A new complimentary web‐based tool for manual analysis of microcirculation videos: Validation of the Capillary Mapper against the current gold standard <scp>AVA</scp> 3.2

Heßler, Michael; Arnemann, Philip-Helge; Zamit, Frédéric; Seidel, Laura; Kampmeier, Tim-Gerald; Kathöfer, Ulrich; Morelli, Andrea; İnce, Can; Rehberg, Sebastian; Ertmer, Christian

doi:10.1111/micc.12505

Cited by 10 publications

(13 citation statements)

References 21 publications

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“…The videos obtained went through a quality check, based on the recommendations of Massey et al [33], and were manually discarded if necessary. The remaining 116 high-quality videos were semi-manually analyzed offline by an experienced operator (MH) blinded for the patients' clinical data, as thoroughly described previously [34], using dedicated software (Capillary Mapper 1.4, University of Muenster Medical Centre, Münster, Germany [35]). Total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI), and heterogeneity index (HI) were calculated in the microvessels under 20 μm, based on current recommendations, in order to assess microcirculation abnormalities in critically ill patients [25], as described in detail previously [36].…”

Section: Assessment Of Sublingual Microcirculationmentioning

confidence: 99%

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

et al. 2019

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Background The endothelial glycocalyx (eGC) covers the luminal surface of the vascular endothelium and plays an important protective role in systemic inflammatory states and particularly in sepsis. Its breakdown leads to capillary leak and organ dysfunction. Moreover, sepsis-induced alterations of sublingual microcirculation are associated with a worse clinical outcome. The present study was performed to investigate the associations between eGC dimensions and established parameters of microcirculation dysfunction in sepsis. Methods This observational, prospective, cross-sectional study included 40 participants, of which 30 critically ill septic patients were recruited from intensive care units of a university hospital and 10 healthy volunteers served as controls. The established microcirculation parameters were obtained sublingually and analyzed according to the current recommendations. In addition, the perfused boundary region (PBR), an inverse parameter of the eGC dimensions, was measured sublingually, using novel data acquisition and analysis software (GlycoCheck™). Moreover, we exposed living endothelial cells to 5% serum from a subgroup of study participants, and the delta eGC breakdown, measured with atomic force microscopy (AFM), was correlated with the paired PBR values. Results In septic patients, sublingual microcirculation was impaired, as indicated by a reduced microvascular flow index (MFI) and a reduced proportion of perfused vessels (PPV) compared to those in healthy controls (MFI, 2.93 vs 2.74, p = 0.002; PPV, 98.53 vs 92.58, p = 0.0004). PBR values were significantly higher in septic patients compared to those in healthy controls, indicating damage of the eGC (2.04 vs 2.34, p < 0.0001). The in vitro AFM data correlated exceptionally well with paired PBR values obtained at the bedside (rs = − 0.94, p = 0.02). Both PBR values and microcirculation parameters correlated well with the markers of critical illness. Interestingly, no association was observed between the PBR values and established microcirculation parameters. Conclusion Our findings suggest that eGC damage can occur independently of microcirculatory impairment as measured by classical consensus parameters. Further studies in critically ill patients are needed to unravel the relationship of glycocalyx damage and microvascular impairment, as well as their prognostic and therapeutic importance in sepsis. Trial registration Retrospectively registered: Clinicaltrials.gov, NCT03960307 Electronic supplementary material The online version of this article (10.1186/s13054-019-2542-2) contains supplementary material, which is available to authorized users.

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Section: Assessment Of Sublingual Microcirculationmentioning

confidence: 99%

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

et al. 2019

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“…Videos of the sublingual microcirculation were reviewed using the microcirculatory image quality score (MIQS) 53 and discarded if necessary. Analysis was conducted online using dedicated software 54 (Capillary Mapper 1.4, University of Muenster Medical Centre, Muenster, Germany) according to the consensus conference criteria for analysis of the microcirculation in microvessels (<20 μm) following established protocols 26,55,56 . From 3-5 high quality videos of the sublingual microcirculation were analyzed in a blinded manner for each participant, noting values of microvascular flow index (MFI by quadrants ), total vessel density (TVD), perfused vessel density (PVD by IDF ) and proportion of perfused vessels (PPV).…”

Section: Incident Dark Field Illumination Of the Sublingual Microcircmentioning

confidence: 99%

“…3). Afterwards the vessel length relative to the image size was determined in each of the exported image sections using dedicated software (Capillary Mapper 1.4, University of Muenster Medical Centre, Muenster, Germany) 54 .…”

