Microcirculatory Abnormalities Research Articles

Case of fulminant type 1 diabetes with coronary microcirculatory dysfunction.

A 29-year-old man was transferred to the Jichi Medical University Saitama Medical Center, Saitama, Japan, because of disturbance of consciousness and was admitted. A total of 6 days before the admission, he felt fatigue and fever. He first visited another clinic and was diagnosed with acute gastroenteritis. However, his symptoms remained unchanged and his consciousness level gradually worsened. On the admission day, his blood pressure was 122/46 mmHg, his pulse rate was 106 b.p.m. and he was afebrile. Laboratory data showed plasma glucose of 2,348 mg/dL and ketonuria. The patient had coexisting severe rhabdomyolysis and acute kidney injury (maximum CK 26,852 mU/mL, CK-MB 699 mU/mL and creatinine 5.6 mg/dL). Arterial blood gas analysis showed a pH of 7.03. The patient's glycated hemoglobin level was 6.0%, but serum and urinary C-peptide levels were undetectable. Islet-specific autoantibodies (anti-GAD, anti-IA2 antibodies and ICA) were undetectable. These suggested fulminant type 1 diabetes. Electrocardiography (ECG) was normal on admission. Insulin and saline intravenous infusion were started. After 14 h, ST-T elevation in II, III, aVF, V5 and V6 were observed, and ST-T depression in aVL (Figure​(Figure1)1) and plasma glucose level was 976 mg/dL. Echocardiography showed diffuse severe hypokinesis, especially of the inferior wall of the left ventricle. We carried out coronary angiography (CAG) to rule out acute myocardial infarction (AMI). CAG showed normal coronary arteries, but a contrast medium staining in capillaries was seen through all coronary lesions. 123I-MIBG and 201TlCl scintigraphy on the third hospital day showed less perfusion in the posteroinferior wall. Viral antibodies, such as Coxsackie virus (A9, B1-6), Echovirus 9, Herpes simplex virus, Cytomegalovirus and Epstein–Barr virus, were negative. These results suggested myocardial microvascular dysfunction. ECG and echocardiography findings were normalized on the eighth hospital day. Myocardial contrast echocardiography was normal on the 15th hospital day. The no-reflow phenomenon is known as microvascular dysfunction as a result of myocardial ischemia, typically it is described as reperfusion injury after percutaneous coronary intervention of AMI. However, there were no abnormalities detected by coronary angiography. Other than AMI, acute myocarditis, acute pericarditis, stress-induced cardiomyopathy, hyperkalemia, hypophosphatemia and hypomagnesemia could be made into a differential diagnosis. Echocardiography, CAG and scintigraphic findings showed that both acute pericarditis and stress induced cardiomyopathy are unlikely. In addition, the electrolyte disorders were not present. Myocarditis was ruled out from ECG reciprocal change. Eventually, we considered this patient was likely to have impaired microvascular function elicited by hyperglycemia. Cohen et al.1 described a case with ST-T segment change, and hyperkalemia and ketoacidosis. Typical cases of AMI like ST-T segment change in the case with DKA were reported as pseudomyocardial infarction. Although the present patient had no hyperkalemia, he presumably had a pathophysiology similar to the pseudomyocardial infarction pattern with hyperglycemia. Acute hyperglycemia increases oxidative stress, and leads to elevation of inflammatory cytokines and platelet activation2–4. The present case is the first report of fulminant type 1 diabetes in which CAG was carried out just during the occurrence of ST-T elevation. We suggest that hyperglycemia is likely a cause of microcirculation abnormalities and acute myocardial damage. However, there is no clear evidence that hyperglycemia directly causes myocardial damage, although further studies are required. Figure 1 (a) normal electrocardiography on arrival. (b) ST elevations in II, III, aVF, V5 and V6, and ST-T depression in aVL 14 h after hospitalization.

