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Published on: August 1, 2014
Primary cutaneous microangiopathy in heart recipients
F Jung1, C Mrowietz, C Labarrere
1Dresden Institute for Cardiac and Circulatory Research e.V., Forststrasse 5, Dresden, 01099, Germany.
Insights
Heart transplant recipients with cardiac allograft vasculopathy and hypercholesterolemia exhibit impaired microcirculation. This study reveals reduced erythrocyte flow and loss of reactive hyperemia, indicating primary cutaneous microangiopathy.
Area of Science:
- Cardiology
- Vascular Biology
- Transplantation Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure.
- Severe hypercholesterolemia is a risk factor for cardiovascular disease.
- Microcirculatory dysfunction may precede or contribute to macrovascular complications.
Purpose of the Study:
- To investigate microcirculatory disturbances in heart transplant recipients with CAV and severe hypercholesterolemia.
- To compare microcirculation in these patients with those having coronary artery disease and healthy controls.
- To determine if primary cutaneous microangiopathy is present in CAV patients.
Main Methods:
- Measurement of erythrocyte velocity in cutaneous capillaries at the nail fold under resting conditions.
- Assessment of reactive hyperemia following 3-minute ischemia.
- Comparison of flow parameters between patient groups and healthy subjects.
Main Results:
- Patients with CAV and hypercholesterolemia showed significantly reduced resting capillary erythrocyte velocity (0.10 mm/s) compared to controls.
- Temporary cessation of capillary flow occurred in 8/11 CAV patients.
- CAV patients exhibited a complete loss of post-ischemic reactive hyperemia, unlike controls and coronary artery disease patients.
Conclusions:
- Heart transplant recipients with CAV and severe hypercholesterolemia display significant microcirculatory impairment.
- The findings suggest a primary cutaneous microangiopathy in these patients.
- Microcirculatory dysfunction may be a key factor in the development of CAV.
Abstract:
In this study we investigated whether a disturbance in microcirculation is detectable in heart recipients with cardiac allograft vasculopathy (CAV) and severe hypercholesterolemia (n = 11) and in 7 heart recipients without CAV in comparison to patients with severe coronary artery disease (n = 49) and age-matched apparently healthy subjects (n = 100). For this purpose, the flow velocity of erythrocytes through cutaneous capillaries at the nail fold of the finger was measured under resting conditions. In addition, reactive hyperemia in the same capillaries after a 3-min ischemia was determined. Patients with CAV and severe lipid disorder showed a pathological reduction in mean capillary erythrocyte velocity under resting conditions with v(RBC) = 0.10 +/- 0.07 mm/s. The latter was significantly and relevantly lower than in patients with coronary three-vessel disease (v(RBC) = 0.46 +/- 0.35 mm/s). It was notable that under resting conditions temporary cessation of flow occurred in 8 of the 11 patients which did not occur in healthy subjects and rarely in patients with three-vessel disease (1 of 49 patients). In comparison to age-matched healthy subjects (v(max) = 1.46 +/- 0.52 mm/s), the patients with three-vessel disease showed a significant reduction in postischemic maximum erythrocyte velocity (v(max) = 0.85 +/- 0.55 mm/s), with a considerable shortening of the duration of reactive hyperemia. Patients with CAV demonstrated a total loss of postischemic reactive hyperemia (only 1 of the 11 patients presented a weak reactive hyperemia). Since no macroangiopathy was detectable in the upstream arm arteries, primary cutaneous microangiopathy can be assumed in patients with cardiac allograft vasculopathy and severe hypercholesterolemia.
