Avaliação da função endotelial microvascular em pacientes com endocardite infecciosa utilizando a técnica de fluxometria microvascular a laser
Avaliação da função endotelial microvascular em pacientes com endocardite infecciosa utilizando a técnica de fluxometria microvascular a laser
Data
2017
Autores
Barcelos, Amanda Ferreira
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
INTRODUÇÃO: A endocardite infecciosa (EI) é uma condição grave com incidência crescente a alta taxa de mortalidade intrahospitalar e em cinco anos. Poucos estudos tratam da avaliação da microcirculação em pacientes com EI, e até agora nenhum deles utilizou tecnologia a laser. O objetivo deste estudo é avaliar as alterações presentes na microcirculação cutânea de pacientes com EI. MÉTODOS: Trata-se de um estudo comparativo que incluiu pacientes com EI definida pelos critérios de Duke modificados admitidos em nosso centro para tratamento. O grupo referência foi formado por voluntários saudáveis pareados por sexo e idade. O fluxo microvascular foi avaliado foi avaliado no antebraço usando um sistema de imagem de fluxometria microvascular a laser, para medição não invasiva e contínua de alterações de perfusão microvascular cutânea. Esse sistema foi utilizado em combinação com micro iontoforese de acetilcolina, um vasodilatador dependente do endotélio e nitroprussiato de sódio (independente do endotélio), para testar a reatividade microvascular. RESULTADOS: Estudamos 22 pacientes com EI; sendo 15 do sexo masculino e sete do sexo feminino. A idade média e o desvio padrão (SD) foram de 45,5 +- 17,3 anos. A apresentação clínica foi aguda em 13,6% e subaguda em 86,3%. Os agentes etiológicos foram divididos em estreptococos do grupo viridans presente em 10 pacientes (45,4%), estafilococos agrassivs em 4 (18,2%), estafilococos coagulase negativos de menos virulência em 4 (18,2%) e enterococos em 4 (18,2%). A condutância microvascular da pele basal foi significativamente aumentada em pacientes com EI, em comparação com indivíduos saudáveis (0,36 +- 0,13 versus 0,21 +- 0,08 APU / mmHg; p<0,0001). A vasodilatação microvascular dependente e independente do endotélio foi reduzida em pacientes com EI. O aumento da condutância microvascular induzida pela acetilcolina em pacientes foi de 0,21 +- 0,17 e no grupo referência de 0,37 +- 0,14 APU / mmHg (p=0,0012). Além disso, o aumento da condutância microvascular induzida pelo nitroprussiato de sódio em pacientes foi de 0,18 +- 0,14 e em saudáveis de 0,29 +- 0,15 APU / mmHg (p=0,0140). CONCLUSÃO: As alterações principais da microcirculação cutânea em pacientes com EI encontradas foram uma maior vasodilatação microcirculatória basal e uma redução da reatividade microvascular dependente e independente do endotélio
INTRODUCTION: Infective endocarditis (IE) is a severe condition with a high in- hospital and 5-year mortality. Few studies have evaluated the microcirculation in patients with IE, and so far, none have utilized laser-based technology. The aim of the study is to evaluate the changes in the cutaneous microvascular bed of patients with IE. METHODS: This is a comparative study of patients with definite IE by the modified Duke criteria admitted to our center for treatment. A reference group of sex- and age-matched healthy volunteers was included. Microvascular flow was evaluated in the forearm using a laser speckle contrast imaging system, for noninvasive and continuous measurement of cutaneous microvascular perfusion changes. Laser speckle contrast imaging system was used in combination with skin iontophoresis of acetylcholine, an endothelium dependent vasodilator, and sodium nitroprusside (endothelium independent), to test microvascular reactivity. RESULTS: We studied 22 patients with IE; 15 were male and seven female. The mean age and standard deviation (SD) was 45.5 ± 17.3 years. Clinical presentation was acute in 13.6% and subacute in 86.3%.The etiological agents were divided into viridans group streptococci, present in 10 patients (45.4%), aggressive staphylococci, in four (18.2%), indolent coagulase negative staphylococci in four (18.2%) and enterococcus in four (18.2%). Basal skin microvascular conductance was significantly increased in patients with IE, compared to healthy individuals (0.36 ± 0.13 versus 0.21 ±0.08 APU/mmHg; p<0.0001). Endothelial-dependent and-independent microvascular vasodilation was reduced in patients with IE. The increase in microvascular conductance induced by acetylcholine in patients was of 0.21 ± 0.17 and in in the reference group it was 0.37 ± 0.14 APU/mmHg (p=0.0012). Moreover, the increase in microvascular conductance induced by sodium nitroprusside in patients was of 0.18 ± 0.14 and in healthy volunteers it was 0.29 ± 0.15 APU/mmHg (p=0.0140).Conclusion: The most prominent alterations of the cutaneous microcirculation in patients with IE found were greater basal vasodilation and a reduction of the endothelium-dependent and -independent microvascular reactivity. Keywords: Infective endocarditis, microcirculation, microvascular dysfunction, speckle contrast imaging.
INTRODUCTION: Infective endocarditis (IE) is a severe condition with a high in- hospital and 5-year mortality. Few studies have evaluated the microcirculation in patients with IE, and so far, none have utilized laser-based technology. The aim of the study is to evaluate the changes in the cutaneous microvascular bed of patients with IE. METHODS: This is a comparative study of patients with definite IE by the modified Duke criteria admitted to our center for treatment. A reference group of sex- and age-matched healthy volunteers was included. Microvascular flow was evaluated in the forearm using a laser speckle contrast imaging system, for noninvasive and continuous measurement of cutaneous microvascular perfusion changes. Laser speckle contrast imaging system was used in combination with skin iontophoresis of acetylcholine, an endothelium dependent vasodilator, and sodium nitroprusside (endothelium independent), to test microvascular reactivity. RESULTS: We studied 22 patients with IE; 15 were male and seven female. The mean age and standard deviation (SD) was 45.5 ± 17.3 years. Clinical presentation was acute in 13.6% and subacute in 86.3%.The etiological agents were divided into viridans group streptococci, present in 10 patients (45.4%), aggressive staphylococci, in four (18.2%), indolent coagulase negative staphylococci in four (18.2%) and enterococcus in four (18.2%). Basal skin microvascular conductance was significantly increased in patients with IE, compared to healthy individuals (0.36 ± 0.13 versus 0.21 ±0.08 APU/mmHg; p<0.0001). Endothelial-dependent and-independent microvascular vasodilation was reduced in patients with IE. The increase in microvascular conductance induced by acetylcholine in patients was of 0.21 ± 0.17 and in in the reference group it was 0.37 ± 0.14 APU/mmHg (p=0.0012). Moreover, the increase in microvascular conductance induced by sodium nitroprusside in patients was of 0.18 ± 0.14 and in healthy volunteers it was 0.29 ± 0.15 APU/mmHg (p=0.0140).Conclusion: The most prominent alterations of the cutaneous microcirculation in patients with IE found were greater basal vasodilation and a reduction of the endothelium-dependent and -independent microvascular reactivity. Keywords: Infective endocarditis, microcirculation, microvascular dysfunction, speckle contrast imaging.
Description
Palavras-chave
Endocardite infecciosa, Microcirculação, Disfunção microvascular, Fluxometria microvascular a laser, Infective endocarditis, Microcirculation, Microvascular dysfunction, Speckle contrast imaging
Citação
Barcelos AF. Avaliação da função endotelial microvascular em pacientes com endocardite infecciosa utilizando a técnica de fluxometria microvascular a laser. Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2017.