Current understanding on venous leg ulcer

Venous leg ulcer (VLU) or stasis ulcer is a relatively common, chronic and recurring problem. Besides being costly to the health-care system, it significantly impairs the quality of life of the patients. Nearly 1% of adults and 3.6% of older patients are reported to suffer from this chronic condition. Chronic venous insufficiency is considered to be the predominant cause of VLU. The most recent theories associate the pathogenesis of venous ulcer with microcirculatory abnormalities and generation of an inflammatory response. The pharmacological treatment for VLU is based on the pathogenesis and often includes diosmin, pentoxifylline, diuretics as well as antibiotics and the non-pharmacological treatment like compression and skin grafting. VLU has a high rate of recurrence and requires self-care to avoid relapse. Treatment of VLU should always focus for complete treatment, and improve quality of life for patients along with minimum relapse. In recent years novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder.

Functional and structural abnormalities of the skin microcirculation in hemodialysis patients

The changes that occur at the level of the skin microvessels reflect changes at other microvessels including the cardiac microvessels. Several disease states seem to alter skin microvascular function and structure such as diabetes, hypertension, and hypercholesterolemia. Many of these disease states are frequently encountered in hemodialysis (Hdx) patients. The process of Hdx itself is also associated with vascular abnormalities. It was thus the aim of our study to examine the structure and function of skin microcirculation in Hdx patients. Sixty patients were examined: 20 patients on regular Hdx, younger than 60 years old, with no diabetes, hypertension, or hypercholesterolemia, 20 patients on regular hemodialysis with coexisting hypertension (Htn-Hdx), and 20 young healthy volunteers. The skin microcirculation was assessed using the laser Doppler fluxmetry and the capillaroscope. Results showed significant differences in the laser Doppler fluxmetry measurements between the Hdx group and the Htn-Hdx group compared with the control group, with no significant differences in the capillaroscope study. The study of skin microcirculation in Hdx patients indicated the presence of functional abnormalities without significant structural changes.

THU0312 Microcirculation Comparative Study in Fibromyalgia Patients with and without Raynaud's Phenomenon

BackgroundPrevious studies demonstrated functional and morphological microcirculatory abnormalities that may be relevant to the pathophysiology and clinical manifestations of fibromyalgia (FM).ObjectivesTo ascertain and compare capillary morphology of FM patients with...

Precocious markers of cardiovascular risk and vascular damage in apparently healthy women with previous gestational diabetes.

Previous gestational diabetes mellitus (pGDM) indicates future risk for type 2 diabetes (T2DM). Insulin resistance (IR) may precede T2DM in many years and is associated with an increased risk for cardiovascular diseases.AimThis study aims to identify endothelial dysfunction and cardiovascular risk factors in women with pGDM.MethodsThis cross-sectional analysis included 45 non diabetic women, 20 pGDM and 25 controls, at least one year after delivery. Body mass index (BMI), abdominal circumference (AC), blood pressure, serum lipids, liver enzymes, uric acid, nonesterified fatty acids, C-reactive protein and plasma glucose, insulin, fibrinogen and plasminogen activator inhibitor 1 were measured. HOMA IR and β were calculated. Pre and post induced ischemia videocapillaroscopy was performed in hand nailfold to evaluate microvascular morphologic aspect and functional response.ResultsAC and fasting glucose were significantly higher in pGDM (p = 0.01 and p = 0.002 respectively). Women with pGDM and BMI < 25 kg/m2 had significantly higher levels of fasting insulin and HOMA IR than controls (p = 0.008 and 0.05 respectively). Abnormal morphologic findings were more frequent and papillae rectification were 3.3 times more prevalent in pGDM (p = 0.003). Other microvascular parameters did not differ between groups.ConclusionCardiovascular risk factors and a microcirculation abnormality (papillae rectification) were significantly increased in young non-diabetic women with pGDM.

