Association between coronary artery disease severity and videocapillaroscopic findings of nail fold capillary circulation



Coronary artery disease, Nail fold videocapillaroscopy, SYNTAX, Gensini Score


Aim: Endothelial dysfunction plays a significant role in the etiology of coronary artery disease (CAD), which develops due to atherosclerosis, and is a major cause of morbidity and mortality. Nail fold videocapillaroscopy (NVC) assessment is a surrogate marker of endothelial dysfunction. To the best of our knowledge, the relationship between the microcirculation features on NVC and the severity of coronary atherosclerosis has not previously been investigated. In this study, we aimed to investigate the relationship between severity of coronary atherosclerosis (shown by SYNTAX and Gensini scores) and NVC findings which is an indirect indicator of systemic endothelial damage.
Methods: The study was designed as a retrospective cohort. One-hundred consecutive patients who underwent coronary angiography (CAG) and had at least one lesion in the epicardial coronary arteries, narrowing the lumen by more than 50%, were included. Coronary angiographic images of the patients were evaluated by two experienced interventional cardiologists and SYNTAX and Gensini scores were calculated. Patients were divided into three groups according to the SYNTAX scores (SYNTAX score ≤22, between 23-32, and ≥33) and two groups according to Gensini scores (Gensini score ≥30 and ˂30). The NVC examinations were performed by a rheumatologist who was experienced in this field, and the reduction in capillary density, presence of dilated capillaries, giant capillary, microhemorrhage, branching, disorganization, tortuosity, avascular area, extravasation, and neoangiogenesis were investigated.
Results: Dilated capillary vessels were more common in diabetic patients (85%) than in non-diabetics (66.7%) (P=0.041). Besides, there was no significant difference in NVC parameters between patients with and without diabetes mellitus (P>0.05 for all), with and without hypertension (P>0.05 for all). There was no significant difference between the SYNTAX groups in terms of NVC findings (P>0.05 for all). The NVC findings were similar between Gensini groups (P>0.05 for all).
Conclusion: The severity of atherosclerosis surrogated by SYNTAX and Gensini scores was not related to the NVC findings. Therefore, NVC is inappropriate for determining the severity of CAD.


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Hitaka Y, Miura S, Koyoshi R, Suematsu Y, Miyase Y, Norimatsu K, et al. Associations between parameters of flow-mediated vasodilatation obtained by continuous measurement approaches and the presence of coronary artery disease and the severity of coronary atherosclerosis. Clinical and Experimental Hypertension. 2016;38(5):443-50. doi: 10.3109/10641963.2016.1163365. PubMed PMID: 27359079.

Kaya H, Ertas F, Oylumlu M, Bilik MZ, Yildiz A, Yuksel M, et al. Relation of epicardial fat thickness and brachial flow-mediated vasodilation with coronary artery disease. Journal of Cardiology. 2013;62(6):343-7. doi: 10.1016/j.jjcc.2013.05.009. PubMed PMID: 23810068.

Manganaro A, Ciraci L, Andre L, Trio O, Manganaro R, Saporito F, et al. Endothelial dysfunction in patients with coronary artery disease: insights from a flow-mediated dilation study. Clinical and applied thrombosis/hemostasis: official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2014;20(6):583-8. Epub 2014/02/27. doi: 10.1177/1076029614524620. PubMed PMID: 24569627.

Kurtoglu Gumusel H, Catakoglu AB, Yildirimturk O, Yurdakul S, Helvacioglu F, Ziyrek M, et al. Relationship between endothelial dysfunction and cardiovascular risk factors and the extent and severity of coronary artery disease. Turk Kardiyol Dern Ars. 2014;42(5):435-43. doi: 10.5543/tkda.2014.72798. PubMed PMID: 25080949.

Arakawa K, Ohno M, Horii M, Ishigami T, Kimura K, Tamura K. Impact of flow-mediated dilatation and coronary calcification in providing complementary information on the severity of coronary artery disease. Atherosclerosis. 2017;267:146-52. Epub 2017/11/14. doi: 10.1016/j.atherosclerosis.2017.11.003. PubMed PMID: 29132034.

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. Epub 2018/12/21. doi: 10.1016/j.autrev.2018.09.002. PubMed PMID: 30572139.

