Assessment of the structural and functional state of blood vessels in patients with hypertrophic cardiomyopathy

Aim      To evaluate the structural and functional condition of the vasculature using fingertip photoplethysmography and computerized videocapillaroscopy in patients with hypertrophic cardiomyopathy (HCMP).

Material and methods  The study included patients with HCMP (n=48; 28 (57 %) men; age, 54.3±13.6 years) and healthy volunteers (control group, n=33, 15 (45 %) men; age, 58.2±8.8 years). Standard laboratory and instrumental examination (blood count and biochemistry, electrocardiography, echocardiography, Holter electrocardiogram monitoring) were performed for all HCMP patients. The condition of vascular wall at various levels of the vasculature was evaluated by fingertip photoplethysmography (apparatus Angioscan-01) and computerized nail-fold videocapillaroscopy (apparatus Capillaroscan-01). The photoplethysmography study analyzed structural parameters, including the arterial wall stiffness index (aSI) of large blood vessels and the resistance index (RI) of small muscular arteries. Endothelial dysfunction was evaluated by the occlusion index (OI) and phase shift (PS). The capillaroscopy study assessed structural parameters, including the resting capillary density (rCD) and the capillary density following venous occlusion (voCD), and functional parameters, including the percentage of perfused capillaries (PPC), the percentage of restored capillaries (PRC), and the capillary density after the reactive hyperemia test (rhCD).

Results The study showed increases in aSI (8.8 [6.8; 12.2] and RI (32.5 [17.4; 47.9] in the HCMP group. The OI was significantly lower in the HCMP group (1.3 [1.1; 1.5]) than in the control group (1.8 [1.5; 2.7], р<0.001). Also, PS values were significantly decreased in the HCMP group (4.4 [2.3; 8.6]) compared to the control group (8.4 [5.1; 12.1]. p=0.018). Disorders of structural and functional capillary indexes were observed in HCMP patients compared to the control group; rCD and voCD were decreased in the HCMP group (60 [52.6; 68] and 88 [75; 90], respectively) compared to the control group (75.8 [60; 87] and 90 [73; 101]), however, no intergroup difference reached a statistical significance. The rhCD, PPC, and PRC values were decreased in the HCMP group (66.3 [55; 72], 86.7 [70.9; 104.2] and 1.7 [–6.95; 20.3], respectively) compared to the control group (86 [68.6; 100], 103 [96; 114] and 18.4 [8.1; 27.4], respectively); PPC and PRC values were significantly different (р<0.005 and p<0.004, respectively).

Conclusion      In patients with HCMP, fingertip photoplethysmography and computerized videocapillaroscopy showed increased wall stiffness in both large blood vessels and microvasculature, pronounced endothelial dysfunction, and decreases in capillary density and percentage of restored capillaries following respective tests.

1. Ministry of Health of Russian Federation. Clinical Recommendation. Hypertrophic cardiomyopathy. I42.1/I42.2. 2020. Av. at: https://scardio.ru/content/Guidelines/2020/Clinic_rekom_Kardiomiopatiya.pdf.

2. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020;142(25):e533–57. DOI: 10.1161/CIR.0000000000000938

3. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW et al. Heart Disease and Stroke Statistics–2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254–743. DOI: 10.1161/CIR.0000000000000950

4. Bick AG, Flannick J, Ito K, Cheng S, Vasan RS, Parfenov MG et al. Burden of Rare Sarcomere Gene Variants in the Framingham and Jackson Heart Study Cohorts. The American Journal of Human Genetics. 2012;91(3):513–9. DOI: 10.1016/j.ajhg.2012.07.017

5. Ho CY, Day SM, Ashley EA, Michels M, Pereira AC, Jacoby D et al. Genotype and Lifetime Burden of Disease in Hypertrophic Cardiomyopathy: Insights From the Sarcomeric Human Cardiomyopathy Registry (SHaRe). Circulation. 2018;138(14):1387–98. DOI: 10.1161/CIRCULATIONAHA.117.033200

6. Maron BJ, Maron MS, Maron BA, Loscalzo J. Moving Beyond the Sarcomere to Explain Heterogeneity in Hypertrophic Cardiomyopathy. Journal of the American College of Cardiology. 2019;73(15):1978–86. DOI: 10.1016/j.jacc.2019.01.061

7. Konst RE, Guzik TJ, Kaski J-C, Maas AHEM, Elias-Smale SE. The pathogenic role of coronary microvascular dysfunction in the setting of other cardiac or systemic conditions. Cardiovascular Research. 2020;116(4):817–28. DOI: 10.1093/cvr/cvaa009

