Heart disease often develops quietly over many years before serious symptoms appear. By the time a person feels chest pain, shortness of breath, or fatigue, damage may already be widespread.
Scientists have long known that some of the earliest warning signs begin in the body’s smallest blood vessels, far beyond what standard medical scans can detect.
Now, researchers in Germany have developed a new imaging tool that may finally allow doctors to see these early changes clearly and safely.
Researchers at Helmholtz Munich and the Technical University of Munich have created a technology called fast-RSOM, short for fast raster scan optoacoustic mesoscopy.
This tool can produce extremely detailed images of tiny blood vessels just beneath the skin, without needles, radiation, or invasive procedures. By simply scanning the skin, fast-RSOM can reveal how well the smallest blood vessels are functioning, offering a new way to spot cardiovascular risk at a very early stage.
The smallest blood vessels in the body, known as capillaries, play a crucial role in delivering oxygen and nutrients to tissues. When these vessels lose their ability to widen and narrow properly, the condition is known as microvascular endothelial dysfunction.
This problem often appears years before larger arteries are affected, making it an early signal of future heart disease. Until now, doctors had no direct and reliable way to observe this process in living patients without invasive tests.
Fast-RSOM changes that situation. The technology captures high-resolution images that show individual capillaries and different layers of skin in real time. It can detect subtle changes in blood vessel structure and function that are linked to cardiovascular risk.
These changes are commonly associated with smoking, high blood pressure, obesity, and other well-known risk factors, but fast-RSOM goes beyond simply identifying risk factors. It shows the physical damage that has already begun inside the microvascular system.
According to the researchers, this ability to directly measure blood vessel health is a major breakthrough. Instead of estimating risk based on age, weight, or medical history alone, doctors could see how a person’s smallest blood vessels are actually behaving.
This could help identify individuals who appear healthy on the surface but already show early signs of cardiovascular damage.
Fast-RSOM works by sending brief pulses of light into the skin. When this light is absorbed by blood and tissue, it produces tiny sound waves that can be detected and turned into detailed three-dimensional images.
This approach allows the system to capture both structure and function, showing not only where blood vessels are located, but also how well they respond to changes in blood flow and oxygen levels.
One of the most important advantages of fast-RSOM is its speed and portability. The system is designed to work quickly and comfortably, making it suitable for use in outpatient clinics rather than specialized research centers. This raises the possibility that advanced microvascular imaging could one day become part of routine cardiovascular checkups.
The research team plans to test fast-RSOM in larger and more diverse groups of patients. They aim to confirm how well the technology predicts future heart disease and how sensitive it is to improvements from lifestyle changes or medication.
Because fast-RSOM can be repeated easily over time, it could also be used to monitor whether treatments such as exercise, weight loss, or blood pressure control are truly improving blood vessel health.
In reviewing and analyzing the study findings, the importance of this technology lies in its ability to shift cardiovascular care toward prevention.
Rather than waiting for symptoms or major artery damage to appear, doctors could intervene earlier, when changes are still small and potentially reversible. This could lead to more personalized treatment plans and reduce the long-term burden of heart disease on patients and healthcare systems.
The study also highlights a broader message about cardiovascular health. Heart disease does not begin suddenly in the heart itself, but develops gradually through widespread changes in the body’s smallest vessels.
By making these hidden processes visible, fast-RSOM provides a new window into how heart disease truly begins. If future studies confirm its clinical value, this technology could reshape how cardiovascular risk is assessed, managed, and prevented long before serious disease takes hold.
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The study is published in Light: Science.
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