Cutaneous microcirculation in cardiac allograft recipients with severe hypercholesterolemia before, during, and after the first HELP apheresis
Jai-Wun Park, Christoph Mrowietz, Stephan Schüler, Carlos Labarrere, Friedrich Jung

Background: Hyperlipidemic heart transplant patients who develop cardiac allograft vasculopathy benefit from HELP-apheresis (Heparin-induced Extracorporeal LDL Precipitation). There is evidence that HELP-apheresis improves microcirculation by an improvement of endothelial dysfunction and hemorheologic defects.

Methods: Cutaneous microcirculation was examined before, during, and 60 minutes after a single HELP-apheresis in eight hyperlipidemic heart recipients with cardiac allograft vasculopathy (CAV). Mean erythrocyte velocity vRBC was measured in nail fold capillaries by using intravital microscopy.

Results: In hyperlipidemic CAV patients (all males, 51±9 years, 8-36 months post transplantation) the baseline mean vRBC was pathologically reduced with 0.13±0.07 mm/s. This was well below the reference range of 0.48 mm/s – 0.72 mm/s in healthy volunteers. During the HELP-apheresis vRBC increased significantly (p=0.0001) and remained increased until the end of the HELP procedure (p < 0.05). Even one hour after the end of treatment, vRBC was still increased by 30.7% (0.17±0.11 mm/s vs baseline value of 0.13±0.07 mm/s; p < 0.05). Furthermore, vRBC one hour after the HELP procedure was significantly more continuous than at baseline. The variation coefficient of vRBC measurements was significantly higher at baseline than after HELP treatment (32.7±18.1 % vs 23.5±11.0 %; p=0.0159), indicating that the capillary perfusion was discontinuous at baseline and was normalized after the HELP treatment. 

Conclusions: In hyperlipidemic CAV patients vRBC in nail fold capillaries is significantly reduced compared to normal subjects, indicating severely disturbed cutaneous microcirculation. Even a single HELP-apheresis results in a significant improvement of the cutaneous microcirculation.

Keywords: Heart transplantation, HELP-LDL-apheresis, microcirculation

Applied Cardiopulmonary Pathophysiology 9: 19-25, 2000

Jai-Wun Park, M.D.
Cardiovascular Institute
Technical University Dresden
Fetscherstr. 76
D-01307 Dresden
Germany
Phone: +49-351-450-1200
Fax: +49-351-1202