Noninvasive Bedside Approaches for Assessing Microvascular Dysfunction.

backgroundMicrovascular dysfunction is implicated in a range of acute and chronic conditions, ranging from cardiovascular disease to sepsis, often preceding organ damage and clinical symptoms. Within conditions such as diabetes or septic shock, microvascular compromise frequently correlates with disease severity and outcomes, emphasizing the importance of timely, targeted assessment. Noninvasive bedside methods for evaluating microvascular function have rapidly evolved, driven by advances in computational power, artificial intelligence, and novel imaging hardware. SUMMARY: This review provides an overview of clinically feasible noninvasive techniques - including optical coherence tomography angiography, handheld videomicroscopy, laser speckle contrast imaging, reflectance spectroscopy, and related techniques. These methods allow observation under resting conditions and can be combined with functional tests such as post-occlusive reactive hyperemia, heating provocation, or iontophoresis to evaluate microvascular function. KEY MESSAGES: Collectively, these methods provide valuable insights into the structural and functional aspects of the microcirculation, but their clinical application is constrained by need for standardized protocols, validation, and evidence linking microvascular metrics to meaningful patient outcomes. Collaborations among academia, industry, and healthcare remain pivotal to transitioning these methods into regulated, accessible devices. As standardization progresses and evidence grows, this integrative approach of evaluating microvascular function may emerge as a mainstay in clinical practice and translational research.