Uso de capilaroscopía para diagnóstico de daño microvascular en cardiopatía isquémica.

Abstract

Alterations of the microvasculature are related to cardiovascular risk factors1. This relationship has been established over the last few years, with Diabetes Mellitus being the central theme of the study, where qualitative and quantitative microvascular changes have been observed. Videocapilaroscopy is a study that allows the accurate visualization of morphological characteristics of the capillaries ofthe nailfold. It has been applied in the analysis of multiple rheumatologicalentities (eg Systemic Lupus Erythematosus, Polymyositis / Dermatomyositis, Antiphospholipid Syndrome, etc.); as well as in non-rheumatological diseases (Diabetes Mellitus) where different types of static and dynamic alterations have been evidenced. Despite its benefits, it is still not a common tool used inthe usual clinical practice. Objective: To establish the usefulness of videocapillaroscopy in the detection of microvascular damage in patients with ischemic heart disease. With a total of 36 individuals, 16 of them (44%) have a diagnosis of acute coronary syndrome, established in the hospitalization service of Hospital Luis Vernaza in Guayaquil. Methods: The present study included patients diagnosed with acute coronary syndrome, who meet the criteria established by the American College of Cardiology. A selected group of patients with similar anthropometric characteristics, age and sex was included. The study was carried out using videocapillaroscopy, a non-invasive method that allows the precise observation of the microcirculation of the nailfold. The capillary density was measured and the capillary morphology was classified, within the established patterns. The respective measurements were made by two experts in the technique. Results: 36 patients were studied; 16 with coronary arterial disease (CAD) and 20 in control group. In our study we evidenced structural microvascular disturbances. Capillary density was lower in the study group, although it was not statistically significant (p> 0.05). According to the morphological changes that we visualized; In the CAD group, 31% presentedcapillary ectasia (p = 0.01), while the presence of tortuosities occurred in 50% of the study group and having the same number in the control group, showing no statistically significant difference. According to the relationship between the risk factors and the study group, the presence of arterial hypertension stands out (p = 0.0046 and 95% CI).