Vilela VS, da Silva BRA, da Costa CH, Lopes AJ, Levy RA, Rufino R. Effects of treatment with rituximab on microcirculation in patients with long-term systemic sclerosis. BMC Research Notes. 2018;11(1):874. Epub 2018/12/12. doi: 10.1186/s13104-018-3994-1. PubMed PMID: 30526656; PubMed Central PMCID: PMCPMC6288955.

Pizzorni C, Cutolo M, Sulli A, Ruaro B, Trombetta AC, Ferrari G, et al. Long-term follow-up of nailfold videocapillaroscopic changes in dermatomyositis versus systemic sclerosis patients. Clinical Rheumatology. 2018. Epub 2018/07/15. doi: 10.1007/s10067-018-4211-2. PubMed PMID: 30006917.

Caetano J, Paula FS, Amaral M, Oliveira S, Alves JD. Nailfold Videocapillaroscopy Changes Are Associated With the Presence and Severity of Systemic Sclerosis-Related Interstitial Lung Disease. Journal of clinical rheumatology. Practical Reports on Rheumatic & Musculoskeletal Diseases. 2018. Epub 2018/05/22. doi: 10.1097/rhu.0000000000000815. PubMed PMID: 29782426.

Xia Z, Wang G, Xiao H, Guo S, Liu Y, Meng F, et al. Diagnostic value of nailfold videocapillaroscopy in systemic sclerosis secondary pulmonary arterial hypertension: a meta-analysis. Internal Medicine Journal. 2018;48(11):1355-9. Epub 2018/05/16. doi: 10.1111/imj.13968. PubMed PMID: 29761614.

Dancour MA, Vaz JL, Bottino DA, Bouskela E. Nailfold videocapillaroscopy in patients with systemic lupus erythematosus. Rheumatology İnternational. 2006;26(7):633-7. Epub 2005/09/24. doi: 10.1007/s00296-005-0033-z. PubMed PMID: 16180000.

Cavazzana I, Piantoni S, Sciatti E, Fredi M, Taraborelli M, Bonadei I, et al. Relationship between endothelial dysfunction, videocapillaroscopy and circulating CD3+CD31+CXCR4+ lymphocytes in systemic lupus erythematosus without cardiovascular risk factors. Lupus. 2019:961203318821161. Epub 2019/01/05. doi: 10.1177/0961203318821161. PubMed PMID: 30608206.

Yuksel S, Yuksel EP, Yenercag M, Soylu K, Zengin H, Gulel O, et al. Abnormal nail fold capillaroscopic findings in patients with coronary slow flow phenomenon. International Journal of Clinical and Experimental Medicine. 2014;7(4):1052.

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. Arthritis & Rheumatism. 2013;65(11):2737-47.

Ruaro B, Sulli A, Smith V, Pizzorni C, Paolino S, Alessandri E, et al. Microvascular damage evaluation in systemic sclerosis: the role of nailfold videocapillaroscopy and laser techniques. Reumatismo. 2017;69(4):147-55. Epub 2018/01/13. doi: 10.4081/reumatismo.2017.959. PubMed PMID: 29320840.

Andracco R, Irace R, Zaccara E, Vettori S, Maglione W, Riccardi A, et al. The cumulative number of micro-haemorrhages and micro-thromboses in nailfold videocapillaroscopy is a good indicator of disease activity in systemic sclerosis: a validation study of the NEMO score. Arthritis Research & Therapy. 2017;19(1):133. Epub 2017/06/15. doi: 10.1186/s13075-017-1354-5. PubMed PMID: 28610600; PubMed Central PMCID: PMCPMC5470283.

Corrado A, Correale M, Mansueto N, Monaco I, Carriero A, Mele A, et al. Nailfold capillaroscopic changes in patients with idiopathic pulmonary arterial hypertension and systemic sclerosis-related pulmonary arterial hypertension. Microvascular Research. 2017;114:46-51. Epub 2017/06/18. doi: 10.1016/j.mvr.2017.06.005. PubMed PMID: 28619664.

Soulaidopoulos S, Triantafyllidou E, Garyfallos A, Kitas GD, Dimitroulas T. The role of nailfold capillaroscopy in the assessment of internal organ involvement in systemic sclerosis: A critical review. Autoimmunity Reviews. 2017;16(8):787-95. Epub 2017/06/04. doi: 10.1016/j.autrev.2017.05.019. PubMed PMID: 28576600.

Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. The American Journal of Cardiology. 1983;51(3):606. Epub 1983/02/01. PubMed PMID: 6823874.

Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-27. Epub 2005/08/01. PubMed PMID: 19758907.

Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the Syntax study. EuroIntervention. 2009;5(1):50-6. Epub 2009/07/07. PubMed PMID: 19577983.

Garg S, Girasis C, Sarno G, Goedhart D, Morel MA, Garcia-Garcia HM, et al. The SYNTAX score revisited: a reassessment of the SYNTAX score reproducibility. Catheter Cardiovasc Interv. 2010;75(6):946-52. Epub 2010/02/11. doi: 10.1002/ccd.22372. PubMed PMID: 20146321.

Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. The New England Journal of Medicine. 2009;360(10):961-72. Epub 2009/02/21. doi: 10.1056/NEJMoa0804626. PubMed PMID: 19228612.

Cutolo M, Pizzorni C, Secchi ME, Sulli A. Capillaroscopy. Best Practice & Research Clinical rheumatology. 2008;22(6):1093-108. Epub 2008/12/02. doi: 10.1016/j.berh.2008.09.001. PubMed PMID: 19041079.

Cutolo M, Sulli A, Secchi ME, Paolino S, Pizzorni C. Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement? Rheumatology (Oxford, England). 2006;45 Suppl 4:iv43-6. Epub 2006/09/19. doi: 10.1093/rheumatology/kel310. PubMed PMID: 16980724.

Oz F, Elitok A, Bilge AK, Mercanoglu F, Oflaz H. Relationship between brachial artery flow-mediated dilation, carotid artery intima-media thickness and coronary flow reserve in patients with coronary artery disease. Cardiology Research. 2012;3(5):214.

Mahdavi-Roshan M, Salari A, Doostdar-Sanaye M. Brachial endothelial function and carotid intima-media thickness in patients with coronary artery disease. Journal of Paramedical Sciences. 2015;6(4).

Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, et al. The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography (Mount Kisco, NY). 2010;27(3):300-5. Epub 2010/05/22. doi: 10.1111/j.1540-8175.2009.01019.x. PubMed PMID: 20486958.

Gupta N, Giri S, Rathi V, Ranga GS. Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India. J Clin Diagn Res. 2016;10(10):OC35-OC9. Epub 2016/11/29. doi: 10.7860/jcdr/2016/20872.8751. PubMed PMID: 27891375; PubMed Central PMCID: PMCPMC5121713.

Mutlu B, Tigen K, Gurel E, Ozben B, Karaahmet T, Basaran Y. The predictive value of flow-mediated dilation and carotid artery intima-media thickness for occult coronary artery disease. Echocardiography (Mount Kisco, NY). 2011;28(10):1141-7. Epub 2011/08/23. doi: 10.1111/j.1540-8175.2011.01492.x. PubMed PMID: 21854440.

Rajaei A, Dehghan P, Farahani Z. Nailfold Capillaroscopy Findings in Diabetic Patients (A Pilot Cross-Sectional Study). Open Journal of Pathology. 2015;5(02):65.

Penna GLdA, Garbero RdF, Neves MF, Oigman W, Bottino DA, Bouskela E. Treatment of essential hypertension does not normalize capillary rarefaction. Clinics. 2008;63(5):613-8.

Agrawal S, Mehta PK, Bairey Merz CN. Cardiac Syndrome X: update 2014. Cardiology Clinics. 2014;32(3):463-78. doi: 10.1016/j.ccl.2014.04.006. PubMed PMID: 25091971; PubMed Central PMCID: PMC4122947.

Gallucci F, Russo R, Buono R, Acampora R, Madrid E, Uomo G. Indications and results of videocapillaroscopy in clinical practice. Advances in Medical Sciences. 2008;53(2):149.

Wang X, Nie S-P. The coronary slow flow phenomenon: characteristics, mechanisms and implications. Cardiovascular Diagnosis and Therapy. 2011;1(1):37.






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Polat E, Sucu MM, İnanç İbrahim H, Zengin O. Association between coronary artery disease severity and videocapillaroscopic findings of nail fold capillary circulation. J Surg Med [Internet]. 2020 Jun. 1 [cited 2024 Jun. 13];4(6):465-9. Available from: