FMSF–PORH Test Services
The first test implemented by Angionica is the FMSF–PORH test (Flow Mediated Skin Fluorescence–Post-Occlusive Reactive Hyperemia), which is used to assess microvascular circulation (vascular endothelial function) based on circulatory stimulation in response to induced reactive hyperemia (PORH). The test makes it possible to assess levels of both contraction and vasodilation and to follow the kinetics of changes in response to reactive hyperemia. In general, the FMSF-PORH test enables identification of patients requiring prophylactic or therapeutic interventions, and more accurate and complex diagnostic tests. It also facilitates monitoring of the treatment process, the influence of drugs on the condition of vessels and the effects of training and physical exertion on overall health.
Main parts of a typical trace recorded for an individual patient using AngioExpert
- Baseline – collected for 3 min (or 4 min if unstable).
- Ischemic response (IR) – 3 min occlusion with cuff inflated to 60 mmHg above systolic blood pressure, resulting in an increase of NADH fluorescence.
- Hyperemic response (HR) caused by releasing pressure in the occlusion cuff – NADH fluorescence decreases below the baseline, reaching a minimum followed by a return to the baseline.
- Hyperemic response (HR) with two distinct phases:
- hyperemia – related to a sharp drop in NADH fluorescence for 20–30 s;
- reperfusion – a much slower return to the baseline.
Definition of measured parameters
Hyperemic response parameters HRmax and HRindex express changes in NADH fluorescence (mainly from the keratinocytes in the epidermis) and determine the metabolic reaction of the skin cells to hyperemia and reperfusion.
Ischemic response parameters IRmax and IRindex express changes in NADH fluorescence (mainly from keratinocytes in the epidermis) and determine the sensitivity of skin cells to hypoxia caused by blocking blood flow in the forearm. This sensitivity is determined primarily by the efficiency of oxygen transport to the epidermal cells just before occlusion.
Interpretation of the measured parameters
- HRmax refers to the efficacy of oxygen supply to the epidermis during hyperemia via skin microcirculation and can be treated as an indirect measure of NO bioavailability in the microcirculation.
- HRindex refers to the recovery of metabolic status in the epidermis following hyperemia caused by the release of pressure in the occlusion cuff.
- HRmax and HRindex are key parameters demonstrating the diagnostic power of the FMSF technique.
- Parameters IRmax and IRindex are sensitive to deviations from the measurement procedure and carry auxiliary diagnostic significance.
- Microvascular oscillations on the baseline and the hyperemic response line express the efficacy of vascular-metabolic regulation related to microvascular dermal flow. A weakening of their amplitude and changes in frequency may indicate the presence of microvascular dysfunction.
Threshold values of the key parameters for diabetes
Based on the results of tests and experiments, threshold values have been established indicating serious disorders in microvascular and metabolic regulation and signaling the risk of vascular complications in diabetes patients.
The HRindex parameter has particularly high diagnostic sensitivity and specificity for assessing the risk of developing vascular complications.
- enables early diagnosis of dysfunctional vascular circulation,
- identifies diabetic patients at risk of vascular complications at an early stage,
- assesses the risk of metabolic disorders in patients with type 1 diabetes,
- assesses the risk of serious cardiovascular complications in patients with type 2 diabetes,
- is recommended for monitoring patients with diabetes over time to enable early identification of dysfunction and disturbances in vascular circulation and metabolic regulation.
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