Section: Incident Dark Field Illumination Of the Sublingual Microcircmentioning

confidence: 99%

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Heßler

Nelis

Ertmer

et al. 2020

Sci Rep

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Microcirculatory disorders are crucial in pathophysiology of organ dysfunction in critical illness. Evaluation of sublingual microcirculation is not routinely conducted in daily practice due to timeconsuming analysis and susceptibility to artifacts. We investigated the suitability of optical coherence tomography angiography (octA) for contactless evaluation of sublingual microcirculation. Sublingual microcirculation was imaged in 10 healthy volunteers, using an OCTA device and an incident dark field (IDF) illumination microscopy (current gold standard). OCTA images were analyzed with regard to flow density and perfused vessel density (PVD byoctA). IDF videos were analyzed following current recommendations. Flow density was automatically extracted from OCTA images (whole en face 48.9% [43.2; 54.5]; central ring 52.6% [43.6; 60.6]). PVD byoctA did not differ from the PVD calculated from IDF videos (PVD byoctA 18.6 mm/mm² [18.0; 21.7]) vs. PVD byIDF 21.0 mm/mm² [17.5; 22.9]; p = 0.430). Analysis according to Bland-Altman revealed a mean bias of 0.95 mm/mm² (95% Confidence interval −1.34 to 3.25) between PVD byoctA and PVD byIDF with limits of agreement of −5.34 to 7.24 mm/mm². This study is the first to demonstrate the suitability of OCTA for evaluating sublingual microcirculation. comparison of the perfused vessel density between methods showed a plausible level of agreement. In recent years, research has highlighted the importance of the microcirculation (vessels smaller than 100 μm) in the pathophysiology of diseases and organ dysfunction in critical illness. It is known that blood flow in the microcirculation is often impaired in critically ill patients and altered blood flow in the microcirculation is associated with outcome 1-6. A decoupling of macro-and microcirculation ("loss of hemodynamic coherence"), as can occur, for example, in advanced stages of septic shock is of particular interest here 7. In such conditions, macrohemodynamic parameters such as cardiac output and perfusion pressure are no longer indicative of perfusion in the microcirculation. The aim of hemodynamic therapy should therefore be restoration not only of the macrocirculation but also the microcirculation 7. Hence the demand for bedside methods to monitor the microcirculation. Bedside analysis of the microcirculation became possible with the introduction of modern handheld video microscopes using sidestream dark field (SDF) imaging or incident dark field (IDF) illumination technology 8-10. Unfortunately, the analysis of the microcirculation has not yet become established in routine clinical practice, as video microscopy of capillary blood flow has so far been limited by artifacts (e.g.

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“…Video analysis was performed on-line in a free-of-charge software, namely Capillary Mapper (https://capillary-mapper.uni-muenster.de). This website was successfully validated for manual analysis of microcirculation videos against the gold standard analyzer software AVA 3 [13]. Thus, our results suggest that landiolol has neither bene cial nor detrimental effect on microcirculation according current monitoring of the study.…”

Section: Discussionmentioning

confidence: 73%

“…Videomicroscopy records were performed according to current recommendations [12] to reach consensus statements in images acquisitions, quality and analysis. Video analyses were extracted in a speci c and validated software [13], namely Capillary Mapper® 1.4.1 online version (https://capillary-mapper.uni-muenster.de), to collect the following data: microvascular ow index (MFI) quadrant, proportion of perfused vessels (PPV), total vessel density (TVD) and heterogeneity index (HI).…”

Section: Patients' Management and Data Acquisitionmentioning

confidence: 99%

Micro- and Macrocirculatory Effects of Landiolol: A Double-Blind, Randomized Study Following Cardiac Surgery

Ferraris

Jacquet-Lagrèze

Cazenave

et al. 2021

Preprint

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Background: Postoperative atrial fibrillation (POAF) increases morbidity and mortality after cardiac surgery. Landiolol, a selective ultra-short-acting betablocker has been recently suggested to prevent POAF in the cardiac surgical setting with a good safety profile. Micro- and detailed macrocirculatory effects of landiolol remain however largely unknown in that setting.Methods: We conducted a prospective, randomized, double-blind study versus placebo in patients undergoing conventional cardiac surgery. Incremental doses of intravenous landiolol from 0.5 to 10 μg-1.kg-1.min-1 or placebo were administrated postoperatively. Microcirculatory variables were assessed by both peripheral near-infrared spectroscopy (NIRS) in combination with a vascular occlusion test and sublingual videomicroscopy. Macrocirculatory variables were obtained from transpulmonary thermodilution and transthoracic echocardiography. Results: Fifty-nine adult patients were allocated to the landiolol group (n=30) or the placebo group (n=29) from January to November 2019. Heart rate significantly decreased in the landiolol group (P<0.01) whereas mean arterial pressure (P=0.05) and stroke volume (P=0.63) were not significantly modified throughout the study. No modification was found in left and right systolic and diastolic ventricular functions except a significant increase in E/A ratio in the landiolol group (P=0.02). No difference was evidenced between groups in microcirculatory parameters at any landiolol dose. POAF occurred in 9 (32%) vs. 5 (17%) patients in placebo and landiolol groups, respectively (P=0.28). Conclusions: Postoperative incremental doses of landiolol up to 10 μg-1.kg-1.min-1 are efficacious to control heart rate without significant alterations in both micro- and macrocirculation following conventional cardiac surgery.

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A new complimentary web‐based tool for manual analysis of microcirculation videos: Validation of the Capillary Mapper against the current gold standard AVA 3.2

Abstract: The newly developed CM was successfully validated for manual analyses of microcirculation videos against the current gold standard, the software AVA 3.2.

Cited by 10 publications

References 21 publications

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis

Optical coherence tomography angiography as a novel approach to contactless evaluation of sublingual microcirculation: A proof of principle study

Micro- and Macrocirculatory Effects of Landiolol: A Double-Blind, Randomized Study Following Cardiac Surgery

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