Abstract 157: Microvascular Perfusion is Significantly Decreased in Both Stable and Decompensated Heart Failure
Introduction: Heart failure (HF) is a prevalent and costly condition. Current evaluation centers on global perfusion parameters, such as B-type natriuretic peptide and ejection fraction measurements, but there is limited data concerning microvascular blood perfusion in HF. We hypothesized that microvascular perfusion is decreased in HF, with worse perfusion in decompensated HF when compared to stable disease.
Methods: This was a prospective, observational study in which sublingual functional capillary density (FCD) was measured using sidestream darkfield imaging in stable outpatient HF clinic patients and in emergency department decompensated HF patients. Two separate 20 second images were independently and blindly analyzed by 3 investigators using a commercially available image analysis software program (Micro Vision Medical, Amsterdam, The Netherlands). These values were compared to outpatient non-HF patients who had similar frequencies of hypertension, coronary artery disease and diabetes. Mean arterial pressure (MAP) and heart rate (HR) were also compared. ANOVA testing compared the stable HF, decompensated HF and control groups, with between-group comparisons analyzed with Tukey-Kramer HSD testing (p < 0.05 considered significant).
Results: A total of 99 patients were enrolled: 35 stable HF patients, 44 acutely decompensated HF patients and 20 control patients. ANOVA analysis found MAP (p < 0.01), HR (p = 0.01) and FCD (p = 0.03) all differed significantly among the three groups, but age, gender and race did not (see Table). Subgroup analysis of FCD demonstrated a difference between only the control and decompensated HF groups (p = 0.02), but not the stable HF and decompensated HF groups (p = 0.80).
Conclusions: Microvascular perfusion measured by FCD is significantly decreased in decompensated HF patients when compared to patients without HF. FCD may represent a quantitative assessor of microvascular perfusion with which to guide treatment.
- © 2010 by American Heart Association, Inc.