Atherosclerosis in patients with prediabetes and type 2 diabetes is associated with more significant microcirculation abnormalities

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Association of parental blood pressure with retinal microcirculatory abnormalities indicative of endothelial dysfunction in children

Microcirculatory abnormalities precede the onset of hypertension and may explain its familial nature. We examined the relationship between parental blood pressure (BP) and offspring retinal microvasculature in Pakistani trios [father, mother, and child (aged 9-14 years)]. This is a substudy of a population-based trial of BP reduction. Data were available on 358 normotensive, and 410 offspring of at least one hypertensive parent. Retinal vessel characteristics were measured from digital images. Multivariable linear regression models were built to assess the associations between maternal and paternal BP and offspring retinal microvasculature. Optimality deviation was greatest in offspring of two hypertensive parents, compared with those with one or no hypertensive parent (P=0.030 for trend). Paternal SBP and DBP were each significantly associated with optimality deviation in offspring (P=0.023 and P=0.006, respectively). This relationship persisted after accounting for offspring cardiovascular risk factors [increase in optimality deviation (95% confidence interval, CI) 0.0053 (0.0001-0.0106, P=0.047) and 0.0109 (0.0025-0.0193, P=0.011), for each 10 mmHg increase in paternal SBP and DBP, respectively]. Maternal DBP was inversely associated with offspring arteriovenous ratio -0.0102 (-0.0198 to -0.0007, P=0.035). Microvascular endothelial dysfunction in children is associated with increasing levels of parental hypertension. The association with paternal BP is independent of other cardiovascular risk factors, including the child's BP. Higher maternal DBP is associated with evidence of arteriolar narrowing in offspring. These early microcirculatory changes may help explain familial predisposition to hypertension in people of Pakistani origin at an early age. :

The Microcirculation Is Preserved in Emergency Department Low‐acuity Sepsis Patients Without Hypotension

Microcirculatory dysfunction plays an important role in sepsis pathophysiology. Previous studies using sidestream dark-field (SDF) imaging have demonstrated microcirculatory flow abnormalities in patients with septic shock; however, the microcirculation is relatively unstudied in lower-acuity sepsis patients. The hypothesis was that patients with sepsis, but without hypotension, will demonstrate signs of flow abnormalities compared to noninfected control patients. This was a prospective, observational study in a convenience sample of patients with sepsis and noninfected controls, conducted in three urban, tertiary care emergency departments (EDs) in the United States. Sepsis was defined as suspected infection plus two or more systemic inflammatory response syndrome (SIRS) criteria; those with hypotension were excluded. Noninfected controls were ED patients without infection and without SIRS criteria. SDF imaging was obtained in all study patients during ED evaluation. Recommended microcirculatory flow parameters were measured, and the difference in these measures between sepsis patients and noninfected controls were calculated. The authors also correlated microcirculatory flow parameters with patient variables, including serum lactate. A total of 106 patients were enrolled: 63 with sepsis and 43 noninfected controls. There were no differences in microcirculatory flow scores between sepsis patients and noninfected controls. Median microvascular flow index (MFI; with interquartile range [IQR] was 3.00 (IQR=2.73 to 3.00) in sepsis patients versus 2.93 (IQR=2.73 to 3.00) in control patients (p=0.33), and mean proportion of perfused small vessels (PPV) was 91.5% (95% CI= 89.7% to 93.3%) versus 91.8% (95% CI= 89.7% to 93.9%), with a mean difference of 0.3% (95% CI=-2.5% to 3.1%; p=0.84). Similarly, there were no significant differences in total vessel density, perfused vessel density, or heterogeneity index (HI). In the subset of infected patients for whom serum lactates were obtained (n%37), MFI and PPV were negatively correlated with elevated serum lactate values: r=-0.32, p=0.04; and r=-0.44, p<0.01, respectively. Measureable microcirculatory flow abnormalities were not observed in patients with early sepsis in the absence of hypotension. However, microcirculatory abnormalities were correlated with elevated serum lactate in normotensive sepsis patients, supporting the notion that impaired microcirculatory flow is coupled with cellular distress.

