Microcirculatory Abnormalities Research Articles

GW29-e1815 The evaluation of left ventricular systolic function in different types of ischemic heart disease by two-dimensional speckle-tracking echocardiography

Coronary microvascular dysfunction (CMD) induced by abnormalities of coronary microcirculation and obstructive coronary artery disease (CAD) with epicardial coronary stenosis are two types of ischemic heart disease. Both CMD and obstructive CAD can induce ventricular remodeling, eventually

Sublingual microcirculatory alterations in patients with stable systemic sclerosis

IntroductionSystemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, inflammation, and microcirculatory alterations. ObjectiveTo evaluate abnormalities in the sublingual microcirculation of SSc patients and to establish any differences compared to healthy controls. MethodsThe sublingual microcirculation was determined using a Sidestream dark-field (SDF) imaging device (MicroScan; MicroVision Medical, Amsterdam, the Netherlands) in patients with SSc and controls. ResultsTwelve patients with SSc (75% with diffuse cutaneous SSc) were evaluated (mean age: 52.08±2.08 years). A group of 20 volunteers was used as the control. Significantly lower total capillary density (TCD) (9.2 [8.5–9.7] vs. 10.9 [9.8–12.5]) and functional capillary density (FCD) (7.0 [6.8–7.5] vs. 8.6 [7.5–9.8]) were observed in SSc patients than in healthy controls. ConclusionsSSc is related to significantly lower capillary density in the sublingual microcirculation, and the SDF imaging technique could be an alternative to nailfold videocapillaroscopy for diagnosing and following-up patients with SSc.

Sublingual microcirculatory alterations in patients with stable systemic sclerosis

IntroductionSystemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, inflammation, and microcirculatory alterations. ObjectiveTo evaluate abnormalities in the sublingual microcirculation of SSc patients and to establish any differences compared to healthy controls. MethodsThe sublingual microcirculation was determined using a Sidestream dark-field (SDF) imaging device (MicroScan; MicroVision Medical, Amsterdam, the Netherlands) in patients with SSc and controls. ResultsTwelve patients with SSc (75% with diffuse cutaneous SSc) were evaluated (mean age: 52.08±2.08 years). A group of 20 volunteers was used as the control. Significantly lower total capillary density (TCD) (9.2 [8.5–9.7] vs. 10.9 [9.8–12.5]) and functional capillary density (FCD) (7.0 [6.8–7.5] vs. 8.6 [7.5–9.8]) were observed in SSc patients than in healthy controls. ConclusionsSSc is related to significantly lower capillary density in the sublingual microcirculation, and the SDF imaging technique could be an alternative to nailfold videocapillaroscopy for diagnosing and following-up patients with SSc.

Association of Foveal Avascular Zone Enlargement and Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography

Purpose: The purpose of this article is to evaluate long-term change of the foveal avascular zone (FAZ) area in diabetic eyes using optical coherence tomography angiography (OCTA) (AngioVue, Avanti OCT, Optovue). Methods: A retrospective chart review was conducted of patients who had undergone OCTA fundus examinations with at least 12 months of follow-up. Eyes with previous laser photocoagulation and antivascular endothelial growth factor treatments were excluded. ImageJ software was used to evaluate the FAZ area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Forty eyes were analyzed in this study and divided into 3 groups: healthy controls (13 eyes), diabetic patients without diabetic retinopathy (DR) (14 eyes), and diabetic patients with DR (13 eyes). During the 22 months of follow-up, the FAZ area of eyes with DR in the DCP enlarged from 0.64 ± 0.20 mm2 to 0.70 ± 0.20 mm2 ( P = .021), which was a 10.1% increase from baseline (5.1% per year). No significant changes were observed during the study period for FAZ areas in the DCP of controls and diabetic patients without DR. Enlargement of FAZ in the DCP was significantly greater in eyes with DR progression vs those without progression (19.2% and 1.2%, respectively, P = .013). Conclusions: Our data suggest FAZ enlargement in the DCP is associated with DR progression. Assessment of the FAZ by OCTA might be useful for the evaluation of microcirculation abnormalities in DR and the onset of DR progression.

