1. Evaluation of the heterogeneity of sublingual microcirculation in acute cardiac patients
Jakutis G.1, Polevoda V.1, Serpytis R.2, Serpytis P.2,3
1Vilnius University Faculty of Medicine, 2Centre of Cardiology and Angiology, Vilnius University Hospital Santariskiu Klinikos, 3Vilnius University, Faculty of Medicine, Clinic of Cardiovascular Diseases
Background
Results
Microvascular alterations can play an important role in the development of organ failure in critically ill patients. Microcirculatory changes are observed in septic shock as well as in acute cardiac conditions such as myocardial infarction (MI), unstable angina (UA) and other. Patients with acute cardiac pathology are at risk for developing cardiogenic shock. We aimed to assess the heterogeneity of microcirculation in this cohort of patients and evaluated whether early changes in sublingual microcirculation might serve as a predictor of worsening clinical condition or developing hemodynamic deterioration.
16 (69,5%) patients were male and 7 (30,5%) female. MI group consisted of 15 (65,2%) patients, CS group of 5 (21,7%) and OACP group of 3 (13,1%) patients. Mean total vessel perfusion was 89,83 ± 15,25% in the CS group, 91,96 ± 9,34% in the MI group and 99,54 ± 0,76% in the OACP group (p>0,05). Both small and medium vessel perfusion was most altered in the CS group (93,04 ± 10,05% and 83,31 ± 32,97% respectively). De Backer vessel density showed no significant difference between three groups (10,35 ± 2,03 in CS group vs. 10,91 ± 1,67 in MI group vs. 11,14 ± 1,05 in OACP group). Total vessel density was 8,06 ± 3,08 in the CS group vs. 6,67 ± 1,51 in the MI group and 4,99 ± 1,84 in the OACP group. Perfused vessel density was 7,42 ± 3,63 in the CS group vs. 6,12 ± 1,53 and 4,97 ± 1,85 in the MI and OACP groups respectively.
Patients and Methods
We have carried out a prospective, non-randomized study of 23 patients admitted to the intensive cardiac care unit. The inclusion criteria were: acute MI (last 24 hours), UA pectoris, cardiogenic shock (CS), myocarditis or severe arrhythmia. Patient groups were defined based on the admission diagnosis: MI group, CS group and other acute cardiac pathology (OACP) group. Real time patients’ microcirculation was assessed with The MicroScan Video Microscope system, data was processed with Automated Vascular Analysis 4.0 research software. Patients‘ clinical data and laboratory test results were obtained from electronical hospital records. Data was analyzed using SPSS v23 statistical package. Independent samples T-tests and analysis of variance (ANOVA) was used to compare the results amongst individual groups.
Fig. 3. Schematic comparison of microcirculation results between patient groups
Conclusions & Perspectives
Altered sublingual microcirculation can serve as a valuable early indicator of tissue hypoperfusion and herald the onset of cardiogenic shock and multiorgan failure after acute MI, however the method still needs further investigation with a larger cohort of patients. Certain inconsistencies of microcirculation are visible between patient groups with different acute cardiac pathologies, nonetheless current cohort is yet not sufficient to analyze the significance of these alterations. Further research is needed to establish the role of microcirculation in the development of CS.
Discussion
1. Imaging Unit
2. Calibration Unit
3. Detachable Handle
4. Battery Unit
5. Connecting Video Cable
6. A/C Adapter
7. Sterile Disposable Lenses
Key function of the microcirculation is regulating and distributing oxygen carrying RBCs in different organs. Our study of acute cardiac patients revealed distinctive microvascular alterations that included a decreased vascular density and a large number of non-perfused or intermittently perfused small and medium vessels. In critically ill patients, impairment of microcirculatory blood flow has been implicated as a pivotal pathophysiologic event associated with MODS and death. Recent clinical studies performed with patients in shock states, reported that microcirculatory abnormalities occur independent of macrocirculatory indices and the use of vasopressors provide no improvement in microcirculatory perfusion.
Fig. 1. Scheme of the MicroScan Video Microscope System
Fig. 2. Microcirculation imagining of 4 different patients with ava 4.0 software