Sublingual functional capillary rarefaction in chronic heart failure

Patricia P. Wadowski, Martin H€ulsmann, Christian Sch€orgenhofer, Irene M. Lang, Raphael Wurm,Thomas Gremmel, Renate Koppensteiner, Barbara Steinlechner, Michael Schwameis, Bernd Jilma
European Journal of Clinical Investigation, Volume 48, Issue2 February 2018


Background and objective: Microcirculatory changes contribute to clinical symptoms and disease progression in chronic heart failure (CHF). A depression of coronary flow reserve is associated with a lower myocardial capillary density in biopsies. We hypothesized that changes in cardiac microcirculation might also be reflected by a systemic reduction in capillaries and visualized by sublingual videomicroscopy. The aim was to study in vivo capillary density and glycocalyx dimensions in patients with CHF vs healthy controls.

Methods: Fifty patients with ischaemic and nonischaemic CHF and standard treatment were compared to 35 healthy age-matched subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using a side- stream darkfield videomicroscope. Functional and perfused total capillary densities were compared between patients and controls. A reduced glycocalyx thickness was measured by an increased perfused boundary region (PBR).

Results: Median functional and total perfused capillary densities were 30% and 45% lower in patients with CHF (both P < .001). Intake of oral vitamin K antagonists was associated with significantly lower capillary densities (P < .05), but not independent of NT-proBNP. Dimensions of the glycocalyx were marginally lower in CHF patients than in healthy controls (<7% difference). However, PBR correlated significantly with inflammation markers (fibrinogen: r = .58; C-reactive protein: r = .42), platelet counts (r = .36) and inversely with measures of liver/renal function such as bilirubin (r = .38) or estimated glomerular filtration rate (r = .34) in CHF patients.

Conclusion: CHF patients have got a markedly lower functional and total per- fused capillary density in sublingual microvasculature when compared to controls, indicating a systemic decrease in microcirculation.