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. 2014 May;11(4):504-12.
doi: 10.1513/AnnalsATS.201308-277OC.

Sublingual microcirculation in pulmonary arterial hypertension

Luma Dababneh  1 , Frank Cikach, Laith Alkukhun, Raed A Dweik, Adriano R Tonelli
Affiliations

Sublingual microcirculation in pulmonary arterial hypertension

Luma Dababneh et al. Ann Am Thorac Soc. 2014 May.

Abstract

Rationale: Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy that leads to failure of the right ventricle and premature death.

Objectives: To determine whether the sublingual microcirculation is affected in patients with PAH compared with healthy age- and sex-matched control subjects.

Methods: Using the CapiScope Handheld Video Capillaroscope we measured the sublingual microvasculature density, flow index, tortuosity, and curvature. Videos were acquired immediately after right heart catheterization, and determinations were made off-line by investigators blinded to the group assignment or hemodynamics.

Measurements and main results: In this cross-sectional pilot study, we included 26 patients with PAH (age, mean ± SD, 56.7 ± 10 yr; 77% women) and 14 healthy control subjects (age, 53.1 ± 12 yr; 71% women). Sublingual microvasculature flow index was lower (2 ± 0.66 vs. 2.7 ± 0.37, P < 0.001) with higher heterogeneity index (0.63 ± 0.63 vs. 0.25 ± 0.25, P = 0.04) in patients with PAH than control subjects. Microvasculature density was similar between the groups, but tortuosity was more pronounced in patients than control subjects (tort 0: 45 ± 19 vs. 23.6 ± 12, P = 0.001 and tort 1: 0.2 ± 0.16 vs. 0.06 ± 0.04, P < 0.001).

Conclusions: Patients with PAH showed lower sublingual microvasculature flow index and higher tortuosity compared with healthy age- and sex-matched control subjects. Further investigations are needed to assess whether this methodology can provide information on disease prognosis and/or response to therapy in this condition.

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Figures

Figure 1.
Figure 1.
CapiScope handheld device connected to a laptop computer. Reprinted by permission from KK Technology.
Figure 2.
Figure 2.
Small vessel density of sublingual microvasculature in a control subject (A) and patient with pulmonary arterial hypertension (B). Microvascular density is measured by counting the small vessels (<20 μm) that cross the gridlines.
Figure 3.
Figure 3.
Tortuosity and curvature in a control subject (A) and patient with pulmonary arterial hypertension (B).
Figure 4.
Figure 4.
CapiScope software used to measure the tortuosity and curvature of sublingual vessels. Red lines were drawn along the vessels to obtain the calculations provided.
See this image and copyright information in PMC

Comment in

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