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Impairment of Skin Blood Flow During Post-Occlusive Reactive Hyperhemy Assessed by Laser Doppler Flowmetry Correlates with Renal Resistive Index

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Impairment of Skin Blood Flow During Post-Occlusive Reactive Hyperhemy Assessed by Laser Doppler Flowmetry Correlates with Renal Resistive Index Journal of Human Hypertension (2012) 26, 56–63 & 2012 Macmillan Publishers Limited All rights reserved 0950-9240/12 www.nature.com/jhh ORIGINAL ARTICLE Impairment of skin blood flow during post-occlusive reactive hyperhemy assessed by laser Doppler flowmetry correlates with renal resistive index P Coulon1, J Constans2 and P Gosse1 1Service de Cardiologie et Hypertension Arte´rielle, University Hospital of Bordeaux, Hoˆpital Saint Andre´, Bordeaux, France and 2Service de Maladies Vasculaires, University Hospital of Bordeaux, Hoˆpital Saint Andre´, Bordeaux, France We lack non-invasive tools for evaluating the coronary evaluated from an ambulatory measurement of the cor- and renal microcirculations. Since cutaneous Doppler rected QKD100–60 interval. We included 22 hypertensives laser exploration has evidenced impaired cutaneous micro- and 11 controls of mean age 60.6 vs 40.8 years. In this vascular responses in coronary artery disease and in population, there was a correlation between RI and basal impaired renal function, we wanted to find out if there zero to peak flow variation (BZ-PF) (r ¼À0.42; P ¼ 0.02) and was a link between the impairments in the cutaneous and a correlation between RI and rest flow to peak flow variation renal microcirculations. To specify the significance of the (RF-PF) (r ¼À0.44; P ¼ 0.01). There was also a significant rise in the renal resistive index (RI), which is still unclear, correlation between RI and the corrected QKD100–60 (r ¼ we also sought relations between RI and arterial stiffness. À0.47; P ¼ 0.01). The significant correlation between PORH We conducted a cross-sectional controlled study in a parameters and RI indicates that the functional modifica- heterogeneous population including hypertensive patients tions of the renal and cutaneous microcirculations tend to of various ages with or without a history of cardiovascular evolve in parallel during ageing or hypertension. The disease along with a healthy control group. The cutaneous relation between RI and arterial stiffness shows that RI is microcirculation was evaluated by laser Doppler flowmetry a compound index of both renal microvascular impairment of the post-occlusive reactive hyperhemy (PORH) and of and the deterioration of macrovascular mechanics. the hyperhemy to heat. The renal microcirculation was Journal of Human Hypertension (2012) 26, 56–63; evaluated by measurement of the RI. Arterial stiffness was doi:10.1038/jhh.2010.117; published online 20 January 2011 Keywords: microcirculation; skin blood flow; laser Doppler flowmetry; renal resistive index Introduction renal resistive index (RI) calculated from pulsed Doppler flow at the interlobular arteries have been In daily clinical practice, the possibilities of evalu- proposed for evaluating the renal microcircula- ating the quality of the microcirculation of certain tion.1–3 However, we still lack simple tools for territories of ‘vascular’ patients are relatively limited evaluating the coronary and cerebral microcircu- compared with the many tools for evaluating ‘large lations. In this context, study of the cutaneous vessels’. However, even in the absence of significant microcirculation has been the subject of numerous impairment of the large vessels, a deterioration in investigations.4,5 Laser Doppler flowmetry (LDF) can the microcirculation might cause certain compli- determine alterations in the blood flow of the cations such as impaired renal function, blindness, capillaries over a small area of skin after applying neuropathy, myocardiopathy and mental dysfunc- various stimuli. This technique has evidenced tion. Examination of the ocular fundus, measure- deteriorations during ageing, diabetes and hyperten- ment of the transcutaneous oxygen pressure and sion.6–12 However, this technique will only be of capillaroscopy have been the main clinical tools for value if the cutaneous microcirculation can be used evaluating the microcirculation. More recently, the as a mirror of the vital territories (cerebral, renal and coronary), which are more difficult to access. Correspondence: Dr P Coulon, Service de Cardiologie et Hyper- Indeed, Holowatz et al.13 recently urged for study tension Arte´rielle, University Hospital of Bordeaux, Hoˆpital Saint of the relations between the pathological modifica- Andre´, 1 Rue Jean Burguet, Bordeaux 33075, France. tions of these different microcirculations. E-mail: [email protected] Received 2 September 2010; revised 23 November 2010; accepted To study the relations between the renal and 26 November 2010; published online 20 January 2011 cutaneous