English

Photoacoustic imaging, also called optoacoustic imaging, is a new biomedical imaging modality based on the use of laser-generated ultrasound. It is a hybrid modality, combining the high- contrast and spectroscopy based specificity of optical imaging with the high spatial resolution of ultrasound imaging. In essence, a Photoacoustic image can be regarded as an ultrasound image in which the contrast depends not on the mechanical and elastic properties of the tissue, but its optical properties, specifically optical absorption. As a result, it offers greater specificity than conventional sonographic imaging with the ability to detect haemoglobin, lipids, water and other light-absorbing chromophores, but with greater penetration depth than purely optical imaging modalities that rely on ballistic photons. In addition to visualizing anatomical structures such as the microvasculature, it can also provide functional information such as blood oxygenation, blood flow and temperature. These attributes make photoacoustic imaging applicable in clinical medicine, preclinical research and early detection of cancer, cardiovascular disease and abnormalities of microcirculation. Photoacoustic microscopy is a promising tool for imaging both dental decay and dental pulp. Using photoacoustics, near-infrared optical contrast between sound and carious dental tissues can be detected relatively easily and accurately at ultrasound resolution and may ultimately allow for continuous monitoring of caries before and during treatment. Photoacousting imaging compares favorably to other imaging modalities with its precise depth information, submillimeter resolution, and nanomolar sensitivity. With further improvement in background reduction, as well as the use of lasers with high-repetition rates, it is likely that Photoacoustic imaging will find wide use in the future in both basic research and clinical care. It is a highly vibrant research field in the years to come. This paper intends to discuss recent technical progress in photoacousting imaging and presents corresponding applications. INTRODUCTION: Photoacoustic imaging, an emerging hybrid imaging modality that can provide strong endogenous and exogenous optical absorption contrasts with high ultrasonic spatial resolution using the photoacoustic (PA) effect, has overcome the fundamental depth limitation. The image resolution is scalable with the ultrasonic frequency. The imaging depth is limited to the reach of photons and up to a few centimeters deep in biological tissues.Possessing many attractive characteristics such as the use of nonionizing electromagnetic waves, good resolution and contrast, portable instrumentation, and the ability to partially quantitate the signal, photoacoustic techniques have been applied to the imaging of cancer, wound healing, disorders in the brain, and gene expression, among others. As a promising structural, functional, and molecular imaging modality for a wide range of biomedical applications, photoacoustic imaging can be categorized into two types of systems: photoacoustic computed tomography (PACT) and photoacoustic microscopy (PAM).The photoacoustic computed tomography (PACT), which uses reconstruction algorithms to generate an

Microcirculação na sepse: aspectos fisiopatológicos e diagnósticos

Due to its high incidence, morbidity, mortality and cost to the healthcare system, sepsis stands out among the many indications for intensive care unit admission. The microcirculatory dysfunction plays a central role in the genesis and maintenance of the septic syndrome, being a pathophysiologic milestone in this syndrome. In fact, one can say that sepsis is a disorder of the microcirculation being the first organ to fail during the progression of sepsis to the multiple organ dysfunction syndrome and death. It is now known that, despite adequate treatment of macro-hemodynamics, there is little correlation between the improvement in systemic hemodynamics and the correction of microcirculatory abnormalities, being the presence of these abnormalities more common among non survivors than in survivors. The reason for this disparity between the macro and micro‑hemodynamics is the presence of functional shunts in the microcirculation that “hide” the microcirculatory dysfunction from the systemic circulation. By not assessing the intrinsic events that occur in the microcirculation, conventional hemodynamic monitoring systems available in clinical practice fail to detect such abnormalities and response to treatments. This knowledge points to a great need in the diagnosis and treatment of sepsis: the diagnostic evaluation of the microcirculatory dysfunction. Fortunately, there are some diagnostic methods specifically targeted for the evaluation of the microcirculatory alterations. These methods can be divided into biomarkers, videomicroscopy techniques, techniques for assessment of the tissue oxygenation and techniques for evaluation of the microcirculation using the partial pressure of carbon dioxide. Aiming at a better understanding of the pathophysiological processes involved in the sepsis’s microcirculatory dysfunction, and of the currently available diagnostic tools, some fundamental concepts are presented.

