Abnormal cutaneous vasomotion and reduced cutaneous blood mass remain in congestive heart failure even with normalized cardiovascular hemodynamics.
To elucidate the pathophysiologic role of cutaneous microcirculation in congestive heart failure, finger cutaneous microcirculation was analyzed in 17 patients with acute heart failure (AHF) and 12 patients with hemodynamically compensated heart failure (c-HF) by using laser Doppler spectroscopy; the results were correlated with simultaneously obtained cardiovascular hemodynamics. Mean finger cutaneous blood flow in AHF was significantly lower compared with c-HF (p < 0.01) and control (n = 20, p < 0.001). Mean finger cutaneous blood mass was significantly reduced in both AHF (p < 0.01) and c-HF (p < 0.01) compared with control. Frequency of characteristic giant concave waves indicating sudden occurrence of flow reduction (B wave) was significantly higher in AHF (p < 0.01) and c-HF (p < 0.05) than that in control. Frequency of B waves correlated significantly with pulmonary capillary wedge pressure (PCWP) (r = 0.73, p < 0.01) and pulmonary artery systolic pressure (r = 0.54, p < 0.05). When changes after medical treatments were compared there were significant correlations between changes in B-wave frequency and changes in PCWP (r = 0.89, p < 0.01) and changes in finger cutaneous blood flow and changes in total systemic peripheral resistance (r = -0.75, p < 0.05). Cutaneous microcirculation in AHF was characterized by decreased finger cutaneous blood flow and finger cutaneous blood mass and prominent B waves, which reflected abnormal vasomotion activity. B-wave prominence and reduced finger cutaneous blood mass remained in c-HF even with normalized cardiovascular hemodynamics.
Seino
Y
Y
First Department of Medicine, Nippon Medical School, Tokyo, Japan.
Tsukamoto
H
H
Ohki
K
K
Nakamura
T
T
Kashiwagi
M
M
Takano
T
T
Hayakawa
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D002319:Cardiovascular System / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008833:Microcirculation / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012867:Skin / Q000098:blood supply*; D014666:Vasomotor System / Q000503:physiopathology*