Abnormal Microcirculation and Red Blood Cell Function as a Cardiovascular Risk Factor in Metabolic Syndrome

The metabolic syndrome is a highly prevalent condition associated with increased cardiovascular risk in the population. Microvasculature is the terminal part of the cardiovascular system which primarily reacts to the increased secretion of the pro inflammatory adipokines typical for the metabolic syndrome. Microcirculation and blood cell abnormalities are the leading mechanisms of cardiovascular events development in this condition. Prevalence of microcirculation abnormalities and red blood cell dysfunction in metabolic syndrome and their role in the increased blood viscosity and cardiovascular events development are covered by the paper. The microcirculation abnormalities with a special focus on red blood cell dysfunction (impaired aggregation, stiffness) seen in metabolic syndrome and associated conditions are discussed in detail. The impact of abnormal red blood cell deformability (secondary to cholesterol accumulation in the cellular membranes) on the hemorheological abnormalities is revealed. Abnormal red blood cell surface charge due to proinflammatory changes associated with insulin resistance in diabetes mellitus is highlighted. These abnormalities lead to increased red blood cell aggregation and plasma viscosity that are the essential components of cardiovascular events pathogenesis. Their timely diagnosis is crucial for effective cardiovascular prevention.

ESTIMATION OF EFFICIENCY OF COLLAGEN AND BIOLOGICAL GLUE AT DUODENAL FISTULA IN EXPERIMENT

Introduction. One of the worst complication of different surgical diseases of abdominal cavity organs and of performed, on that regard, operational interventions, are intestinal festulas including without limitation deodenum fistulas. Longterm experience of surgical treatment of patients with unformed duodenal and high enteric fistulas show that it is feasible to have a clear surgical tactics with account of location level and type of fistulas, their quantity, volume of sarcous reduction, peritonitis and multi-organ failure syndrome. In this regard, the objective of this research is to find optimal surgical tactics and to determine the most effective method of treating duodenum fistulas of various causation.Materials and methods. Experimental work was carried out under conditions of experimentally formed intestinal fistula in rabbits of “Shinshilla” breed. After formation of fistula the animals were divided into 3 groups based on the method of removing artificially installed duodenal fistula: sealing through Albert — Schmieden — Lembert suture without fastening of suture line; sealing through fastening of intestinal suture with biological surgical glue; sealing through fastening with swine dermal collagen. Mechanical constancy of the sutures was measured with pneumocompression of sealed intestinal tract areas as well as with morphological study of surgical wound edges.Results. The results of histological study show that experiments with application of bio-implant demonstrated less vascular congestion and interstitial swelling. Phologistic infiltration also responded more efficiently both quantitatively (manifestation rate) and qualitatively (quick change of cell elements) in the group that used bio-implant.Conclusion. Results of morphological studies and pneumocompression data under modelling of duodenal fistulas in experimental animals show that application of bio-implant helps to earlier restore microcirculatory abnormality.

Hypertension and Organ Damage in Women.

An adequate cardiovascular (CV) prevention strategy in women should consider the acknowledgement of sex-specific risk factors, such as hypertension in pregnancy, the concomitant presence of autoimmune diseases and the benefit of evaluating subclinical organ damage and treating hypertension. In accordance to current guidelines, the diagnostic approach does not differ between men and women, although the cardiac response to pressure overload may suggest greater sensitivity in women, and may vary according to age, ethnic background and obesity, that potentiates the effect of hypertension on left ventricular (LV) hypertrophy. Several studies have observed peculiar abnormalities in LV systolic and diastolic function according to gender. The possible mechanisms that influence a different cardiac adaptation to chronic pressure overload in men and women are not fully understood, although hormonal status, and in particular the lack of estrogen effects after menopause may contribute to the cardiovascular adaptation response to increased afterload. The increase in LV mass in response to chronic pressure overload is associated with higher LV ejection fraction in women than in men and LV torsion is maintained with aging in women but not in men. Interstitial fibrosis may reduce circumferential shortening and early diastolic strain rate, in the presence of a preserved ejection fraction in women, favoring the development of heart failure with preserved ejection fraction. Changes in aortic stiffness with aging may influence cardiac structural and functional changes. Isolated systolic hypertension reflects an increase in aortic stiffness, is frequent in women and may be associated to a greater development of concentric LVH. The regression of hypertensive LVH is more difficult in women, and residual hypertrophy is more common in women than in men despite effective antihypertensive treatment and blood pressure control. Carotid atherosclerosis has been extensively investigated in men and women, showing that women usually develop carotid plaques after menopause, with smaller and less unstable plaques; however large and/or a hypoechogenic plaques are more strictly related to cerebrovascular events in women than in men. More advanced abnormalities in the subcutaneous microcirculation have been recently observed, and well translate in the evidence of more prevalent coronary microcirculation involvement in women ischemic heart disease. The prevalence of albuminuria and of reduced estimated glomerular filtration rate (eGFR < 60ml/min/1.73) are respectively lower and higher in postmenopausal women than in men. Experimental data suggest the possible involvement of renin-angiotensin-aldosterone system and of T regulatory lymphocytes to this regard.

MACRO- AND MICROCIRCULATORY ABNORMALITIES OF VASCULAR WALL IN HYPERTENSIVE PATIENTS

Objective: To study arterial wall elasticity and stiffness in hypertensive's patients with moderate and high cardiovascular risk not receiving antihypertensive treatment. Design and method: The study included 41 hypertensive's patients (16 male and 27 female) with mean age of 61.1 ± 10.7 years, systolic, diastolic blood pressure (162.7 ± 20.8 mm Hg, 98.6 ± 11.2 mm Hg), hypertension duration 9.3 ± 7.2 years. Obesity was found in 32% of participants, 21% of patients were smokers. Carotid Doppler ultrasound study with intima-media thickness (IMT) measurement (using Aloka SSD 2000 ultrasound system) and photoplethysmography with augmentation index (AI), stiffness index (SI), delay in time between early and late systolic waves (dTPP), vascular age (VA) and stress index (SI) scores assessment (using Angioscan Professional system, Russia, 2015) were performed on all patients. Statistical analysis was done using Statistica 10.0 software. Results: There were 3 groups of patients: I (N = 14) with normal IMT (<0.9 mm) and no carotid atherosclerotic plaque present, II (N = 13) with increased IMT (>0.9 mm) and no plaques, and III (N = 14) with carotid atherosclerotic plaques (average number 2.0 ± 1.6 with the mean % narrowing of 32.4 ± 12.6). There were no differences in age, hypertension grade, obesity and smoking prevalence between the groups. With the increase in carotid atherosclerosis, a significant rise in AI was seen (−1.3 ± 19.7% in group I, 10.5 ± 12.7% in group II and 18.6 ± 13.8% in group III; p < 0.05), whereas dTPP was significantly lower in group III than in groups II and I (90.5 ± 30.7 vs 89.2 ± 17.2 ms vs 96.5 ± 29.3 ms, respectively; p < 0,05 between groups I and III). Significant difference in SI was found only between groups I and II (7.4 ± 1.07 m/s vs 8.2 ± 0.88 m/s, respectively; p < 0.05), while this parameter was 7.6 ± 1.09 m/s in group III. Patients from groups I, II, and III demonstrated a significant elevation of VA (44.7 ± 14.9 vs 58.3 ± 7.4 vs 63.5 ± 12.9 years, respectively; p < 0.05) and SI (3.1 ± 1.2 vs 3.5 ± 1.04 vs 3.9 ± 0.95, respectively; p < 0.05). A correlation between VA and carotid diameter (R = –0.7; p < 0.05), AI and the number of atherosclerotic plaques (R = 0.73; p < 0.05) was revealed in hypertensive's. Conclusions: Carotid atherosclerosis in hypertensive's is associated with microcirculatory abnormalities and increased vascular age and stress index scores.

