Preview

Systemic Hypertension

Advanced search

Features of cutaneous microcirculatory blood flow in patients with pulmonary hypertension of different etiology

Abstract

Aim: to evaluate features of the functional state of microvascular bed of the skin in patients with pulmonary arterial hypertension associated to congenital cardiac disease (PAH-CCD) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods. In study included 25 patients (41.6±15.8) with PAH-CCD, 25 patients (48.8±14.2) with CTEPH and 25 healthy volunteers (39.3±10.1 years). All the patients underwent a six-minute walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) and Laser Doppler flowmetry (LDF) with amplitude and frequency wavelet analysis of blood flow oscillations and evaluation of constrictory and dilatatoryskin resistive microvesselsfunctions. Results. In the PAH-CCD in relation to the CTEPH groupaccording to the RHC were noted significantly higher values of systolic pressure in pulmonary artery (93.2 and 77.8 mm Hg respectively) and venous mixted blood saturation(63 and 57% Hg respectively). On this background 6- MWT distance was 356 and 325 m, the Borg dyspnea scale index was on average 3.12 and 3.76 respectively. According to the LDF pulseoximetry PAH-CCD and CTEPH patients had 90.1 and 94.7% respectively. According to the LDF with amplitude and frequency wavelet analysis the PAH-CCD patients had sig-nificantly higher values of the amplitude of myogenic, respiratory and pulse sectionof blood flow modulation, and also increased constrictory activity smooth muscle cells of skin precapillary arterioles in response to the stretching at venous occlusion and decreased dilatatory reserve at post-occlusi-ve reactive hyperemia. According to the LDF the CTEPH patients had elongationof time development of microvessel constriction in response to acti-vation of sympathetic nervous systemin respiratory and cold tests. Conclusion. According to the LDF functional state of skin microvessels in systemic circulation of the CTEPH patients was comparable with control groupexcept for elongation of time development of microvessel reactions for sympathetic vasoconstrictor stimulations. The PAH-CCD patients demonstrated basal tonus decreasing of smooth muscle cells of skin precapillary arterioles in systemic circulation, which can be regarded as a manifestation of autoregulatory response to systemic hypoxia.

About the Authors

E. V. Dolgova
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation
Russian Federation


A. A. Fedorovich
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation
Russian Federation


T. V. Martynyuk
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation
Russian Federation


A. N. Rogoza
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation
Russian Federation


I. E. Chazova
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation
Russian Federation


References

1. Simonneau G, Gatzoulis M.A, Adatia I et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62 (Suppl. 25): D34-41.

2. Чазова И.Е., Авдеев С.Н., Царева Н.А. и др. Клинические рекомендации по диагностике и лечению легочной гипертензии. Тер. архив, 2014, 9: 4-23.

3. Wilkens H, Lang I, Behr J et al. Chronic thromboembolic pulmonary hypertension (CTEPH): updated Recommendations of Cologne Consesus Conferense 2011. Int J Cardiol 2011; 154 (Suppl. 1): S54-60.

4. Beghetti M, Galie N, Bonnet D. Can ‘‘inoperable’’ congenital heart defects become operable in patients with pulmonary arterial hypertension? Dream or reality? Congenit Heart Dis 2012; 7: 3-11.

5. Lekakis J, Abraham P, Balbarini A et al. Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation. Eur J Cardiovasc Prev Rehabil 2011; 18 (6): 775-89.

6. Peled N, Bendayan D, Shitrit D et al. Peripheral endothelial dysfunction in patients with pulmonary arterial hypertension. Respir Med 2008; 102 (12): 1791-6.

7. Nakamura M, Yoshida H, Naganuma Y et al. Peripheral vasodilatory dysfunction in adult patients with congenital heart disease and severely elevated pulmonary vascular resistance. Angiology 2002; 53 (6): 715-20.

8. Pedersen C.M, Schmidt M.R, Mortensen B et al. Preserved flow - mediated dilation in adults with cyanotic congenital heart disease. Pediatr Cardiol 2009; 30: 965-70.

9. Сiftel M, Simsek A, Turan O et al. Endothelial dysfunction and atherosclerosis in children with irreversible pulmonary hypertension due to congenital heart disease. Ann Pediatr Card 2012; 5: 160-4.

10. Almond N. Laser Doppler flowmetry: Theory and practice, Laser Doppler. London, Los Angeles, Nicosia, Med - Orion Publishing Company, 1994; p. 17-31.

11. Stefanovska A, Bracic M, Kvernmo H.D. Wavelet analysis of oscillations in peripheral blood circulation measured by Doppler technique. IEEE Trans Biomed Eng 1999; 46: 1230-9.

12. Bernjak A, Clarkson P.B.M, Mc Clintock P.V.E, Stefanovska A. Low - frequency blood flow oscillations in congestive heart failure and after b1-blocade treatment. Microvasc Res 2008; 76: 224-32.

13. Федорович А.А. Неинвазивная оценка вазомоторной и метаболической функции микрососудистого эндотелия в коже человека. Рег. кровообращение и микроциркуляция. 2013; 12: 15-25.

14. Braverman I.M. The cutaneous microcirculation: ultrastructure and microanatomical organization. Microcirculation 1997; 4 (3): 329-40.

15. Stefanovska A, Bracic M. Physics of the human cardiovascular system. Contemporary Physics 1999; 40 (1): 31-5.

16. Borgos J. Principles of instrumentation: Calibration and technical issues. Laser Doppler. London - Los Angeles - Nicosia: Med - Orion Publishing Company 1994: 3-16.

17. Meyer M.F, Rose C.J, Hоlsmann J.O et al. Impaired 0.1-Hz vasomotion assessed by laser Doppler anemometry as an early index of peripheral sympathetic neuropathy in diabetes. Microvasc Res 2003; 65 (2): 88-95.

18. Крупаткин А.И., Сидоров В.В., Федорович А.А. и др. Колебательный контур регуляции числа функционирующих капилляров. Рег. кровообращение и микроциркуляция. 2006; 3: 54-8.


Review

For citations:


Dolgova E.V., Fedorovich A.A., Martynyuk T.V., Rogoza A.N., Chazova I.E. Features of cutaneous microcirculatory blood flow in patients with pulmonary hypertension of different etiology. Systemic Hypertension. 2016;13(3):35-41. (In Russ.)

Views: 111


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2075-082X (Print)
ISSN 2542-2189 (Online)