Pulmonary Vascular Disease |

Sublingual Capillaroscopy in Pulmonary Arterial Hypertension FREE TO VIEW

Luma Dababneh, MD; Frank Cikach, BS; Laith Alkukhun, MD; Cynthia Beall, PhD; Raed Dweik, MD; Adriano Tonelli, MD
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Cleveland Clinic, Cleveland, OH

Chest. 2013;144(4_MeetingAbstracts):856A. doi:10.1378/chest.1702404
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary arterial hypertension (PAH) is a pulmonary vasculopathy that leads to elevated mean pulmonary pressure, failure of the right ventricle and premature death. There is a pressing need to identify non-invasive methods to diagnose and assess severity of disease in PAH. We hypothesized that the sublingual microcirculation in PAH patients might be distorted compared to healthy controls (gender and age matched).

METHODS: Using the CapiScope Handheld Video Capillaroscope we measured sublingual (SL) capillary density, flow, tortuosity and curvature. Videos were acquired immediately after making the diagnosis of PAH with right heart catheterization. In addition, we recruited healthy volunteers. Capillaroscopy measurements were obtained using current guidelines by investigators blinded to the clinical conditions of the patients.

RESULTS: In this cross-sectional study, we included 22 PAH patients, mean age (SD) 54 (9) years, 82 % women. Etiologies of PAH were idiopathic (n=11, 50 %), portopulmonary (n=6, 27 %), connective tissue (n=4, 18%) and HIV associated (n=1, 5%). We included 10 healthy controls, age 51 (13) years, 70 % women. In PAH, average SL capillary density was 7.5 (2) vessels/mm, SL capillary flow score was 1.9 (0.7), tortuosity was 0.2 (0.2) units, number of curves 69 (20) units. In the control group capillary density was 8.1 (2) vessels/mm, flow score was 2.7 (0.4), tortuosity was 0.06 (0.04) unit and number of curves 34.6 (11) units. SL capillary flow was significantly lower (p=0.001) while tortuosity (p=0.001) and curvature (p<0.001) were significantly higher in PAH patients compared to controls. SL capillary density was not different between the groups (p=0.36). Inter-rater agreement was good for tortuosity and curvature (kappa: 0.7 for both), moderate for flow (kappa: 0.47) and poor for density (kappa: 0.17).

CONCLUSIONS: PAH patients showed lower sublingual capillary flow and higher tortuosity and curvatures compared to healthy controls.

CLINICAL IMPLICATIONS: SL capillaroscopy might be useful in differentiating patients with or without PAH; however further investigations are needed to assess whether this methodology can provide information on disease prognosis and/or response to therapy in PAH.

DISCLOSURE: The following authors have nothing to disclose: Luma Dababneh, Frank Cikach, Laith Alkukhun, Cynthia Beall, Raed Dweik, Adriano Tonelli

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