Spectral analysis of the blood flow in the foot microvascular bed during thermal testing in patients with diabetes mellitus

Timely diagnostics of microcirculatory system abnormalities, which are the most severe diabetic complications, is one of the major problems facing modern health care. Functional abnormalities manifest themselves earlier than the structural ones, and therefore their assessment is the issue of primary importance. In this study Laser Doppler flowmetry, a noninvasive technique for the cutaneous blood flow monitoring, was utilized together with local temperature tests and wavelet analysis. The study of the blood flow in the microvascular bed of toes was carried out in the control group of 40 healthy subjects and in two groups of 17 type 1 and 23 type 2 diabetic patients.The local temperature tests demonstrated that the diabetic patients have impaired vasodilation in response to local heating. The tendency for impaired low frequency pulsations of the blood flow associated with endothelial and neurogenic activities in both diabetes groups was observed. Local thermal tests induced variations in perfusion and its spectral characteristics, which were different in the groups under study. In our opinion, the obtained preliminary results can be a basis for further research and provide a deeper understanding of pathological processes that drive microvascular abnormalities caused by diabetes mellitus.

Sublingual microcirculatory alterations in cirrhotic patients.

To assess sublingual microcirculation in cirrhotic patients and its relationship to spider angiomas, complications, and outcome. Thirty-one cirrhotic patients were prospectively compared to 31 matched controls. Sublingual microcirculation was evaluated by videomicroscopy. We specifically looked for capillaries with increased RBCV, which was defined as a velocity higher than the percentile 100th of controls. Compared to controls, cirrhotic patients showed decreased total and PVD (14.4±2.2 vs 16.0±1.3 and 14.1±2.3 vs 15.9±1.6mm/mm2 , respectively, P<.001 for both) and increased HFI (0.64±0.39 vs 0.36±0.21, P=.001). They also exhibited high RBCV in 2% of the microvessels (P<.0001). Patients with MELD score ≥10 had higher RBCV than patients with score <10 (1414±290 vs 1206±239μm/s, P<.05). Patients with spider angiomas showed lower vascular densities. Microcirculation did not differ between survivors and nonsurvivors. Cirrhosis is associated with microcirculatory alterations that can be easily monitored in the sublingual mucosa. Alterations included decreased density and PPV and hyperdynamic microvessels. The most striking finding, however, was the microvascular heterogeneity. Patients with spider angiomas had more severe alterations. Larger studies should clarify the relationship between microcirculatory abnormalities and outcome.

An opportunity to improve pulmonary capillary circulation in patients with chronic obstructive pulmonary disease and comorbidity

This study was aimed at investigating pathogenesis of pulmonary vascular abnormalities in COPD with systemic features, and ways to treat these circulatory disorders. Methods. We analyzed pulmonary vascular parameters, molecular markers of endothelial dysfunction, pulmonary artery pressure (PAP) and gas exchange in patients with moderate (n = 64) and severe (n = 70) COPD treated with basic therapy with or without an endothelial protector. Results. The results showed that perfusion disorders could appear in different parts of the lungs, probably, due to different mechanisms of these abnormalities. Localization of perfusion disorders was related to blood levels of molecular markers of endothelial dysfunction: adhesion molecules sP-selectin and sVCAM-1 were related to perfusion abnormalities in the upper lobes, VEGF-A was related to perfusion abnormalities in the lower lobes, and diffuse perfusion abnormalities were related to endothelin-1. Additional treatment with sulodexide improved endothelial function and pulmonary circulation, decreased PAP and blood concentrations of molecular markers of endothelial dysfunction. Conclusion. Predominant localization of microcirculatory abnormalities in COPD patients, especially in the lower lobes, is related to ventilation abnormalities, could predict clinical course of the disease and indicates the need in endotheliotropic therapy.

