Abstract 16839: Maternal Placental Vascular Malperfusion Lesions Associated With Increased Cardiometabolic Risk and Reduced Microvascular Density in Women a Decade After Delivery: Which Placental Features Matter?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Robin E Gandley ◽  
Judith Brands ◽  
Carl A Hubel ◽  
Alisse Hauspurg ◽  
William Tony Parks ◽  
...  
Keyword(s):  
Cardiometabolic Risk ◽  
Later Life ◽  
Boundary Region ◽  
Dark Field ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Dark Field Imaging ◽  
Microvascular Changes ◽  
History Of ◽  
Adverse Pregnancy

Introduction: Maternal vascular malperfusion (MVM) lesions in the placenta are commonly found in women with adverse pregnancy outcomes associated with increased CVD in later life. Minimal criteria for MVM include vasculopathy, accelerated villous maturation and increased syncytial knots, and villous infarction upon pathologic examination; expanded definitions have included presence of fibrin deposition (intervillous or perivillous) or low placental weight (<10 th %). Hypothesis: Women with a history of MVM lesions would have evidence of cardiometabolic risk factors and peripheral microvascular changes a decade after delivery independent of pregnancy outcome. Methods: A total of 469 women with placental pathology data available were evaluated at 8-10 years postpartum. Placental specimens were reviewed by a perinatal pathologist. Cardiometabolic variables were measured at the time of the study visit. Sidestream dark field imaging was used to assess the sublingual microcirculation. We compared the median size (diameter) of microvessels, density (total length of perfused microvessels/mm 2 ) and penetration of red cells into the glycocalyx of vessels 5-25μm diameter (perfused boundary region, PBR) in women 8-10 years after pregnancy, using the minimal MVM criteria (compared to none). Expanded criteria were examined alone. Significance =*p<0.05 vs no MVM lesions. Results: Women with minimally defined MVM lesions in their placentas had higher diastolic blood pressure (79mmHg MVM vs. 75 mmHg No MVM*), LDL (111mg/dL MVM vs. 101 mg/dL No MVM*), Cholesterol (185 mg/dL MVM vs. 175mg/dL No MVM*) and insulin (14mg/dL MVM vs. 12mg/dL No MVM*), along with smaller-sized microvessels (median 8.75±1.1 μM vs. 9.06±0.7 μM*), and a lower density of perfused microvessels compared to women without MVM lesions (3590±1260mm/mm 2 MVM vs. 3970±820 mm/mm 2 No MVM*) a decade after delivery. Glycocalyx PBR was smaller in women with prior MVM vs. women without lesions (2.01±0.23μm vs. 2.09±0.15μm, P=0.02). Similar results were not seen in subjects with either presence of fibrin or small placenta in the absence of other MVM criteria. Discussion: Using minimal criteria MVM was associated most strongly with maternal cardiometabolic and microvascular differences a decade later.

Abstract MP61: Evidence of Impaired Microvascular Function a Decade After Delivery in Women With Placental Malperfusion Lesions

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Alisse Hauspurg ◽  
Judith Brands ◽  
Robin Gandley ◽  
Matthew F Muldoon ◽  
William Tony Parks ◽  
...  
Keyword(s):  
Disease Risk ◽  
Gestational Hypertension ◽  
Boundary Region ◽  
Dark Field ◽  
Endothelial Glycocalyx ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation ◽  
Dark Field Imaging ◽  
Median Diameter ◽  
History Of