8. Johansson B, Mörner S, Waldenström A, Stål P. Myocardial capillary supply is limited in hypertrophic cardiomyopathy: A morphological analysis. International Journal of Cardiology. 2008;126(2):252–7. DOI: 10.1016/j.ijcard.2007.04.003

9. Olivotto I, Girolami F, Sciagrà R, Ackerman MJ, Sotgia B, Bos JM et al. Microvascular Function Is Selectively Impaired in Patients With Hypertrophic Cardiomyopathy and Sarcomere Myofilament Gene Mutations. Journal of the American College of Cardiology. 2011;58(8):839–48. DOI: 10.1016/j.jacc.2011.05.018

10. Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary Microvascular Dysfunction and Prognosis in Hypertrophic Cardiomyopathy. New England Journal of Medicine. 2003;349(11):1027–35. DOI: 10.1056/NEJMoa025050

11. van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Annals of the Rheumatic Diseases. 2013;72(11):1747–55. DOI: 10.1136/annrheumdis-2013-204424

12. Ciaffi J, Ajasllari N, Mancarella L, Brusi V, Meliconi R, Ursini F. Nailfold capillaroscopy in common non-rheumatic conditions: A systematic review and applications for clinical practice. Microvascular Research. 2020;131:104036. DOI: 10.1016/j.mvr.2020.104036

13. Sirufo MM, Bassino EM, De Pietro F, Ginaldi L, De Martinis M. Nailfold capillaroscopy: Clinical practice in non-rheumatic conditions. Microvascular Research. 2021;134:104122. DOI: 10.1016/j.mvr.2020.104122

14. Safonova J.I., Kozhevnikova M.V., Danilogorskaya Yu.A., Zheleznykh E.A., Zektser V.Yu., Shchendrygina A.A. et al. Positive Effects of Perindopril on Microvascular Vessels in Patients With Chronic Heart Failure. Kardiologiia. 2020;60(8):65–70. DOI: 10.18087/cardio.2020.8.n1216

15. Zhito A.V., Iusupova A.O., Kozhevnikova M.V., Shchendrygina A.A., Privalova E.V., Belenkov Yu.N. E-Selectin as a Marker of Endothelial Dysfunction in Patients with Coronary Artery Disease Including Those with Type 2 Diabetes Mellitus. Kardiologiia. 2020;60(4):24–30. DOI: 10.18087/cardio.2020.4.n1066

16. Fernlund E, Gyllenhammar T, Jablonowski R, Carlsson M, Larsson A, Ärnlöv J et al. Serum Biomarkers of Myocardial Remodeling and Coronary Dysfunction in Early Stages of Hypertrophic Cardiomyopathy in the Young. Pediatric Cardiology. 2017;38(4):853–63. DOI: 10.1007/s00246-017-1593-x

17. Laina A, Stellos K, Stamatelopoulos K. Vascular ageing: Underlying mechanisms and clinical implications. Experimental Gerontology. 2018;109:16–30. DOI: 10.1016/j.exger.2017.06.007

18. Dall’Olio L, Curti N, Remondini D, Safi Harb Y, Asselbergs FW, Castellani G et al. Prediction of vascular aging based on smartphone acquired PPG signals. Scientific Reports. 2020;10(1):19756. DOI: 10.1038/s41598-020-76816-6

19. Katunaric B, Cohen KE, Beyer AM, Gutterman DD, Freed JK. Sweat the small stuff: The human microvasculature and heart disease. Microcirculation. 2021;28(3):e12658. DOI: 10.1111/micc.12658

20. Sheikh AR, Difiore D, Rajendran S, Zeitz C, Beltrame J. 1346Laser doppler assessment of dermal microcirculatory endothelial function in patients with angina and non-obstructive coronary arteries. European Heart Journal. 2018;39(Suppl 1):1346. DOI: 10.1093/eurheartj/ehy565.1346

21. Zanatta E, Famoso G, Boscain F, Montisci R, Pigatto E, Polito P et al. Nailfold avascular score and coronary microvascular dysfunction in systemic sclerosis: A newsworthy association. Autoimmunity Reviews. 2019;18(2):177–83. DOI: 10.1016/j.autrev.2018.09.002

22. Maron MS, Maron BJ, Harrigan C, Buros J, Gibson CM, Olivotto I et al. Hypertrophic Cardiomyopathy Phenotype Revisited After 50 Years With Cardiovascular Magnetic Resonance. Journal of the American College of Cardiology. 2009;54(3):220–8. DOI: 10.1016/j.jacc.2009.05.006

23. Basso C, Thiene G, Corrado D, Buja G, Melacini P, Nava A. Hypertrophic cardiomyopathy and sudden death in the young: Pathologic evidence of myocardial ischemia. Human Pathology. 2000;31(8):988–98. DOI: 10.1053/hupa.2000.16659