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The Sublingual Glycocalyx : A Novel Noninvasive Predictor of Coronary Artery Disease in Females

The glycocalyx (GC) provides in healthy blood vessels limited access to flowing red blood cells (RBC). Recent studies have suggested that RBCs penetrate deeper into a damaged GC, which has been associated with microcirculatory dysfunction that accompanies coronary artery disease (CAD). We hypothesize that the presence of CAD could be predicted by measuring the dimension of the RBC perfused boundary region (PBR), the space between median RBC column width and the outer edge of RBC permeable vascular lumen. In healthy vessels PBR is relatively small due to limited penetration of RBC into the GC and it is hypothesized that PBR will increase when GC is damaged. We used sidestream dark field imaging of the sublingual microvasculature in post‐menopausal female subjects with angiographic CAD (N=10) and healthy controls (N=15). From these images, PBR was determined in over 3000 vascular segments (diameter 5–30 μm) per subject. The mean PBR increased from 2.08 ± 0.07 μm to 2.34 ± 0.08 μm (P<0.05) comparing controls with CAD patients, respectively. These data demonstrate that CAD patients have a significant increase in the RBC accessible component of the sublingual microvascular GC compared to control subjects. A wider permeable portion of the GC indicates a change in GC structure which may be associated with a reduced vascular protective function of the GC. Supported by AHA 12POST9400001 and NIH K08 1 K08 HL086730–01