Evaluation of systemic microvascular reactivity in adults with congenital heart disease
Pablo Marino1,2, Gabriella de Oliveira Lopes1,3, Juliana Pereira Borges3
1National Institute of Cardiology, Rio de Janeiro, Brazil.
Insights
Adults with congenital heart disease show higher baseline microvascular blood flow but no endothelial dysfunction. However, impaired endothelium-independent reactivity suggests vascular smooth muscle or structural changes, particularly in those with lower functional capacity.
Area of Science:
- Cardiovascular Research
- Microcirculation Physiology
- Adult Congenital Heart Disease
Background:
- Adults with congenital heart disease (ACHD) share similarities with chronic heart failure patients.
- Microvascular endothelial dysfunction is known in heart failure, but unstudied in ACHD.
- Systemic microvascular reactivity in ACHD requires investigation.
Purpose of the Study:
- To investigate systemic microvascular reactivity in adults with congenital heart disease.
- To compare microvascular function between ACHD patients and healthy controls.
Main Methods:
- Cardiopulmonary exercise testing was performed on ACHD patients.
- Cutaneous microvascular reactivity assessed using laser speckle contrast imaging.
- Iontophoresis of acetylcholine and sodium nitroprusside, plus postocclusive reactive hyperemia (PORH), evaluated endothelial-dependent and -independent responses.
Main Results:
- ACHD patients exhibited higher basal microvascular flow and acetylcholine response compared to controls.
- Endothelium-independent vasodilation to sodium nitroprusside was reduced in ACHD patients.
- No significant difference in PORH response was observed between groups.
- Lower functional capacity in ACHD patients correlated with higher basal microvascular flow.
Conclusions:
- ACHD patients have elevated baseline cutaneous microvascular blood flow but lack systemic endothelial dysfunction.
- Blunted endothelium-independent microvascular reactivity in ACHD suggests vascular smooth muscle or structural alterations.
- Reduced functional capacity in ACHD is associated with increased basal microvascular flow.
Objective:
Adults with congenital heart disease share some features with those with chronic heart failure. Although microvascular endothelial dysfunction has been described in chronic heart failure, evaluation of the microcirculation in adults with congenital heart disease is lacking. The present study aimed to investigate systemic microvascular reactivity in adults with congenital heart disease.
Interventions:
The patients initially underwent cardiopulmonary exercise testing. Then, the cutaneous microvascular reactivity was evaluated in these patients using a laser speckle contrast imaging system coupled with skin iontophoresis of endothelial-dependent (acetylcholine) or -independent (sodium nitroprusside) vasodilators and postocclusive reactive hyperemia (PORH) and compared with healthy controls matched for age and sex.
Results:
Thirty-one patients and 29 healthy controls were evaluated. The basal microvascular flow (P < .0001) and area under the curve in response to acetylcholine (P < .0001) were higher in the patients than in the healthy volunteers. The increase in cutaneous vascular conductance in response to sodium nitroprusside was reduced in the patients compared to the healthy volunteers (P = .0031). No difference in the microvascular response was observed during postocclusive reactive hyperemia. The basal microvascular flow of patients with peak oxygen consumption below 16.0 mL kg-1 min-1 was superior to that of patients with values greater than 16.0 mL kg-1 min-1 (P = .0046).
Conclusions:
Adults with congenital heart disease present a higher baseline cutaneous microvascular blood flow than healthy controls and do not present systemic microvascular endothelial dysfunction. Nevertheless, endothelium-independent microvascular reactivity is blunted, suggesting an altered vascular smooth muscle response or vascular structural alterations. Finally, patients with a lower functional capacity presented a greater microvascular basal blood flow than subjects with a higher functional capacity.
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