microcirculations, we carried out an PORH assessed by LDF correlates with RI P Coulon et al 57 exploration of the cutaneous microcirculation by (small angle thermostatic probe 457, PERIMED LDF followed by measurement of the RI of healthy FRANCE, Craponne, France) fixed on the skin subjects and hypertensive patients of different previously cleansed with acetone by a transparent ages. In parallel, the same subjects benefited from sticky strip, connected to a laser Doppler module measurement of arterial rigidity by analysis of (Periflux System 500, PERIMED FRANCE) con- corrected QKD100–60 interval, obtained from ambula- nected to a computer. This probe includes a heat tory measurement of blood pressure (ABPM). channel, which can heat an area of skin from a Indeed, it has recently been suggested that RI might thermal module (Peritemp 400S Heater, PERIMED be a marker of the cardiovascular risk in the hyper- FRANCE). The results are expressed in arbitrary tensive.14 We suggest that this could be accounted laser Doppler units (U) or in unit seconds (Us) for by its relations with both the micro- and the for the area under the curve of occlusion (AO) macrocirculations. and of post-occlusive hyperhemy (AH). The varia- tions of cutaneous blood flow during applications of the various vasoactive stimuli were recorded and Materials and methods then processed semi-automatically using Perisoft This was a pilot study conducted on a small sample software (PERIMED FRANCE). of patients and healthy controls. Fitting of device. The patients who had fasted for at least 4 h, lay on their backs for 15 min in an air- Studied population conditioned quiet room whose temperature ranged Taking into account the exploratory character of this from 21 to 24 1C. An arm-band was fixed on the right study, the population of hypertensives had different arm. The laser Doppler probe was placed on the ages in order to survey the range of normal to highly ventral side of the right forearm 10 cm from the wrist impaired microcirculation. We studied two quite crease, on the centre line away from hairy areas and distinct groups: hypertensive patients and healthy surface veins of the patient. controls. Recording. We performed a continuous recording Inclusion criteria for patients of laser Doppler flow during 12 min, starting with Treated or untreated hypertensives with elevated the rest flow (RF) for 3 min then throughout the ABPM (24 h mean BP4130/80). application of the vasoactive stimuli. Those with good quality ABPM-QKD recordings, namely 480% of the 96 measurements programmed Vasoactive stimuli. Post-occlusive reactive hyperh- over 24 h validated after manual elimination of emy (PORH): Inflation of the arm-band to a supra- aberrant measurements. Verification of good detec- systolic pressure, around 200 mm Hg for 3 min tion of the last Korotkoff sound corresponding to the provided a biological zero of the laser flow (BZ) as diastolic pressure by the microphone by analyzing well as the area under the curve of the occlusion the slope of the QKD/diastolic blood pressure (DBP) phase (AO). Then abrupt deflation enabling analysis relationship, which must be negative. of the various criteria of PORH: peak flow (PF), rise Renal echo-Doppler of good quality defined by the time to the peak flow (TM), the time of half-rise to ability to formally exclude renal arterial stenosis peak (TH1), the time of half-return to the resting and a Doppler flow recording providing a reliable flow (TH2) and the area under the curve of the post- measurement of systolic and diastolic velocities occlusive hyperhemy zone (AH). at six different sites (three measurements per Maximum hyperhemy by heating the cutaneous kidney: upper, middle and lower segments). zone of interest to 44 1C: After the return to the resting flow following the PORH (individually Inclusion criteria for controls assessed but in general in 3 min following deflation of the arm-band) powering up the heating module Good quality ABPM-QKD recording (same criteria as for the patients) and normal blood pressure connected to the probe bringing the area of skin under study to 44 1C, enabled recording of a plateau (24 h mean blood pressure o130/80). of hyperhemy, with a peak flow (PF 44 1C) and the Absence of self-reported cardiovascular, renal or average over the third minute of heating (mean other chronic disease. Renal echo-Doppler of good 44 1C). quality (same criteria as for the patients). Exclusion criteria Data processing. The data were analyzed semi- automatically with the Perisoft software. The zones Renal arterial stenosis. were positioned manually corresponding to the Single kidney or other renal abnormality. resting flow, flow on occlusion of the humeral artery, the PORH and the third minute of heating Evaluation of the cutaneous microcirculation to 44 1C. The software calculated laser Doppler flows Materials. Recording of the cutaneous blood flow in arbitrary laser Doppler unit at
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