P.13.1 Molecular biomarker of angiogenesis in neuromuscular disorders

In patients with neuromuscular disorders, microcirculation abnormalities in muscle tissues and angiogenesis affect pathomechanism. A total of 57 patients from 1.3 to 47.7years old with Duchenne muscular dystrophy (DMD), a total of 19 patients from 1.7 to 67.7years old with myotonic dystrophy (DM), a total of 31 patients with spinal muscular atrophy (SMA) from 3.0 to 58.3years old and 14 healthy controls (HC) from 6.9 to 48.7years old participated. We measured peripheral blood levels of circulating CD34+ cells and serum levels of creatine kinase (CK) in all participants, and serum levels of angiogenin and matrix metalloproteinase-9 (MMP-9) in 39 DMD and 13 HC. Levels of CD34+ cells of DMD were 1.94±1.20 count/μl, and those of DM were 0.86±0.47 count/μl, and those of SMA were 1.59±1.16 count/μl, and those of HC were 1.52±0.92 count/μl. Levels of CD34+ cells in DMD and SMA showed higher tendency than HC. Levels of CD34+ cells in DM were significantly lower than others. Levels of CD34+ cells were higher in younger DMD group, but not correlated with CK. In SMA group, cases with unstable respiratory condition showed higher levels of CD34+ cells. Levels of angiogenin in DMD were significantly lower than those in HC (1467.0±524.2pg/ml, 1885.8±325.6pg/ml, respectively), while levels of MMP-9 in DMD were significantly elevated as compared to HC (4.25±2.65ng/ml, 2.90±1.27ng/ml, respectively). Angiogenin and MMP-9 showed higher tendency in elder DMD group, and there was no significant correlation between levels of CD34+ cells and angiogenin or MMP-9 in DMD. Muscle disintegration in DMD and respiratory insufficiency in SMA may be related with CD34+ cells. As a source of angiogenesis factor, circulating CD34+ cells and angiogenin have pivotal role in angiogenesis. CD34+ cells seem to play an important role in pathomechanism in DMD, but angiogenin does not.

Coronary microvascular dysfunction in primary cardiomyopathies

Myocardial ischaemia is usually caused by abnormalities of the epicardial coronary arteries. In the past 30 years, however, several studies have shown that abnormalities in the coronary microcirculation may also...

Impaired Coronary Autoregulation Is Associated With Long-term Fatal Events in Patients With Stable Coronary Artery Disease

Abnormalities in the coronary microcirculation are increasingly recognized as an elementary component of ischemic heart disease, which can be accurately assessed by coronary flow velocity reserve in reference vessels (refCFVR). We studied the prognostic value of refCFVR for long-term mortality in patients with stable coronary artery disease. We included patients with stable coronary artery disease who underwent intracoronary physiological evaluation of ≥ 1 coronary lesion of intermediate severity between April 1997 and September 2006. RefCFVR was assessed if a coronary artery with <30% irregularities was present. RefCFVR >2.7 was considered normal. Patients underwent revascularization of all ischemia-causing lesions. Long-term follow-up was performed to document the occurrence of (cardiac) mortality. RefCFVR was determined in 178 patients. Kaplan-Meier estimates of 12-year all-cause mortality were 16.7% when refCFVR >2.7 and 39.6% when refCFVR ≤ 2.7 (P<0.001), whereas Kaplan-Meier estimates for cardiac mortality were 7.7% when refCFVR >2.7 and 31.6% when refCFVR ≤ 2.7 (P<0.001). After multivariable adjustment, refCFVR ≤ 2.7 was associated with a 2.24-fold increase in all-cause mortality hazard (hazard ratio, 2.24; 95% confidence interval, 1.13-4.44; P=0.020) and a 3.32-fold increase in cardiac mortality hazard (hazard ratio, 3.32; 95% confidence interval, 1.27-8.67; P=0.014). Impairment of refCFVR originated from significantly higher baseline flow velocity in the presence of significantly lower reference vessel baseline microvascular resistance (P<0.001), indicating impaired coronary autoregulation as its cause. In patients with stable coronary artery disease, impaired refCFVR, resulting from increased baseline flow velocity indicating impaired coronary autoregulation, is associated with a significant increase in fatal events at long-term follow-up.

