Hemorheological, microvascular and hemodynamic disorders during coronary heart disease

57Urdulashvili T., Momtselidze N.,
Mantskava M., Narsia N.,
Mchedlishvili G.

 

Department of Internal Medicine, State Medical University; Microcirculation Research    Center, I. Beritashvili Institute of Physiology, Tbilisi,  Georgia.

Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide. Even more, it is projected that CAD mortality rates will double from 1990 to 2020, with approximately 82% of the increase attributable to the developing world [5]. Prevention and targeted control of risk factors for CAD could potentially reduce the impact of CAD in the developing world.

Furthermore, several studies demonstrated a strong relationship between ischemic vascular disease and worsening in hemorheological parameters mainly in patients affected by ischemic vascular diseases [10]. Some scientists suggested that hemorheological parameters constitute independent risk factors for ischemic cardiovascular events. It has been suggested that the whole blood viscosity, plasma viscosity and erythrocyte aggregation might be influence by the lipids and plasmatic lipoproteins [3]. Our resent Studies showed significance of the hemorheological disorders in pathogenesis and development of the coronary heart disease [11].


Aim of the present study was to investigate relationship between hemorheological, microvascular and hemodynamic abnormalities during various forms of the chronic coro- nary heart disease.
Material and methods. We investigated 64 patients with chronic coronary heart disease – angina, functional classes I – I V, heart failure I-IV (NYHA), and unstable angina. For evaluation of the hemoreological disorders we investigated their most significant symptom, the erythrocyte aggregabil- ity, with the “Georgian technique” that provided us with direct and quantitative data [7]. We investigated also the tone of the hands resistance arteries with an original non- invasive technique based on measurement of the flow velocity changes in the radial arteries by using the Doppler technique during standardized postischemic hyperemia [8]. Echocardiographically we studied the standard characteristics of the left ventricular function (systolic and diastolic volume, its mass and ejection fraction). ECG by standard leads and blood pressure was measured in all patients. Control group was consisted of 20 healthy subjects, 10 men, 10 women with a mean age of 57+2 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.


Results and their discussion. We found that the rheological disorders are manifested in the early stages of the disease before its functional manifestation. The most pronounced hemorheological disorders were in evidence in the patients with unstable angina and heart failure (Fig. 1). There was a positive correlation between erythrocyte aggregability index and the severity of the disease (P<0,01). As tî the arteriolar resistance index, it was increased only in 45 per cent of all the investigated patients and no signif- icant difference between the patients with the heart failure and without it was found (Fig. 2). There was a negative relationship between erythrocyte aggregability and the ejec- tion fraction of the left ventricle and a positive correlation between erythrocyte aggregability and left ventricle hyper- trophy (p<0,01). ECG changes were most pronounced in patients with high levels of the erythrocyte aggregation.


RBC aggregation is a major determinant of blood viscosity, particularly under the conditions of low shear stress, and therefore it affects blood flow dynamics mainly within the microcirculation, where such conditions prevail [9]. Experimental models and clinical studies demonstrate the potential of RBC aggregation to hinder blood flow through the microcirculation in various diseases [1]. The formation of “sludge” blood under these conditions is assumed to cause tissue hypoxia and acidosis, and to lead to the met- abolic disturbances. A pathogenic role for erythrocyte aggregation has been postulated in acute coronary syn- dromes [2,6]. These studies examined the blood viscosity, not the erythrocyte aggregation, which seems to be most important from our standpoint. Furthermore, we mentioned the importance of the erythrocyte aggregation for the vessels injury.

Rheological disorders allow atherogenic particles to be longer exposed to the vascular endothelial and consequently greater interaction between the blood cells themselves and the vessel wall [3]. Our data show that arteriolar resistivity is high enough even in the beginning stages of the coronary heart disease and doesn’t change significantly the currency of severity of the disease (Fig. 1). It means that arteriolar walls undergo early changes, before clinical confirmation of the disease is occurred. Simultaneously we observed that erythrocyte aggregability was progressively increased during the severity of the disease (Fig. 2), especially the acute forms (infarction, cardio- genic shock). Interrelationship between the erythrocyte aggregability and arteriolar resistivity is direct in the early stages of the disease, but there is no significant difference between them in patients with and without heart failure. This means that the blood vessels lost there function totally, not only in one region of the coronary supplement. The increased blood viscosity provokes increasing of the peripheral resistance and overloading of the heart muscle with its hypertrophy, which determines high-risk of sudden death.

