TY - JOUR
T1 - Deeper Penetration of Erythrocytes into the Endothelial Glycocalyx Is Associated with Impaired Microvascular Perfusion
AU - Lee, Dae Hyun
AU - Dane, Martijn J. C.
AU - van den Berg, Bernard M.
AU - Boels, Margien G. S.
AU - van Teeffelen, Jurgen W.
AU - de Mutsert, Renee
AU - den Heijer, Martin
AU - Rosendaal, Frits R.
AU - van der Vlag, Johan
AU - van Zonneveld, Anton Jan
AU - Vink, Hans
AU - Rabelink, Ton J.
PY - 2014/5/9
Y1 - 2014/5/9
N2 - Changes in endothelial glycocalyx are one of the earliest changes in development of cardiovascular disease. The endothelial glycocalyx is both an important biological modifier of interactions between flowing blood and the vessel wall, and a determinant of organ perfusion. We hypothesize that deeper penetration of erythrocytes into the glycocalyx is associated with reduced microvascular perfusion. The population-based prospective cohort study (the Netherlands Epidemiology of Obesity [NEO] study) includes 6,673 middle-aged individuals (oversampling of overweight and obese individuals). Within this cohort, we have imaged the sublingual microvasculature of 915 participants using sidestream darkfield (SDF) imaging together with a recently developed automated acquisition and analysis approach. Presence of RBC (as a marker of microvascular perfusion) and perfused boundary region (PBR), a marker for endothelial glycocalyx barrier properties for RBC accessibility, were assessed in vessels between 5 and 25 mm RBC column width. A wide range of variability in PBR measurements, with a mean PBR of 2.14 mm (range: 1.43-2.86 mm), was observed. Linear regression analysis showed a marked association between PBR and microvascular perfusion, reflected by RBC filling percentage (regression coefficient beta: -0.034; 95% confidence interval: -0.037 to -0.031). We conclude that microvascular beds with a thick ("healthy'') glycocalyx (low PBR), reflects efficient perfusion of the microvascular bed. In contrast, a thin ("risk'') glycocalyx (high PBR) is associated with a less efficient and defective microvascular perfusion.
AB - Changes in endothelial glycocalyx are one of the earliest changes in development of cardiovascular disease. The endothelial glycocalyx is both an important biological modifier of interactions between flowing blood and the vessel wall, and a determinant of organ perfusion. We hypothesize that deeper penetration of erythrocytes into the glycocalyx is associated with reduced microvascular perfusion. The population-based prospective cohort study (the Netherlands Epidemiology of Obesity [NEO] study) includes 6,673 middle-aged individuals (oversampling of overweight and obese individuals). Within this cohort, we have imaged the sublingual microvasculature of 915 participants using sidestream darkfield (SDF) imaging together with a recently developed automated acquisition and analysis approach. Presence of RBC (as a marker of microvascular perfusion) and perfused boundary region (PBR), a marker for endothelial glycocalyx barrier properties for RBC accessibility, were assessed in vessels between 5 and 25 mm RBC column width. A wide range of variability in PBR measurements, with a mean PBR of 2.14 mm (range: 1.43-2.86 mm), was observed. Linear regression analysis showed a marked association between PBR and microvascular perfusion, reflected by RBC filling percentage (regression coefficient beta: -0.034; 95% confidence interval: -0.037 to -0.031). We conclude that microvascular beds with a thick ("healthy'') glycocalyx (low PBR), reflects efficient perfusion of the microvascular bed. In contrast, a thin ("risk'') glycocalyx (high PBR) is associated with a less efficient and defective microvascular perfusion.
U2 - 10.1371/journal.pone.0096477
DO - 10.1371/journal.pone.0096477
M3 - Article
C2 - 24816787
SN - 1932-6203
VL - 9
JO - PLOS ONE
JF - PLOS ONE
IS - 5
M1 - e96477
ER -