Introduction: Maternal vascular malperfusion (MVM) lesions in the placenta are characterized by incomplete vascular remodeling and vessel features similar to atherosclerosis. MVM lesions indicate a maladaptive maternal vascular response to pregnancy, are often detected in hypertensive disorders of pregnancy (HDP), and may provide a pathologic link to future cardiovascular disease. The endothelial glycocalyx is a glycoprotein-rich layer that is critical for microvascular health and damage may have an important role in the pathophysiology of microcardiovascular disease risk. Hypothesis: We hypothesized that women with malperfusion lesions of the placenta are more likely to evidence microvascular glycocalyx derangement a decade after delivery compared to women without these lesions and that this effect would be most pronounced among women with a history of HDP. Methods: A total of 412 women with placental pathology (N=129 with MVM lesions, N=283 without MVM lesions) were evaluated at 8-10 years postpartum. Placental specimens were reviewed by a blinded perinatal pathologist . HDP (including preeclampsia and gestational hypertension) were abstracted from the medical record. Glycocalyx barrier function was assessed using sublingual sidestream dark field imaging, with reduction defined as deeper penetration of red blood cells (RBCs) into the glycocalyx of the sublingual microcirculation (5-25μm diameter). We compared the median diameter (size) of microvessels, penetration of RBCs into the glycocalyx (perfused boundary region, PBR) and microvascular density (total length of perfused microvessels/mm 2 surface area) in women with and without MVM lesions. Results: Women with placental MVM lesions had smaller-sized sublingual vessels (median 8.59 μM [IQR 8.12, 9.19] vs. 9.01 μM [IQR 8.37, 9.64]; p<0.001), and a lower density of vessels compared to women without lesions. Glycocalyx perfused boundary region was unexpectedly lower in women with MVM lesions (median 2.20 μM [IQR 2.06, 2.43] vs. 2.32 μM [IQR 2.15, 2.50]; p=0.003) in 10-19 μM vessels. Women with HDP and MVM lesions appear to be the most impacted, with the smallest size vessels (median 8.47 [IQR 8.09-9.13]) and the lowest glycocalyx PBR across all vessel sizes. Women with MVM lesions without a HDP similarly had evidence of microvascular glycocalyx derangement whereas women with HDP without placental lesions had a glycocalyx profile similar to women without MVM or a history of HDP. Conclusions: A decade after delivery, women with a history of placental malperfusion lesions had alterations in microvascular perfusion. Women with MVM lesions and a history of HDP appear to be the most severely impacted, which may reflect an underlying maladaptive vascular phenotype detected in the placenta at the time of pregnancy that might provide pathologic insight into future maternal microvascular health.

scholarly journals Effects of a single aerobic exercise on perfused boundary region and microvascular perfusion: a field study

2021 ◽  
Author(s):  
Alexander Fuchs ◽  
Tobias Neumann ◽  
Hendrik Drinhaus ◽  
Anika Herrmann ◽  
Hans Vink ◽  
...  
Keyword(s):  
Surface Layer ◽  
Aerobic Exercise ◽  
Linear Regression Analysis ◽  
Boundary Region ◽  
Dark Field ◽  
Microvascular Perfusion ◽  
Sidestream Dark Field ◽  
Endothelial Surface Layer ◽  
Sublingual Microcirculation ◽  
Endothelial Surface

AbstractThe endothelium and the glycocalyx play a pivotal role in regulating microvascular function and perfusion in health and critical illness. It is unknown today, whether aerobic exercise immediately affects dimensions of the endothelial surface layer (ESL) in relation to microvascular perfusion as a physiologic adaption to increased nutritional demands. This monocentric observational study was designed to determine real-time ESL and perfusion measurements of the sublingual microcirculation using sidestream dark field imaging performed in 14 healthy subjects before and after completing a 10 km trial running distance. A novel image acquisition and analysis software automatically analysed the perfused boundary region (PBR), an inverse parameter for red blood cell (RBC) penetration of the ESL, in vessels between 5 and 25 µm diameter. Microvascular perfusion was assessed by calculating RBC filling percentage. There was no significant immediate effect of exercise on PBR and RBC filling percentage. Linear regression analysis revealed a distinct association between change of PBR and change of RBC filling percentage (regression coefficient β: − 0.026; 95% confidence interval − 0.043 to − 0.009; p = 0.006). A single aerobic exercise did not induce a change of PBR or RBC filling percentage. The endothelium of the microvasculature facilitates efficient perfusion in vessels reacting with an increased endothelial surface layer.

Can sidestream dark field (SDF) imaging identify subtle microvascular changes of the bowel during colorectal surgery?

2018 ◽  
Vol 22 (10) ◽  
pp. 793-800
Author(s):  
A. F. J. de Bruin ◽  
A. L. M. Tavy ◽  
K. van der Sloot ◽  
A. Smits ◽  
C. Ince ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Dark Field ◽  
Sidestream Dark Field ◽  
Sdf Imaging ◽  
Microvascular Changes

Abstract 2044: Selective Head Cooling Initiated during Cpr Induces Post-Resuscitation Carotid Artery Dilation and Increases in Carotid Artery Flow and Cerebral Cortical Microcirculation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Giuseppe Ristagno ◽  
Jun H Cho ◽  
Tao Yu ◽  
Shijie Sun ◽  
Max H Weil ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Brain Temperature ◽  
Capillary Density ◽  
Dark Field ◽  
Sidestream Dark Field ◽  
Blood Flows ◽  
Dark Field Imaging ◽  
Head Cooling ◽  
Artery Flow