Alterations of conjunctival glycocalyx and microcirculation in non-septic critically ill patients

As of now the relationship between glycocalyx degradation and microcirculatory perfusion abnormalities in non-septic critical ill patients is unclear. In addition, conjunctival sidestream dark field-imaging for the purpose of glycocalyx thickness estimation has never been performed. We aimed to investigate whether changes in glycocalyx thickness in non-septic patients are associated with microcirculatory alterations in conjunctival and sublingual mucosa. In this single-centre prospective observational study, using techniques for direct in-vivo observation of the microcirculation, we performed a single measurement of microcirculatory perfusion parameters and visualized glycocalyx thickness in both ocular conjunctiva and sublingual mucosa in mixed cardio surgical (n = 18) and neurocritical patients (n = 27) and compared these data with age-matched healthy controls (n = 20). In addition we measured systemic syndecan-1 levels. In the sublingual and conjunctival region we observed a significant increase of the perfused boundary region (PBR) in both neuro-critical and cardiac surgical ICU patients, compared to controls. There was a significant increase of syndecan-1 in ICU patients comparing with controls and in cardiac patients comparing with neurological (120.0[71.0–189.6] vs. 18.0[7.2–40.7], p < 0.05). We detected a weak correlation between syndecan-1 and sublingual PBR but no correlations between global glycocalyx damage and conjuctival glycocalyx thickness. We found significantly lower perfused vessel density (PVD) of small vessels in sublingual mucosa in patients after cardiac surgery in comparison with healthy subjects. In neuro-critical, but not cardiac surgery patients conjunctival TVD and PVD of small vessels were found to be significantly lower in comparison with controls.

Simultaneous measurement of pulmonary diffusing capacity for carbon monoxide and nitric oxide

In Europe and America, the newly-developed, simultaneous measurement of diffusing capacity for CO (DLCO) and NO (DLNO) has replaced the classic DLCO measurement for detecting the pathophysiological abnormalities in the acinar regions. However, simultaneous measurement of DLCO and DLNO is currently not used by Japanese physicians. To encourage the use of DLNO in Japan, the authors reviewed aspects of simultaneously-estimated DLCO and DLNO from previously published manuscripts. The simultaneous DLCO-DLNO technique identifies the alveolocapillary membrane-related diffusing capacity (membrane component, DM) and the blood volume in pulmonary microcirculation (VC); VC is the principal factor constituting the blood component of diffusing capacity (DB,DB=θ·VC where θ is the specific gas conductance for CO or NO in the blood). As the association velocity of NO with hemoglobin (Hb) is fast and the affinity of NO with Hb is high in comparison with those of CO, θNO can be taken as an invariable simply determined by diffusion limitation inside the erythrocyte. This means that θNO is independent of the partial pressure of oxygen (PO2). However, θCO involves the limitations by diffusion and chemical reaction elicited by the erythrocyte, resulting in θCO to be a PO2-dependent variable. Furthermore, DLCO is determined primarily by DB (∼77%), while DLNO is determined equally by DM (∼55%) and DB (∼45%). This suggests that DLCO is more sensitive for detecting microvascular diseases, while DLNO can equally identify alveolocapillary membrane and microcirculatory abnormalities.

Microcirculation of the fingers in Raynaud's syndrome: (99m)Tc-DTPA imaging.

We investigated the circulatory characteristics of patients suffering of primary and secondary Raynaud's syndrome. We examined 106 patients presenting with the classical symptoms of Raynaud's syndrom (47 primary, 59 secondary) by hand perfusion scintigraphy developed by our Department of Nuclear Medicine. After visual evaluation we analyzed the images semiquantitatively, using the finger to palm ratio. We statistically compared the patients with primary and those with secondary Raynaud's syndrome. By visual evaluation we constated regional perfusion disturbances in 42 from 59 patients with secondary Raynaud's syndrome. However, this was observed in only 3 from 47 patients with the primary form of this disease. This difference was statistically significant (p<0.001). Semiquantitative analysis showed that the finger/palm ratios (FPR) were significantly lower (p<0.05) for the patients with primary Raynaud's syndrome. No differences in the FPR values concerning sex or right and left side. The hand perfusion scintigraphy with (99m)Tc-DTPA is a noninvasive, cost effective diagnostic tool, which objectively reflects the global and regional microcirculatory abnormalities of the hands, and provides quantitative data for follow-up.

