failure.

Abstract

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 invivo capillary density and glycocalyx dimensions in patients with CHF vs healthy controls. 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). 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. 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.