Marino Pablo, de Oliveira Lopes Gabriella, Pereira Borges Juliana, Carolina Terra Cola Maria, Arkader Kopiler Daniel, Tibirica Eduardo
National Institute of Cardiology, Rio de Janeiro, Brazil.
Antônio Pedro University Hospital, Federal Fluminense University, Niteroi, Brazil.
Congenit Heart Dis. 2018 Nov;13(6):978-987. doi: 10.1111/chd.12660. Epub 2018 Sep 11.
Adults with congenital heart disease share some features with those with chronic heart failure. Although microvascular endothelial dysfunction has been described in chronic heart failure, evaluation of the microcirculation in adults with congenital heart disease is lacking. The present study aimed to investigate systemic microvascular reactivity in adults with congenital heart disease.
The patients initially underwent cardiopulmonary exercise testing. Then, the cutaneous microvascular reactivity was evaluated in these patients using a laser speckle contrast imaging system coupled with skin iontophoresis of endothelial-dependent (acetylcholine) or -independent (sodium nitroprusside) vasodilators and postocclusive reactive hyperemia (PORH) and compared with healthy controls matched for age and sex.
Thirty-one patients and 29 healthy controls were evaluated. The basal microvascular flow (P < .0001) and area under the curve in response to acetylcholine (P < .0001) were higher in the patients than in the healthy volunteers. The increase in cutaneous vascular conductance in response to sodium nitroprusside was reduced in the patients compared to the healthy volunteers (P = .0031). No difference in the microvascular response was observed during postocclusive reactive hyperemia. The basal microvascular flow of patients with peak oxygen consumption below 16.0 mL kg min was superior to that of patients with values greater than 16.0 mL kg min (P = .0046).
Adults with congenital heart disease present a higher baseline cutaneous microvascular blood flow than healthy controls and do not present systemic microvascular endothelial dysfunction. Nevertheless, endothelium-independent microvascular reactivity is blunted, suggesting an altered vascular smooth muscle response or vascular structural alterations. Finally, patients with a lower functional capacity presented a greater microvascular basal blood flow than subjects with a higher functional capacity.
患有先天性心脏病的成年人与慢性心力衰竭患者有一些共同特征。虽然慢性心力衰竭中已描述了微血管内皮功能障碍，但对患有先天性心脏病的成年人的微循环评估尚缺乏。本研究旨在调查患有先天性心脏病的成年人的全身微血管反应性。
患者最初接受心肺运动试验。然后，使用激光散斑对比成像系统结合内皮依赖性（乙酰胆碱）或非依赖性（硝普钠）血管扩张剂的皮肤离子导入法以及闭塞后反应性充血（PORH）来评估这些患者的皮肤微血管反应性，并与年龄和性别匹配的健康对照进行比较。
评估了31例患者和29名健康对照。患者的基础微血管血流量（P <.0001）和对乙酰胆碱反应的曲线下面积（P <.0001）高于健康志愿者。与健康志愿者相比，患者对硝普钠反应的皮肤血管传导性增加有所降低（P =.0031）。在闭塞后反应性充血期间未观察到微血管反应的差异。峰值耗氧量低于16.0 mL·kg·min的患者的基础微血管血流量优于峰值耗氧量高于16.0 mL·kg·min的患者（P =.0046）。
患有先天性心脏病的成年人的基线皮肤微血管血流量高于健康对照，且不存在全身微血管内皮功能障碍。然而，非内皮依赖性微血管反应性减弱，提示血管平滑肌反应改变或血管结构改变。最后，功能能力较低的患者的微血管基础血流量高于功能能力较高的受试者。
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