'Primary' Microvascular Angina: Clinical Characteristics, Pathogenesis and Management.

Microvascular angina (MVA), i.e. angina caused by abnormalities of the coronary microcirculation, is increasingly recognised in clinical practice. The pathogenetic mechanisms of MVA are heterogeneous and may involve both structural and functional alterations of coronary microcirculation, and functional abnormalities may variably involve an impairment of coronary microvascular dilatation and an increased microvascular constrictor activity. Both invasive and non-invasive diagnostic tools exist to identify patients with MVA in clinical practice. Prognosis has been reported to be good in primary MVA patients, although the prognostic implications of coronary microvascular dysfunction (CMVD) in more heterogeneous populations of angina patients need further assessment. Management of primary MVA can be challenging, but pharmacological and non-pharmacological treatments exist that allow satisfactory control of symptoms in most patients.

Heart or Mind? Unexplained Chest Pain in Patients with and Without Coronary Disease

Patients with unexplained chest pain continue to present a difficult challenge for clinicians, especially for cardiologists. Approximately 20% of patients undergoing diagnostic coronary arteriography for acute or chronic cardiac ischemia have angiographically normal coronary arteries. In these cases, patients with chest pain are usually reassured by their physician and other causes of substernal chest pain are searched. However, apart from a sizeable proportion of patients with gastroesophageal disorders, the remaining patients remain symptomatic without apparent reasons. The mechanism behind this phenomenon is likely to be the result of a combination of functional or anatomical abnormalities in the coronary microcirculation, a metabolic disorder which affects the handling of energy substrates by the heart, insulin resistance and neuropsychological components affecting pain perception. These patients often exhibit an increase in sympathetic outflow to the cardiovascular system, which might account for the reduction in coronary flow reserve, changes in metabolic utilization and development of insulin resistance that are seen in some of these patients. Therapeutically, beta-blockers appear to be most effective in controlling the symptoms associated with this condition, although those calcium antagonists which do not affect the neurohormonal system may be of some utility in patients with primary microvascular angina, in which microvascular spasm is operating or in whom excessive constriction of the distal component of the coronary circulation limits the vasodilatory reserve. This article reviews the clinical presentation, differential diagnosis, and approach to evaluation and therapy of this complex group of patients.

VASCULAR PATHOLOGY OF AN EYE AND THE THREAT OF DEVELOPING AGE-RELATED MACULAR DEGENERATION AFTER RADIATION EXPOSURE

On the contrary to the previous expectations, the most common Chornobyl catastrophe victim’s pathology was the vascular pathology of an eye. The work is devoted to the assessment of changes in capillary tubes, arterioles and venules, which were irradiated as a result of Chornobyl catastrophe and those who have been exposed to radiation while working in the Chornobyl exclusion zone. The results of eye vascular system examination is presented by 615 persons: 358 Chornobyl clean-up workers, inspected in 1993–1994, 2007–2008 and 257 participants of works at the «Shelter» object, that were inspected in 2007–2008 and in 2017. Microcirculatory damages in conjunctiva are the most early ionizing radiation induced eye damage. Dose dependence from microcirculatory damages in conjunctiva has been proved. The conjunctiva index, which characterizes the evaluation degree of microcirculatory abnormalities value for individuals irradiated at a dose of up to 10 mSv was 5.33±0.34, at a dose of 10 to 30 mSv – 9.71±0.93. Thus, a significant (t=4.42, p&lt;0.05) increase in the display of microcirculatory abnormalities in conjunctiva was revealed with an increase in the dose load. In the correlation analysis, there was found a direct connection, r = 0.48, between the conjunctiva index and the dose of irradiation. The expressive tendency to correlate the negative dynamics of the macular zone with the degree of deterioration of microcirculation shows the effect of microcirculatory disorders on the development of age-related macular degeneration. At the correlation analysis, there was found a direct connection of significant decreased number of functioning capillaries with the deterioration of the macular zone of the retina (r=0.37). It is also advisable to appoint prophylactic complexes of lutein and zeoxanthine to patients in the case of microcirculatory disorders.

Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis

BackgroundMildly elevated lactate levels (i.e., 1–2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to evaluate the association between relative hyperlactatemia, microcirculatory flow, and outcome.MethodsThis study was a predefined subanalysis of a multicenter international point prevalence study on microcirculatory flow abnormalities, the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Microcirculatory flow abnormalities were assessed with sidestream dark-field imaging. Abnormal microcirculatory flow was defined as a microvascular flow index (MFI) < 2.6. MFI is a semiquantitative score ranging from 0 (no flow) to 3 (continuous flow). Associations between microcirculatory flow abnormalities, single-spot lactate measurements, and outcome were analyzed.ResultsIn 338 of 501 patients, lactate levels were available. For this substudy, all 257 patients with lactate levels ≤ 2 mmol/L (median [IQR] 1.04 [0.80–1.40] mmol/L) were included. Crude ICU mortality increased with each lactate quartile. In a multivariable analysis, a lactate level > 1.5 mmol/L was independently associated with a MFI < 2.6 (OR 2.5, 95% CI 1.1–5.7, P = 0.027).ConclusionsIn a heterogeneous ICU population, a single-spot mildly elevated lactate level (even within the reference range) was independently associated with increased mortality and microvascular flow abnormalities. In vivo microscopy of the microcirculation may be helpful in discriminating between flow- and non-flow-related causes of mildly elevated lactate levels.Trial registrationClinicalTrials.gov, NCT01179243. Registered on August 3, 2010.

Experience of Sublingual Microcirculation Evaluation in Adults Patients with Severe Dengue

BackgroundSevere microcirculatory changes are involved in the pathophysiological mechanisms that lead to irreversible final stages of dengue shock. We report our experience of the evaluation of sublingual microcirculation in adult patients with severe dengueMethodsAdults patients with severe dengue (by WHO 2009 criteria) were included. Dengue diagnostics was made by positive serology for IgM / IgG, antigen NS1 or PCR. Sublingual Microcirculation (SM) was evaluated by Sidestream Dark Field imaging. Microvascular flow index (MFI), proportion of small-perfused vessels (%SVP), heterogeneity index (HI) and Total Vascular Density were calculated. All patients received Fluids Challenge (FC) at hospital admission.ResultsSM was assessed in 10 patients. The median age was 65 years [IQR: 34–70], 60% were male. Eight patients were admitted to the ICU, of which 63% required invasive ventilatory and vasoactive support. One patient died. After the fluid challenge, the median of the %SVP was 94 [IR: 97 – 77], the median of the MFI was 2.82 [IR: 2, 85 – 2, 14]. There were not significant differences in %SVP and MFI among the patients who survived. In the deceased patient, the %SVP with continuous flow was 59, 18% and the MFI was 1, 45; these values were significantly decreased compared with patients who survived. A significant negative correlation between hematocrit and %SVP, and MFI was found.ConclusionInitial fluid challenge, that identifies and treats volume depletion, could correct microcirculation abnormalities evaluated by SDF imaging. However, in the patient who did not respond to this challenge, significant alterations of the MFI and the %SVP were evidenced. There is a need for more studies to improve our understanding of the role of microcirculation evaluation in these patients.Disclosures All authors: No reported disclosures.

Microcirculatory Bed, Microcirculation, and Smoking-Associated Endothelial Dysfunction in Young Adults.

Computer-assisted video biomicroscopy of bulbar conjunctiva was employed to examine the sequelae of endothelial dysfunction manifested by microcirculatory bed abnormalities and microcirculation disturbances. The signs of endothelial dysfunction provoked by tobacco smoking in young adults disappeared after cessation of smoking, which resulted in pronounced widening of arterioles and capillaries as well as moderation of intravascular erythrocyte aggregation.