This condition deteriorates the blood circulation in the whole body especially in the regions with more superfine structure of microcirculation (the heart, the brain). These approaches were postulated in the European guidelines on cardiovascular disease prevention, which indicated that the etiology of myocardial infarction, ischemic stroke and peripheral arterial disease is similar and, indeed, recent intervention trials have show that several forms of therapy prevent not only coronary events and revascularizations but also ischemic stroke and peripheral artery disease [4].


We concluded that increased erythrocyte aggregability is a high risk-factor of developing coronary heart disease and sudden death, and therefore they must be monitored and controlled in all risk-groups of this disease.

 

REFERENCES

1.    Ben Ami R, Barshtein G, Zeltser D, Goldberg Y, Shapira I. Roth A, Keren G, Miller H, Prochorov V, Eldor A, Berliner S, and Yedgar S. Parameters of red blood cell aggregation as corre- lates of the inflammatory state // Am J Physiol Heart Circ Phys- iol. – 2001. – V.280. – 5. – P.1982-1988.

2.    Caimi, G, Hoffmann, E, Montana, M, Canino, B, Dispensa, F, Catania A, and Presti R, LO, Haemorheological pattern in young adults with acute myocardial infarction // Clin. Hemorhe- ology and Microcirc. – 2003. – N29. –  P.11-18.

3.    Contreras T., Vaya A, Palanca S, Sola E, Corella D. And Aznar J.    Influence of plasmatic lipids on the hemoreological profile in healthy adults // Clin. Hemorheology and Microcirc. – 2004. – N30. – P.423-425.

4.    “European guidelines on CVD prevention in Clinical Prac- tice” Executive summery // European Heart Journal. – 2003. – N24(17). – P.1601-1610.

5.    Okrinec K. Coronary artery disease in the developing world // AHJ. – 2004. – V.148. – N1.

6.    Marton Zs, Horvath B, Alexy T, Kesmarky G, Gyevnar Zs, Czopf L, Habon T, Kovacs L, Papp E, Mezey B, Roth E, Juric- skay I, and Toth K, Follow-up of hemorheological parameters and platelet aggregation in patients with acute coronary syn- dromes // Clin. Hemorheology and Microcirc. – 2003. – N29. – P.81-94.

7.    Mchedlishvili G, Beritashvili N, Lominadze D, and Tsinamdzvrishvili B, Technique for direct and quantitative evaluation of erythrocyte aggregability in blood samples // Biorheology. – 1993.
– N30. – P.  153-161.

8.    Mchedlishvili G., Mantskava M., Urdulashvili T., Appraisal of functional state of the human resistance arteries // Russian Journal of Biomechanics. – 2004. – V. 8. – N1. – P.55-59.

9.    Soutani, M, Suzuki Y, Tateishi N, and Maeda N. Quantitative evaluation of flow dynamics of erythrocytes in microvessels: influence of erythrocyte aggregation // Am. J Physiol Heart Circ Physiol. – 1995.- N268. –  P.1959-1965.

10.    Turchetti at all. Endothelium and hemorheology // Clinic. Hemorheology and Microcirculation. – 2004. – N30. – P.289-295.

11.    Urdulashvili T., Momtselidze N., Mantskava M., Narsia N., Mchedlishvili G., Hemorheological disorders and artriolar resis- tance during ischemic heart disease // Clinical Hemorheology and Microcirculation. – 2004. – N30. – P.399-401.


