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Skin microvascular distensibility and structural microangiopathy in idiopathic dilated cardiomyopathy and after heart
V B Sørensen1, H Wroblewski, S Galatius
1The Heart Center, Copenhagen University Hospital, Rigshospital, Copenhagen, DK-2100, USA. vbs@dadlnet.dk
Insights
Peripheral microvascular function, impaired in congestive heart failure (CHF), gradually improves after heart transplantation (HTX). Skin distensibility increases and structural microangiopathy appears to resolve post-transplant.
Area of Science:
- Cardiology
- Vascular Biology
- Transplantation Medicine
Background:
- Peripheral microvascular dysfunction, characterized by reduced skin distensibility and structural microangiopathy, is a known complication of congestive heart failure (CHF).
- The impact of heart transplantation (HTX) on these microvascular alterations and their potential for reversal remains incompletely understood.
Purpose of the Study:
- To investigate the changes in microvascular skin distensibility and structural microangiopathy following heart transplantation in patients with CHF.
- To determine if improvements in microvascular function correlate with structural changes post-HTX.
Main Methods:
- Cross-sectional and longitudinal studies were conducted.
- Microvascular skin distensibility was measured using the local isotope washout method in a histamine-relaxed vascular bed.
- Structural microangiopathy was assessed via skin biopsies to examine terminal arterioles.
Main Results:
- Skin distensibility was significantly reduced in patients with moderate and severe CHF compared to controls.
- Distensibility remained impaired post-HTX in a cross-sectional analysis.
- Longitudinal data revealed a gradual increase in skin distensibility after HTX, approaching control levels over 14 months.
- Structural microangiopathy was present in CHF patients but not in HTX patients in the cross-sectional study; however, normalization was not fully demonstrated longitudinally.
Conclusions:
- Decreased microvascular skin distensibility in CHF patients gradually reverses after heart transplantation.
- Structural microangiopathy associated with CHF appears to improve over time following HTX.
Abstract:
Peripheral microvascular function plays an important role in patients with congestive heart failure (CHF). Decreased microvascular distensibility in skin and structural microangiopathy of the lower leg have been demonstrated in CHF due to idiopathic dilated cardiomyopathy. Whether microvascular skin distensibility reverses after heart transplantation and is related to the structural microangiopathy has not been elucidated before now. Distensibility (stiffness) of resistance vessels in the skin was measured using the local isotope washout method in a histamine-relaxed vascular bed at the dorsum of the foot. The structure of terminal arterioles was determined from skin biopsies. The measurements were performed in two studies. A cross-sectional study included 20 patients with clinical moderate CHF (NYHA II), 11 severe CHF patients (NYHA III and IV), and 28 patients 9 +/- 6 months (mean +/- SD) after heart transplantation (HTX). Furthermore, 12 patients were studied in a longitudinal study before (CHF) and 3 +/- 1 months (HTX-3) and 14 +/- 4 months (HTX-14) after HTX. A control group of 24 healthy subjects was included. In the cross-sectional study, distensibility in skin was reduced with increasing severity of CHF (severe CHF 22 +/- 10% and moderate CHF 38 +/- 21% vs controls 54 +/- 14%; P < 0.0001 and P < 0.01, respectively). Distensibility was reduced in patients after HTX (HTX, 41 +/- 18%) compared to controls (P < 0.01). In the longitudinal study, distensibility was decreased before transplantation (20 +/- 10%, P < 0.0001 vs controls) and increased gradually after HTX to 35 +/- 16% at 3 months (P < 0.01 vs CHF, P < 0.005 vs controls) and to 40 +/- 12% at 14 months (P < 0.05 vs controls, P < 0.01 vs HTX-3, P < 0.005 vs CHF). Structural microangiopathy was demonstrated in CHF, but not in HTX, in the cross-sectional study. However, a normalization could not be demonstrated after HTX in the longitudinal study. We conclude that the decreased microvascular skin distensibility (increased stiffness) gradually reverses after HTX. Furthermore, the structural microangiopathy seems to improve gradually.