Introduction. We have previously reported that selective head cooling initiated during CPR prevented increases in brain temperature and improved neurological outcome. In the present study, we explored the relationship between head cooling during CPR and cerebral blood flows. We hypothesized that head cooling during CPR would yield carotid artery dilation with consequent increases in carotid flows and cerebral cortical microcirculation. Methods. Eight pigs weighing 37 ± 1 kg were intubated and mechanically ventilated. The common carotid artery was isolated and a parietal craniotomy was created. Ventricular fibrillation was electrically induced and untreated for 4 min. Animals were then randomized to head cooling or control. Head cooling was initiated with the aid of the RinoChill device (BeneChill Inc) at the beginning of CPR. CPR was performed for 4 min prior to defibrillation. Common carotid artery diameter and flow were assessed with a Doppler transducer. Cerebral cortical capillary density, representing the number of perfused capillaries, was assessed with Sidestream Dark Field imaging (MicroVisionMedical Inc). Brain temperature was measured with a needle sensor inserted in the cerebral cortex. Results. All the animals were resuscitated. After resuscitation, the brain temperature was significantly decreased in animals subjected to head cooling. Significantly greater carotid artery diameters and flows were observed in animals subjected to selective head cooling compared to the control animals. These increases in carotid blood flows were accompanied by significantly greater numbers of perfused capillaries in the cerebral cortices. No differences in cardiac output were observed between the two groups (Table ). Conclusion. Early selective head cooling induces carotid artery dilation and increases in carotid flows and cerebral cortical microcirculation after resuscitation.

scholarly journals Exposure to acute normobaric hypoxia results in adaptions of both the macro- and microcirculatory system

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Moritz Mirna ◽  
Nana-Yaw Bimpong-Buta ◽  
Fabian Hoffmann ◽  
Thaer Abusamrah ◽  
Thorben Knost ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Acute Hypoxia ◽  
Capillary Density ◽  
Dark Field ◽  
Normobaric Hypoxia ◽  
Vessel Density ◽  
Resistance Arteries ◽  
Compensatory Mechanisms ◽  
Sidestream Dark Field ◽  
Sublingual Microcirculation

AbstractAlthough acute hypoxia is of utmost pathophysiologic relevance in health and disease, studies on its effects on both the macro- and microcirculation are scarce. Herein, we provide a comprehensive analysis of the effects of acute normobaric hypoxia on human macro- and microcirculation. 20 healthy participants were enrolled in this study. Hypoxia was induced in a normobaric hypoxia chamber by decreasing the partial pressure of oxygen in inhaled air stepwisely (pO2; 21.25 kPa (0 k), 16.42 kPa (2 k), 12.63 kPa (4 k) and 9.64 kPa (6 k)). Macrocirculatory effects were assessed by cardiac output measurements, microcirculatory changes were investigated by sidestream dark-field imaging in the sublingual capillary bed and videocapillaroscopy at the nailfold. Exposure to hypoxia resulted in a decrease of systemic vascular resistance (p < 0.0001) and diastolic blood pressure (p = 0.014). Concomitantly, we observed an increase in heart rate (p < 0.0001) and an increase of cardiac output (p < 0.0001). In the sublingual microcirculation, exposure to hypoxia resulted in an increase of total vessel density, proportion of perfused vessels and perfused vessel density. Furthermore, we observed an increase in peripheral capillary density. Exposure to acute hypoxia results in vasodilatation of resistance arteries, as well as recruitment of microvessels of the central and peripheral microcirculation. The observed macro- and microcirculatory effects are most likely a result from compensatory mechanisms to ensure adequate tissue oxygenation.

scholarly journals Microstructural studies of laser irradiated graphite surfaces

1990 ◽  
Vol 5 (5) ◽  
pp. 980-988 ◽  
Author(s):  
J.S. Speck ◽  
J. Steinbeck ◽  
M.S. Dresselhaus
Keyword(s):  
Surface Deformation ◽  
Solid Phase ◽  
Boundary Region ◽  
Dark Field ◽  
Dark Field Imaging ◽  
Irradiated Graphite ◽  
Lateral Extent ◽  
Region Exterior ◽  
Field Imaging ◽  
Microstructural Studies

The structure of pulsed laser irradiated graphite surfaces has been elucidated. The pulse fluences range up to 4 J cm−2 with durations no longer than 30 ns. The region exterior to the irradiated spot is littered with ∼0.1 μm diameter carbon spheroids. The boundary region is characterized by both spheroids and torn layers 1–5 μm. in lateral extent. The central region displays carbon spheroids and surface upheavals. The carbon spheroids are attributed to hydrodynamic sputtering of carbon. The surface upheavals and torn carbon layers are attributed to constrained thermal expansion and contraction of the irradiated region. It is estimated that a nearly instantaneous 1000°C temperature change is necessary to cause the observed surface deformation. Pulse fluences in excess of 0.8 J cm−2 cause a thin layer of carbon to melt. This is proven by the fact that the irradiated layer in the solid phase has a turbostratic structure. Electron diffraction experiments and dark-field imaging experiments show that the basal plane grain size of the resolidified material varies from ∼20 Å at the melt threshold to ∼100 Å for samples irradiated with 4.0 J cm−2.

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