title: Non-invasive assessment of microcirculation by sidestream dark field imaging as a marker of coronary artery disease in diabetes.
abstract: OBJECTIVE
  In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes.
  
  
  METHODS
  SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD.
  
  
  RESULTS
  Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04).
  
  
  CONCLUSIONS
  Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, The Netherlands.
authors.forename: Roxana
authors.initials: R
authors.lastname: Djaberi
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Eelco J
authors.initials: EJ
authors.lastname: de Koning
authors.forename: D Champa
authors.initials: DC
authors.lastname: Wijewickrama
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Smit
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Albert de
authors.initials: Ad
authors.lastname: Roos
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D002196:Capillaries / Q000473:pathology; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008046:Lip / Q000098:blood supply*; D008297:Male; D008833:Microcirculation; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed