Hemorheological Disorders and Arteriolar Resistance During Ischemic Heart Disease

68T. Urdulashvili,  N. Momtselidze,
M. Mantskava, N. Narsia,
G. Mchedlishvili.

 

Microcirculation research Center, I.Beritashvili Institute of Physiology, Tbilisi, Georgia.
Internal Medicine, State medical University, Tbilisi, Georgia.

 

Abstract. It could be conjectured that the hemorheological disorders are involved in development of the ischemic heart disease. But this fact was so far insufficiently cleared up. The present studies were carried out in patients with various forms of chronic ischemic heart disease. We investigated the most significant factor of rheological disorders in the microcirculation, the erythrocyte aggregability, which a technique that provided us with the direct and quantitative data. Simultaneously we investigated in the some patients the tone of the resistance arteries of the hand with an original non-invasive technique. We found that the erythrocyte aggregability increased almost twice in the blood of investigated patients as compared to the healthy control group. The aggregability was positively correlated with severity of the disease.

Introduction

It is generally accepted that the most common causes of the myocardial ischemia are the obstructive atherosclerosis plaques in the epicardial coronary arteries. However the disease can develop also because of other forms of coronary heart diseases the blood viscosity, hematocrit and blood plasma fibrinogen levels were found significantly increased [1,2]. For a better understanding of such disturbances we investigated in 45 patients the possible involvement of the hemorheological disorders and of the raise of arteriolar resistance in development of the heart diseases.


Material and Methods

The patients under study consisted of two groups, 45 patients had various of chronic ischemic heart disease of the angina-functional class’s I-IV and heart failure without angina pectoris. For appraisal of the blood rheological disorders we investigated their most significant index, the erythrocyte aggregability with the “Georgian technique” that provided us with direst and quantitative data [3]. Functional state of the peripheral arteries was investigated in the same patients with a non-invasive technique based on the blood flow velocity measurement in the radial artery with the Doppler technique under conditions of standardized postischemic hyperemia. Two-dimensional echocardiograph was applied (Mysono-201, Medison, South Korea). ECG and arterial pressure were investigated in all patients.

The control group included healthy people of a comparative age and sex: 10 men and 10 women with a mean age of 56±4,5 years. This group had no evidence of a cardiac disease; they were taking no medication at the time of testing and had a normal resting electrocardiogram (ECG).

Results

The RBC aggregability index was increased almost twice in the patients’ blood as compared to the healthy control group (see Fig.1). It was positively correlated with severity of the disease. Namely, in patients with angina on exertion the index was 45,8±2.3, while during angina at rest it was 53.9±1,4. The highest significance of the index, 59.4±3.6, was found in the patients with the hearts failure (EF<45%). As to the arterial resistance index, it was increased by about 45 per cent in all the investigated patients and no significant differences between the patients with the heart failure and without it was found available. Namely, in patients with angina on exertion this index was mean 0.74±0.15, during angina at rest it was 0.80±0.43, and in the patients with heart failure, 0.79±0.56.


Discussion

Coronary vessels have a wide adaptive range. Their collateral networks are better pronounced when the arterial stenosis developed gradually. Angiographic investigations of coronary arteries showed that clinical severity of the disease does not correlate with the degree of injury of the coronary arteries. Therefore the hemorheoloogical investigations play a very significant role under these conditions. Both the vascular and hemorheological factors might represent themselves to be predictors of the ischemic heart disease. These latter disorders are in evidence in the primary stages of the disease and are progressing simultaneously with its severity. The most pronounced hemorheological disorders were found in the patients with the heart failure (EF<45%). There was an increase of the erythrocyte aggregability, the “sludge-syndrome”, which is most determining the cardiac muscle microcirculation. As to the tone of the resistance arteries, it was found increased even in the primary stages of the disease, but there was a tendency of its diminishing at the end stages when the heart failure was developed.

References

[1] Y.Gregory, H.Lip and D. Gareth Beevers. Abnormalities of rheology.biz and coagulation in hypertension, Human hypertension 8 (1994), 693-702.

[2] G.D.O. Lowe. Blood rheology.biz in arterial disease, Clin. Sci. 71 (1993), 137-146.

[3] G. Mchedlishvili, N.Beritashvili, D. Lominadze, B. Tsinamdzgvrishvili.. Technique for direct and quantitative evaluation of erythrocyte aggregability in blood samples. Biorheology. 30, (1993), 153-161.

 

         

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