Somatostatin Replacement: A New Strategy for Treating Diabetic Retinopathy

Diabetic retinopathy (DR) has been classically considered to be a microcirculatory disease of the retina. However, there is growing evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR which participates in the microcirculatory abnormalities that occur in DR. Among the neuroprotective factors synthesized by the retina, somatostatin (SST) is one of the most relevant. In DR there is a downregulation of retinal expression of SST that is associated with retinal neurodegeneration. There is growing evidence suggesting that SST could play a key role in the main pathogenic mechanisms involved in the development of DR (neurodegeneration, neovascularization and vascular leackage). Recently, first evidence that the topical administration of SST prevents retinal neurodegeneration in streptozotozin- induced diabetic rats has been reported. Indeed, SST eye drops prevented b-wave abnormalities in the ERG which are considered sensitive indicators of DR. In addition, SST eye drops prevented, glial activation, apoptosis and the misbalance between proapoptotic and survival signalling caused by diabetes. Furthermore, SST eye drops reduce glutamate- induced excitotoxicity. Therefore, topical administration of SST could be contemplated as an appropriate therapeutic approach for DR. However, clinical trials will be needed to establish its exact position in the treatment of this devastating complication of diabetes. Diabetic retinopathy (DR) has been classically considered to be a microcirculatory disease of the retina. However, there is growing evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR which participates in the microcirculatory abnormalities that occur in DR [1]. The retina synthesizes neuroprotective factors which counteract the deleterious effects of neurotoxic factors involved in neurodegeneration. The loss of these neuroprotective factors or the reduction of their effectiveness is essential for the development of retinal neurodegeneration. Among the neuroprotective and neurotrophic factors somatostatin (SST) is one of the most relevant. The main aim of the present review is to provide experimental evidence supporting the promising therapeutical use of SST to prevent or arrest DR.

Wartość diagnostyczna wideokapilaroskopii łożyska okołopaznokciowego i testu hsCRP w ocenie subklinicznego zapalenia naczyń u młodocianych pacjentów z objawem Raynauda

&lt;b&gt;Wstęp: &lt;/b&gt;Wideokapilaroskopia wału przypaznokciowego umożliwia ocenę strukturalnych zaburzeń mikrokrążenia obwodowego u pacjentów z zespołem Raynauda (ZR). &lt;br /&gt; Zwiększenie stężenia białka C-reaktywnego, oznaczanego metodą wysokiej czułości (&lt;i&gt;high sensitivity C-reactive protein&lt;/i&gt; – hsCRP), jest natomiast uznanym wyznacznikiem zapalnej aktywacji lub dysfunkcji śródbłonka naczyniowego w wielu schorzeniach z autoimmunizacji, a także w miażdżycy, zwłaszcza w jej przedklinicznym stadium. &lt;br /&gt; &lt;b&gt;Cel pracy:&lt;/b&gt; Ocena zmian kapilaroskopowych w odniesieniu do czasu trwania objawu Raynauda oraz analiza zależności pomiędzy stężeniem hsCRP a ilościowymi i jakościowymi zaburzeniami mikrokrążenia obwodowego u dzieci i młodzieży z ZR. &lt;br /&gt; &lt;b&gt;Materiał i metody:&lt;/b&gt; Analizie poddano 144 pacjentów (104 dziewczęta i 40 chłopców) w średnim wieku 16,07 ±3,66 roku, u których co najmniej dwukrotnie wykonano badanie kapilaroskopowe. Badanych podzielono na 3 grupy w zależności od czasu trwania objawu Raynauda ( 2 lat, 2–5 lat i &gt; 5 lat). Badania przeprowadzano przy użyciu kapilaroskopu STEMI 2000 Firmy ZEISS. Pomiarów kapilar dokonano za pomocą programu komputerowego NIS-Elements D2.30 Nikon Corp. Japan. Pętle kapilar szersze niż 50 µm uznano za poszerzone. U 59 pacjentów z obecnymi nieprawidłowymi wzorami mikronaczyń i stwierdzonymi niskimi klasycznymi wskaźnikami zapalnymi oznaczono hsCRP metodą immunoturbidymetryczną przy użyciu HITACHI 912. &lt;br /&gt; &lt;b&gt;Wyniki&lt;/b&gt;: Wtórny ZR rozpoznano u 43 pacjentów (39,8%), a pierwotny objaw Raynauda (PR) u 101 (70,2%) osób. Zaburzenia w obrazach kapilaroskopowych były bardziej nasilone u pacjentów z dłuższym czasem trwania choroby (p &lt; 0,01). Średnie stężenie hsCRP (0,44 ±0,47 mg/dl) istotnie dodatnio korelowało z wiekiem pacjentów i czasem trwania ZR. Średnia szerokość ramienia tętniczego (35,4 ±11,4 µm) i żylnego (45,3 ±26,5 µm) istotnie dodatnio korelowały ze średnim stężeniem hsCRP (p &lt; 0,05).&lt;br /&gt; &lt;b&gt;Wnioski&lt;/b&gt;: U pacjentów z zespołem Raynauda stwierdzenie zaburzeń strukturalnych mikronaczyń w badaniu kapilaroskopowym jednocześnie ze zwiększonym stężeniem hsCRP sugeruje obecność subklinicznego vasculitis, z możliwą aktywacją śródbłonka. &lt;br /&gt; Dalsze badania strukturalnych i czynnościowych zaburzeń mikrokrążenia u pacjentów z wtórnym ZR mogłyby wspomóc działania ukierunkowane na hamowanie prozapalnej i prozakrzepowej aktywacji śródbłonka.

