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Terashima M, Tamura Y, Takahashi H, Ochiai K, Ehara K, Takahashi M, Otani N, Sandor B, Tomoe T, Sugiyama T, Ueno A, Kitahara K, Kawabe A, Yasu T. Effects of cardiac rehabilitation on in vivo nailfold microcirculation in patients with cardiovascular disease. Heart Vessels 2024:10.1007/s00380-024-02435-0. [PMID: 39133315 DOI: 10.1007/s00380-024-02435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/30/2024] [Indexed: 08/13/2024]
Abstract
This study aimed to explore the impact of cardiac rehabilitation (CR) on in vivo and ex vivo microcirculation, exercise capacity, and oxidative stress in patients with cardiovascular disease (CVD). The study included patients with acute coronary syndrome (ACS; n = 45; age, 69.0 ± 14.1 years) and heart failure (HF; n = 66; age, 77.3 ± 10.7 years) who underwent supervised CR during hospitalization. The control group comprised patients without CVD (NCVD; n = 20; age, 75.9 ± 11.2 years). In vivo microcirculatory observations using nailfold video capillary endoscopy at rest and during hyperemia, exercise capacity, and oxidative stress were assessed at baseline and 12 weeks after discharge. Baseline capillary densities were significantly lower in the ACS (5.0 ± 1.7 capillaries/mm2) and HF (4.9 ± 1.7 capillaries/mm2) groups than in the NCVD group (6.5 ± 1.1 capillaries/mm2, p < 0.01). Similarly, capillary density during reactive hyperemia was significantly lower in the ACS (5.8 ± 1.7 capillaries/mm2) and HF (5.4 ± 1.8 capillaries/mm2) groups than in the NCVD group (7.3 ± 1.4 capillaries/mm2, p < 0.01). Patients with ACS and HF had increased capillary densities at 12 weeks compared with at baseline (p < 0.05). This improvement was particularly pronounced among post-discharge outpatient CR participants (n = 20). Grip strength, exercise capacity, and oxidative stress improved at 12 weeks. Baseline capillary density changes were positively correlated with grip strength changes (r = 0.45, p < 0.001). CR significantly improved nailfold capillary density in patients with ACS and HF 12 weeks after discharge.
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Affiliation(s)
- Masato Terashima
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan
| | - Yuma Tamura
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan.
| | - Harunori Takahashi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan
| | - Kaori Ochiai
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan
| | - Kyosuke Ehara
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan
| | - Momo Takahashi
- Department of Rehabilitation, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321-1298, Japan
| | - Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Barbara Sandor
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
- 1st Department of Medicine, Division of Preventive Cardiology and Rehabilitation, School of Medicine, University of Pecs, Pecs, Hungary
| | - Takashi Tomoe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Takushi Sugiyama
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Asuka Ueno
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Keijiro Kitahara
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Atsuhiko Kawabe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
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Maldonado G, Chacko A, Lichtenberg R, Ionescu M, Rios C. Nailfold capillaroscopy in diabetes mellitus: a case of neo-angiogenesis after achieving normoglycemia. Oxf Med Case Reports 2022; 2022:omac088. [PMID: 36176947 PMCID: PMC9514106 DOI: 10.1093/omcr/omac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Diabetes mellitus (DM) is a disease process characterized by a chronic hyperglycemic milieu that leads to micro and macrovascular complications, including diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. During the last decade, researchers have used nail-fold capillaroscopy to study the microvascular alterations in rheumatologic diseases; however, the technology is gaining momentum in other disease processes that alter microvascular architecture. We observed a drastic improvement in the nail-fold capillary architecture in a patient with uncontrolled DM. After achieving excellent glycemic control 6 months after diagnosis, increased capillary density and evident rearrangement of the capillaries replaced the avascular areas and giant capillaries found at the time of diagnosis.
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Affiliation(s)
| | - Amala Chacko
- MacNeal Hospital Internal Medicine Department, , Berwyn, IL, USA
| | | | | | - Carlos Rios
- Universidad Espiritu Santo Rheumatology Department, , Samborondón, Ecuador
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Marcoccia A, Klein-Weigel PF, Gschwandtner ME, Wautrecht JC, Matuska J, Rother U, Houben AJHM. Microcirculatory assessment of vascular diseases. VASA 2020; 49:175-186. [PMID: 32040388 DOI: 10.1024/0301-1526/a000851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The term "microcirculation" refers to the terminal vascular network of the body, which includes arterioles, capillaries, venules as well as initial lymphatic vessels. Additionally, it insinuates to their unique function in thermoregulation, fluid balance, maintenance of cellular exchange, and metabolism. Disturbances of microvascular function were identified to precede macrovascular involvement in the presence of cardiovascular risk factors and is the hallmark of terminal disease stages like critical limb or acral ischemia. Nevertheless, despite its obvious significance in vascular medicine assessment of microvascular function became increasingly neglected in the clinical institutions during the last decades and seems to play a subordinary role in medical education. We therefore provide an overview over relevant and clinically practicable methods to assess microcirculation in vascular medicine with critical estimations of their pros and cons and their perspectives in the future.
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Affiliation(s)
- Antonella Marcoccia
- Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy
| | - Peter F Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Michael E Gschwandtner
- Medizinische Universtiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria
| | - Jean Claude Wautrecht
- Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium
| | - Jiri Matuska
- MATMED s.r.o., Private Angiology Facility, Hodonin, Czech Republic
| | - Ulrich Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alfons J H M Houben
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM; Maastricht University Medical Center+, Maastricht, The Netherlands
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