Skin microvascular endothelial function as a biomarker in cardiovascular diseases?

Hellmann, Marcin; Roustit, Matthieu; Cracowski, Jean‐Luc

doi:10.1016/j.pharep.2015.05.008

Cited by 82 publications

(68 citation statements)

References 56 publications

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“…To discover the potential of skin microcirculation, the microcirculatory function and its correlation to other vascular measurements needs to be investigated in larger, standardized studies [7]. This integrated system is a new tool for assessing microvascular dysfunction and is recently commercial available for research by the Periflux 6000 EPOS (enhanced perfusion and oxygen saturation) system.…”

Section: Clinical Applications and Future Researchmentioning

confidence: 99%

“…An impaired microcirculation is also considered to be a cardiovascular risk factor [2]. To assess microcirculatory function in the body, the cutaneous microcirculation can be investigated since it is easy accessible and its function can be seen as a representative for the microcirculation in the whole body [6,7]. In diabetes mellitus, an impaired skin microcirculation can be manifested in several ways, including impairment in the capillary recruitment or a reduced ability of the vessels to dilate when needed [8].…”

Section: Introductionmentioning

confidence: 99%

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Model-based quantitative assessment of skin microcirculatory blood flow and oxygen saturation

Jonasson¹

2016

Linköping Studies in Science and Technology. Dissertations

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The microcirculation, involving the smallest vessels in the body, is where the oxygen transport to all tissue occurs. Evaluating microcirculatory parameters is, therefore, important and involves the quantification of oxygen content of red blood cells (RBCs), the amount of RBCs and their speed.Diffuse reflectance spectroscopy (DRS) can be used to estimate blood oxygen saturation and fraction of RBCs in tissue since oxygenated and deoxygenated blood have different light absorption characteristics. By illuminating the skin with white light and detecting the spectrum of the backscattered light, tissue absorption and scattering can be assessed. Laser Doppler flowmetry (LDF) is a technique to measure blood flow in tissue. When laser light encounter moving objects in tissue, i.e. RBCs, the light is Doppler shifted, which can be detected and used to calculate tissue perfusion (the fraction of moving RBCs times their speed). With a small distance between light source and detector, both techniques measure superficially where most vessels are microcirculatory vessels. Photon transport in tissue can be simulated with Monte Carlo techniques and the simulations form the basis of modeled DRS and LDF spectra. The estimated microcirculatory parameters are given by the model that best describe measured DRS and LDF data.This thesis describes the development and the evaluation of an optical method to simultaneously measure oxygen saturation, RBC tissue fraction and speed resolved perfusion in absolute units by integrating DRS and LDF. By combining DRS and LDF into one system with a common tissue model, the two modalities can benefit from each other's strengths. Different calibration methods and model assumptions for the system were evaluated in optical phantoms and in skin measurements. A simple calibration method with two detector distances for DRS was found adequate to accurately estimate absorption and scattering in optical phantoms. It was also necessary to model blood located in vessels, rather than homogeneously distributed in the skin, to obtain accurate parameter estimates. The system was evaluated in healthy subjects during standard provocations, where the parameters were in agreement with other studies and followed an expected pattern during the provocations. In patients with diabetes type 2, tissue fraction of RBCs and nutritive blood flow were reduced in baseline compared to healthy controls. These differences were not related to prevalence of microalbuminuria, a marker sign of microvascular complications in the kidneys.A combined system with DRS and LDF enables a more comprehensive assessment of the microcirculation by measuring oxygen saturation, RBC tissue fraction and speed resolved perfusion simultaneously and in absolute units. This system has clinical potential to assist in the evaluation of the microcirculation both in healthy and diseased individuals. POPULÄRVETENSKAPLIG SAMMANFATTNINGMikrocirkulationen innefattar de minsta kärlen i kroppen och det är här syretransporten till all vävnad i kroppen sker. ...

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Section: Clinical Applications and Future Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Model-based quantitative assessment of skin microcirculatory blood flow and oxygen saturation

Jonasson¹

2016

Linköping Studies in Science and Technology. Dissertations

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“…При этом, микроциркуля-торное русло, благодаря большому количеству различ-ных регуляторных механизмов, обладает большим "запасом прочности" и на протяжении длительного времени компенсирует развивающиеся нарушения гемодинамики, поддерживая трофическое обеспечение кожи на достаточном уровне. Но при дальнейшем про-грессировании патологии, компенсаторные механизмы системы микроциркуляции истощаются, а развиваю-щиеся трофические нарушения кожи выходят на пер-вый план, что требует активного лечения [15,16].…”

Section: результатыunclassified

Microcirculatory Reserves and Tissue Metabolism Reactivity in Various Stage Ischemic Congestive Heart Failure

Клинкова¹,

Kamenskaya²

2016

Russ J Cardiol

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Цель. изучить резервы микроциркуляции и реактивность тканевого метабо-лизма у больных ишемической болезнью сердца (ибС) при различной стадии хронической сердечной недостаточности (ХСН). Материал и методы. В исследование было включено 112 больных ибС. В 1-ю группу (45 человек) вошли пациенты с ХСН I-II ФК, во 2-ю (67 человек) -с ХСН III-IV ФК. Методом лазер-допплеровской флоуметрии (ЛДФ) изучались резервы кожного микроциркуляторного кровотока (МЦК) нижних конечностей. Реактивность тканевого метаболизма нижних конечностей определялась методом транскутанной оксиметрии (ТсрО 2 ). используя однофакторный логи-стический регрессионный анализ, вычисляли предикторы неблагоприятных событий со стороны сердечно-сосудистой системы в отдаленный период после коронарного шунтирования (КШ). Результаты. Уровень МЦК между группами не имел статистически значимых отличий. Резервы капиллярного кровотока (РКК) в 1-й группе были выше по срав-нению со 2-й -169,1±2,25% и 147,3±2,46% от фона, соответственно, (p=0,01). Наиболее низкая эффективность доставки кислорода к периферическим тканям была отмечена во 2-й группе (p=0,03). Резервы метаболической активности тка-ней в период постокклюзионной гиперемии -РТсрО 2 в 1-й и 2-й группах соста-вили 143,2±2,24% и 125,4±2,86% от фона, соответственно, (p=0,01). Однофакторный логистический регрессионный анализ выявил: 1) РКК менее 125% с наличием сахарного диабета 2 типа увеличивают шансы развития в отдаленный период после КШ хирургически значимых стенозов артерий ниж-них конечностей (ОШ 3,8; Ди 1,9-6,5; p=0,002); 2) фракция выброса ЛЖ менее 40%, увеличение уровня гомоцистеина более 15,5 мкмоль/л и показатели РТсрО 2 менее 120% увеличивают шансы развития в отдаленный период после КШ нарушения мозгового кровообращения (ОШ 4,1; Ди 2,2-7,8; p=0,001). Заключение. Взаимосвязь гипоксии периферических тканей на фоне дис-функции ЛЖ и гипергомоцистеинемии с развитием в отдаленные сроки после КШ нарушений церебрального кровообращения, а также исходно низкого РКК на фоне СД 2 типа с развитием после КШ хирургически значимых стенозов артерий нижних конечностей обуславливает необходимость расстановки акцентов на оценку резервов микроциркуляторного русла, как одного из веду-щих факторов развития сосудистых осложнений. ХСН -хроническая сердечная недостаточность, ибС -ишемическая болезнь сердца, ФК -функциональный класс, КШ -коронарное шунтирование, МЦК -микроциркуляторный кровоток, ЛДФ -лазерно-допплеровская флоу-метрия, СКО -среднее квадратическое отклонение, Kv -коэффициент вари-ации, РКК -резерв капиллярного кровотока, РТсрО -резерв ТсрО 2 , МЦК-фон -исходная величина микроциркуляторного кровотока, ТсрО 2 фон -исходная величина тканевого напряжения кислорода, МЦКмакс -максимальные значения МЦК, ТсрО 2 макс -максимальные значения тканевого напряжения кислорода, ОШ -отношение шансов, Ди -доверительный интервал, ЛЖ -левый желудочек, СД -сахарный диабет, САД -систоличе-ское артериальное давление, ДАД -диастолическое артериальное давление, ЧСС -частота сердечных сокращений. Aim. to assess microcirculatory reserves a...

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“…What we know today regarding the correlation between skin microvascular responses and cardiovascular risk factors, is that measurements from the skin can be used as prognostic biomarkers rather than diagnostic biomarkers (Hellmann et al, 2015). Improved understanding of the pathophysiology and linkage between skin response to disease may successively lead to improved prognostics and potential diagnostic tools.…”

Section: Future Perspectivesmentioning

confidence: 99%

Assessment of microvascular and metabolic responses in the skin

Iredahl¹

2016

Linköping University Medical Dissertations

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The general aim of this project was to develop experimental in vivo models that allow for minimally invasive investigations of responses in the skin to microvascular and metabolic provocations. The cutaneous microvasculature has emerged as a valuable model and been proposed to mirror the microcirculation in other organs. Dysfunction in the cutaneous microcirculation has thus been linked to systemic diseases such as hypertension and diabetes mellitus. Models for investigating skin responses could facilitate the understanding of pathophysiological mechanisms as well as effects of drugs. In the first study, three optical measurement techniques (laser Doppler flowmetry (LDF), laser speckle contrast imaging (LSCI) and tissue viability imaging (TiVi)) were compared against each other and showed differences in their ability to detect microvascular responses to provocations in the skin. TiVi was found more sensitive for measurement of noradrenaline-induced vasoconstriction, while LSCI was more sensitive for measurement of vascular occlusion. In the second study, microvascular responses in the skin to iontophoresis of vasoactive drugs were found to depend on the drug delivery protocol. Perfusion half-life was defined and used to describe the decay in the microvascular response to a drug after iontophoresis. In the third study, the role of nitric oxide (NO) was assessed during iontophoresis of insulin. The results showed a NO-dependent vasodilation in the skin by insulin. In the fourth study the vasoactive and metabolic effects of insulin were studied after both local and endogenous administration. Local delivery of insulin increased skin blood flow, paralleled by increased skin concentrations of interstitial pyruvate and lactate, although no change in glucose concentration was observed. An oral glucose load resulted in an increased insulin concentration in the skin paralleled by an increase in blood flow, as measured using the microdialysis urea clearance technique, although no changes in perfusion was measured by LSCI. The thesis concludes that when studying skin microvascular responses, the choice of measurement technique and the drug delivery protocol has an impact on the measurement results, and should therefore be carefully considered. The thesis also concludes that insulin has metabolic and vasodilatory effects in the skin both when administered locally and as an endogenous response to an oral glucose load. The vasodilatory effect of insulin in the skin is mediated by nitric oxide

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Skin microvascular endothelial function as a biomarker in cardiovascular diseases?

Cited by 82 publications

References 56 publications

Model-based quantitative assessment of skin microcirculatory blood flow and oxygen saturation

Model-based quantitative assessment of skin microcirculatory blood flow and oxygen saturation

Microcirculatory Reserves and Tissue Metabolism Reactivity in Various Stage Ischemic Congestive Heart Failure

Assessment of microvascular and metabolic responses in the skin

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