engleski

New Noninvasive Methods to Evaluate Microvascular Structure and Function

Microvascular dysfunction is a systemic process that occurs under similar pathophysiological patterns in multiple tissue beds, and reflects vascular functional and structural remodeling initiated by various cardiovascular and metabolic diseases, including hypertension. Thus, identification of microvascular blood flow and vasoreactivity, but also structural impairment by noninvasive means can lead to early identification of individuals at cardiovascular risk. Moreover, early detection of subclinical cardiovascular alterations, as microvascular dysfunction, may provide the right window of opportunity to ameliorate the earliest pathophysiological processes, and thus mitigate disease and its related complications. In addition, in already clinically existing disease, it can provide a quantitative assessment of the effects of a given treatment. This has led to the development of novel methods, and improvement of some of the old techniques, for the assessment of microvascular structure and function. Structural changes of small resistance arteries, such as an increase in the media or total wall thickness to internal lumen diameter ratio (MLR or WLR), have been evaluated by micromyography which has been considered as a gold standard method for evaluating microvascular structural alterations. And while micromyography of small vessels dissected from tissue biopsies is the most common and reliable method for assessing microcirculatory structure and function ex vivo, several non-invasive methods and techniques has been introduced to evaluate microvasculature in vivo. Strain-gauge venous plethysmography is considered the reference technique for in vivo studies, but in order to extend the microvasculature evaluation to a broader range of patients and clinical settings, laser Doppler flowmetry, laser Doppler imaging, and adaptive optics techniques are increasingly used. The main limitation for wider use of these techniques in daily clinical practice is the lack of robust evidence on their prognostic value. Generation of reference values to identify microvascular dysfunction and harmonization in the interpretation of the microvascular assessment results are needed to move the noninvasive assessment of the microvascular function and structure from bench to bedside.

microvasculature ; structure ; function ; methods

nije evidentirano