The microvascular bed of the skin of lower limbs in patients with intermittent lameness and coronary heart disease as a possible model of their myocardial microcirculation

Abstract

Purpose: to assess possibility to extrapolate findings of skin microvascular bed examination in lower extremities with laser Doppler flowmetry in patients with obliterating atherosclerosis as a model of their myocardial microcirculation in coronary heart disease.Material and methods. Males with angiographically confirmed coronary heart disease (n = 70) and obliterating atherosclerosis in lower limbarteries (n = 74) were taken in the study. Microcirculation of the skin in the left forearm in the Zakharyin – Head zone in patients with coronaryheart disease and skin microcirculation in the foot of affected limb in patients with obliterating atherosclerosis of arteries of lower extremities were examined with laser Doppler flowmetry. The basal blood flow, amplitude-frequency spectrum of its oscillations, myogenic, neurogenic vascular tone and occlusion parameters were assessed as well. Comparison groups included 50 practically healthy males for the patients with coronary heart disease and 20 males – for the patients with obliterating atherosclerosis of arteries of lower extremities. Patients were examinedat the initial stage and in 2–3 weeks after endovascular restoration of blood flow in the myocardium and lower limbs.Results and discussion. At the initial research stage, the microcirculation picture in patients with coronary heart disease and obliterating ath-erosclerosis in lower extremities differed from that of healthy individuals by shifts covering all links of the microvascular bed and characterizedby constriction of the precapillary segment, a statistically significant decrease in median values of capillary blood flow by 17.5 and 43.1 %,microvascular blood flow reserve – by 11.2 and 31.0 %, as well as by the increase in arteriolovenular blood bypass – by 10.3 and 70.8 %,respectively. After the restoration of blood flow in lower extremities in patients with obliterating atherosclerosis, muscular pain disappeared,and the ankle-shoulder index got normalized. At the same time, one could observe a statistically significant increase in the capillary blood flow(+13.6 %), the increase of reserve potential in microvascular bed (+20.6 %) with the simultaneous decrease of vascular tone in the precapillarysegment (–15.1 %) and of the blood bypass index (–25.0 %). Better clinical picture after coronary angioplasty in patients with coronary heart disease was accompanied with a similar and unidirectional tendency to positive changes in the microvascular bed.Conclusion. As far as etiopathogenetic mechanisms and clinical manifestations of coronary heart disease and obliterating atherosclerosis in arteries of lower extremities have much in common and microcirculatory shifts in forearm and foot skin in these patients before and after angioplasty are unidirectional, all these allow to suggest that one can see similar changes in the myocardium microcirculatory system in patients with coronary heart disease. Thus, it opens possibilities to have a targeted medicamentous impact at the microvascular level.