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Review
. 2025;62(5):233-248.
doi: 10.1159/000547636. Epub 2025 Jul 28.

Noninvasive Bedside Approaches for Assessing Microvascular Dysfunction

Jacob Widaeus  1   2 , Ingemar Fredriksson  3   4 , Sara Tehrani  1   2
Affiliations
Review

Noninvasive Bedside Approaches for Assessing Microvascular Dysfunction

Jacob Widaeus et al. J Vasc Res. 2025.

Abstract

Background: Microvascular dysfunction is implicated in a range of acute and chronic conditions, ranging from cardiovascular disease to sepsis, often preceding organ damage and clinical symptoms. Within conditions such as diabetes or septic shock, microvascular compromise frequently correlates with disease severity and outcomes, emphasizing the importance of timely, targeted assessment. Noninvasive bedside methods for evaluating microvascular function have rapidly evolved, driven by advances in computational power, artificial intelligence, and novel imaging hardware.

Summary: This review provides an overview of clinically feasible noninvasive techniques - including optical coherence tomography angiography, handheld videomicroscopy, laser speckle contrast imaging, reflectance spectroscopy, and related techniques. These methods allow observation under resting conditions and can be combined with functional tests such as post-occlusive reactive hyperemia, heating provocation, or iontophoresis to evaluate microvascular function.

Key messages: Collectively, these methods provide valuable insights into the structural and functional aspects of the microcirculation, but their clinical application is constrained by need for standardized protocols, validation, and evidence linking microvascular metrics to meaningful patient outcomes. Collaborations among academia, industry, and healthcare remain pivotal to transitioning these methods into regulated, accessible devices. As standardization progresses and evidence grows, this integrative approach of evaluating microvascular function may emerge as a mainstay in clinical practice and translational research.

Keywords: Microvascular dysfunction; Noninvasive assessment; Perfusion-based imaging; Spectral imaging; Structural imaging.

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Conflict of interest statement

Ingemar Fredriksson is employed by Perimed AB that is marketing products related to some of the techniques described in this publication. However, he or Perimed AB has not been involved in the selection of techniques included in the publication. All other authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Example of MELSCI of the palmar side of forearm, used in conjunction with Ionto of SNP in the right chamber and ACh in the left. Higher signals are illustrated as brighter in this visual representation.
Fig. 2.
Fig. 2.
Example frame of NVC.
Fig. 3.
Fig. 3.
Example of speed-resolved MELSCI. The leftmost showing perfusion equivalent to LDI, the center picture showing 0–1 mm/s perfusion illustrated by a more homogenous network of perfusion, and the rightmost depicting above 1 mm/s and thus emphasizing larger vessels. All perfusion images are calculated from the same raw MELSCI data. Higher signals are illustrated as brighter in this visual representation.
Fig. 4.
Fig. 4.
Example of SFDI: the left frame shows light grid of visible light, to the right; color-graded oxygenation map.
See this image and copyright information in PMC

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