Microvascular Remodelling in Preeclampsia: Quantifying Capillary Rarefaction Accurately and Independently Predicts Preeclampsia

Preeclampsia is a major cause of maternal and neonatal mortality and morbidity. The incidence of preeclampsia seems to be rising because of increased prevalence of predisposing disorders, such as essential hypertension, diabetes, and obesity, and there is increasing evidence to suggest widespread microcirculatory abnormalities before the onset of preeclampsia. We hypothesized that quantifying capillary rarefaction could be helpful in the clinical prediction of preeclampsia. We measured skin capillary density according to a well-validated protocol at 5 consecutive predetermined visits in 322 consecutive white women, of whom 16 subjects developed preeclampsia. We found that structural capillary rarefaction at 20-24 weeks of gestation yielded a sensitivity of 0.87 with a specificity of 0.50 at the cutoff of 2 capillaries/field with the area under the curve of the receiver operating characteristic value of 0.70, whereas capillary rarefaction at 27-32 weeks of gestation yielded a sensitivity of 0.75 and a higher specificity of 0.77 at the cutoff of 8 capillaries/field with area under the curve of the receiver operating characteristic value of 0.82. Combining capillary rarefaction with uterine artery Doppler pulsatility index increased the sensitivity and specificity of the prediction. Multivariable analysis shows that the odds of preeclampsia are increased in women with previous history of preeclampsia or chronic hypertension and in those with increased uterine artery Doppler pulsatility index, but the most powerful and independent predictor of preeclampsia was capillary rarefaction at 27-32 weeks. Quantifying structural rarefaction of skin capillaries in pregnancy is a potentially useful clinical marker for the prediction of preeclampsia.

AB0843 Evaluation of endothelial function in patients with limited systemic sclerosis through echo doppler of the brachial artery and hand fingers capillaroscopy

BackgroundSystemic sclerosis is a chronic disease of the connective tissue, featured by excessive collagen deposition in the skin and internal organs associated to vascular damage. Its limited form (lSSc) is...

SAT0194 Autologous Fat Grafting in the Treatment of Fibrotic Perioral Changes in Patients with Systemic Sclerosis Restores Microvascular and Dermal Features

BackgroundAutologous fat grafts (AFG) for restoring soft tissue defects have been used for many decades and has many clinical applications. Recent studies have shown the efficacy of the AFG in...

The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement

ObjectivesTo assess residual long-term microcirculation abnormalities by capillaroscopy, 15 years after retiring from occupational exposure to vinyl chloride monomer (VCM).DesignCross-sectional study.SettingAllier, one of the major areas of polyvinyl chloride production...

THU0176 Subclinical myocardial dysfunction in primary antiphospholipid syndrome assessed by speckle tracking echocardiography

BackgroundBackground. Measurement of myocardial deformation or Global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is useful for detection of microvascular damage and myocardial contractility impairment in patients with ischemic...