Key result
Evaluation of cutaneous microvascular function by laser-Doppler flowmetry has unsatisfactory reproducibility (CV 10-20%), poor specificity, and lacks correlation with large-vessel disease.
This commentary highlights significant methodological and physiological limitations in using cutaneous laser-Doppler flowmetry as a surrogate for generalized microvascular or endothelial function.
VIEWPOINTCommentary on Viewpoint: The human cutaneous circulation as a model of generalized microvascular functionDamiano RizzoniDamiano RizzoniPublished Online:01 Jul 2008https://doi.org/10.1152/japplphysiol.00172.2008MoreSectionsPDF (26 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations to the editor: Holowatz, Thompson-Torgenson, and Kenney (2) made a valuable attempt to highlight the clinical advantages related to the evaluation of cutaneous microvascular function by laser-Doppler flowmetry. Undoubtedly, there are several reasons that favor a noninvasive approach of microvascular responses; however, my personal feeling is that the authors have substantially underestimated problems and drawbacks related to the concerned approach.A first problem is related, in general, to the unsatisfactory interassay and intra-assay reproducibility of skin blood flow with laser-Doppler techniques. As previously pointed out by Kubli et al. (3), the mean coefficients of variation of responses recorded on different days, on the same site, in the same individual were between 10 and 20%. A even worse reproducibility was observed by Newton et al. (5).A second relevant problem is related to the relatively poor specificity of the evaluation of endothelium-dependent responses of skin blood flow (4). As pointed out by David Celermajer (1), flow responses in the skin circulation are hardly to be considered tests of endothelial dysfunction, and although some of them may be, at least in part, endothelially mediated, this phenomenon appears not to be dependent on nitric oxide (1, 4).Furthermore, tests of microcirculatory responses in the skin to date have not been correlated with large-vessel disease nor to the behavior of skeletal and cardiac muscle microvessels (1). For the previously mentioned reasons, the claim that evaluation of cutaneous microvascular function by laser-Doppler flowmetry may provide relevant and reliable information in clinical practice requires careful scrutiny.REFERENCES1 Celermajer DS. Statins, skin, and the search for a test of endothelial function. Editorial comment. J Am Coll Cardiol 42: 78–80, 2003.Crossref | ISI | Google Scholar2 Holowatz LA, Thompson-Torgenson CS, Kenney WL. Viewpoint: the cutaneous circulation as a model of generalized microvascular function. J Appl Physiol; doi:10.1152/japplphysiol.00858.2007.Link | ISI | Google Scholar3 Kubli S, Waeber B, Dalle-Ave A, Feihl F. Reproducibility of laser Doppler imaging of skin blood flow as a tool to assess endothelial function. J Cardiovasc Pharmacol 36: 640–648, 2000.Crossref | PubMed | ISI | Google Scholar4 Kvandal P, Stefanovska A, Veber M, Kvernmo HD, Kirkebøen KA. Regulation of human cutaneous circulation evaluated by laser Doppler flowmetry, iontophoresis, and spectral analysis: importance of nitric oxide and prostaglandins. Microvasc Res 65: 161–171, 2003.Google Scholar5 Newton DJ, Kahan F, Belch JJF. Assessment of microvascular endothelial function in human skin. Clin Sci 101: 567–572, 2001.Crossref | PubMed | ISI | Google ScholarAUTHOR NOTESAddress for reprint requests and other correspondence: D. Rizzoni, c/o 2a Medicina Spedali Civili, Brescia, Italy 25100 (e-mail: [email protected]) Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Cited ByThe acute effects of passive heating on endothelial function, muscle microvascular oxygen delivery, and expression of serum HSP90αMicrovascular Research, Vol. 142Microvascular blood flow during vascular occlusion tests assessed by diffuse correlation spectroscopy20 December 2019 | Experimental Physiology, Vol. 105, No. 1Novel Noninvasive Assessment of Microvascular Structure and Function in HumansMedicine & Science in Sports & Exercise, Vol. 51, No. 7 More from this issue > Volume 105Issue 1July 2008Pages 383-383 Copyright & PermissionsCopyright © 2008 the American Physiological Societyhttps://doi.org/10.1152/japplphysiol.00172.2008PubMed18641225History Published online 1 July 2008 Published in print 1 July 2008 Metrics
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Damiano Rizzoni (2008) conducted an editorial in Microvascular function. Laser-Doppler flowmetry of cutaneous microvascular function was evaluated. Evaluation of cutaneous microvascular function by laser-Doppler flowmetry has unsatisfactory reproducibility (CV 10-20%), poor specificity, and lacks correlation with large-vessel disease.
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