SUMMARY

HEMORHEOLOGICAL, MICROVASCULAR AND HEMO- DYNAMIC DISORDERS DURING CORONARY HEART DISEASE

Urdulashvili* T., Momtselidze** N., Mantskava** M., Nar- sia*  N.,  Mchedlishvili** G.

*Department of Internal Medicine, State Medical    University;
**Microcirculation Research Center, I. Beritashvili Institute of Physiology, Tbilisi, Georgia

Significance of the hemorheological disorders in development of acute vascular syndromes is presently well known, but their role in pathogenesis of chronic coronary heart disease has not been yet sufficiently analyzed. Aim of the present study was the investigation of the relationship between the hemorheologi- cal, vascular and hemodynemic factors responsible for develop- ment of the coronary heart disease.

We investigated 64 patients with coronary heart disease of the functional classes I-IV with and without the heart failure. For evaluation of the hemorheological disorders we investigated its most significant symptom, the erythrocyte aggregability, with the “Georgian technique” that provided us with direct and quan- titative data. We investigated also the tone of the hand’s resis- tance arteries with an original non-invasive technique based on measurement of the flow velocity changes in the patients and in the healthy controls radial arteries by using the Doppler tech- nique during standardized postischemic hyperemia. Echocar- diographically we studied the standard characteristics of left ventricular function (systolic and diastolic volume, its mass and ejection fraction). ECG by standard leads and the blood pres- sure were investigated in all patients.

We found that the rheological disorders are manifested in the early stages of the disease before its functional manifestation. The most pronounced hemorheological disorders were in evi- dence in the patients with unstable angina and heart failure. As to the arteriolar resistance index, it was increased only in 45 per cent of all the investigated patients and no significant difference between the patients with the heart failure and without it was found. There was a negative relationship between erythrocyte aggregability and the ejection fraction of the left ventricle and the positive correlation between erythrocyte aggregability and left ventricle hypertrophy (p<0,01). We concluded that the blood rheological disorders represent themselves a factor that plays a significant role in pathogenesis of the coronary heart    disease.

They are predictors of the disease and not only risk factors as it is generally believed. Measurement and correction of these dis- turbances in its early stages have a high clinical significance.

 

         

49 Responses to Hemorheological, microvascular and hemodynamic disorders during coronary heart disease

  1. MozillacompatibleMSIEWindowsNTenOpera Windows XP

    It’s actually practically extremely difficult to encounter well-updated men and women on this matter, yet somehow you appear like you are familiar with what exactly you’re posting on! Many Thanks

  2. MozillacompatibleMSIEWindowsNTenOpera Windows XP

    During that he still possesses a sofa for friends and a large mattress for 2 that delivers a peaceful night’s rest.

  3. suba pron says:

    MSIE 6.0 Windows XP

    8NqMDJ Some really good information, Sword lily I discovered this. What you do speaks therefore loudly that i cannot hear that which you say. by Ron Waldo Emerson.

  4. MarilynREarl says:

    Firefox Windows 8.1

    I know this site offers quality dependent content and other information, is there almost
    every other website which gives these things in quality?

  5. MozillacompatibleMSIEWindowsNTenOpera Windows XP

    I like what you guys are up also. Such smart work and reporting! Carry on the superb works guys I’ve incorporated you guys to my blogroll. I think it will improve the value of my website :).

  6. ChuckXCorrie says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 7

    Very quickly this website is going to be famous among all blogging people, because of it’s nice content

  7. KurtisGArras says:

    Firefox Windows 7

    Attractive section of content. I just stumbled upon your blog and in accession capital to assert that
    I acquire actually enjoyed account your blog posts. Anyway I’ll be subscribing to your augment and even I
    achievement you access consistently rapidly.

  8. IsaacBSetias says:

    Firefox Windows 8

    Good day! I really could have sworn I’ve gone to this web site before but after dealing with a few of the
    articles I realized it’s a novice to me. Regardless, I’m certainly pleased I
    came across it and I’ll be bookmarking it and
    checking back regularly!

  9. ElizaTMattan says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 7

    I do believe the admin on this internet site is really spending so much time in support of his website, since here every data is quality
    based stuff.

  10. AletaYEveler says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 7

    Hi there, You have done a fantastic job. I’ll definitely digg it and personally suggest to
    my friends. I am sure they will be benefited from this
    site.

  11. SeasonXNaill says:

    Chrome 39.0.2171.95 Windows 7

    This is the perfect site for everyone who wants to find out about this
    topic. You realize a whole lot its almost hard to argue with you (not that I really
    would want toHaHa). You definitely put a new
    spin on a subject that has been discussed
    for a long time. Excellent stuff, just great!

  12. StacieGKasal says:

    Firefox Windows 7

    Great post. I had been checking constantly this weblog and I am inspired!
    Very useful info specially the ultimate part 🙂 I take care
    of such info a whole lot. I found myself trying to find this certain info for any very long time.
    Thank you and best of luck.

  13. Firefox Windows 7

    Greetings from Los angeles! I’m bored to death at work so I decided to
    check out your site on my iphone during lunch break.
    I love the info you provide here and can’t wait to take a look when I
    get home. I’m amazed at how quick your blog loaded on my cell phone ..
    I’m not even using WIFI, just 3G .. Anyways, excellent blog!

  14. JanitaVAbney says:

    Firefox Windows XP

    I realize this if off topic but I’m looking at starting my own, personal
    blog and was curious what all is needed to obtain setup?
    I’m assuming having a blog like yours would cost a pretty penny?
    I’m not internet smart so I’m not 100% positive. Any suggestions or advice
    would be greatly appreciated. Appreciate it

  15. TishaEChehab says:

    Chrome 39.0.2171.95 Windows XP

    Hi to all, how is the whole thing, I think every one is getting more from this website,
    and your views are pleasant in favor of new viewers.

  16. GayleUErnest says:

    Chrome 39.0.2171.95 MacOS X

    Hello there, You’ve done an incredible job. I will definitely digg it
    and personally suggest to my friends. I’m confident they will be
    benefited from this website.

  17. ChetNStevens says:

    Safari MacOS X

    Hello there, You’ve done an excellent job. I’ll definitely
    digg it and personally suggest to my friends. I’m sure they will be benefited from this site.

  18. LouBKreitlow says:

    Chrome 39.0.2171.99 MacOS X

    If you are planning for best contents like I actually do, only pay a fast visit this website daily because it provides feature contents, thanks

  19. FaithXSzanto says:

    Firefox MacOS X

    Hey! Someone in my Facebook group shared this website along
    with us and so i arrived at look it over. I’m
    definitely loving the info. I’m bookmarking and are tweeting this to
    my followers! Terrific blog and fantastic design and magnificence.

  20. ErvinFMatsuo says:

    Firefox Ubuntu;

    Hey There. I discovered your weblog the utilization of msn. That may
    be an extremely neatly written article. I will make
    sure to bookmark it and revisit to learn extra of the useful info.
    Many thanks for that post. I am going to definitely return.

  21. OllieOReeb says:

    Firefox Ubuntu;

    This is really interesting, You’re a very skilled blogger.
    I’ve joined your rss feed and look forward to seeking more of your magnificent post.
    Also, I’ve shared your site in my social networks!

  22. YoungZBaibak says:

    Chromium 39.0.2171.99 Mozilla/5.0 (X11; Linux x86_64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/39.0.2171.99 Safari/537.36

    Wow, fantastic blog layout! How long have you been blogging
    for? you make blogging look easy. The overall look of your web site is great, let alone the content!

  23. RosaliaZSith says:

    Firefox Linux

    For newest news you have to visit world wide web and on web I found this site as a best
    web site for most recent updates.

  24. CyrilIErrico says:

    Chrome 39.0.2171.96 Chrome OS

    I do believe this can be one of several most significant info to me.

    And i am just glad reading your article. But should remark on few general things, The website style is ideal,
    the articles is very great : D. Good job, cheers

  25. RickRSaxon says:

    Chrome 39.0.2171.96 Chrome OS

    Hey! I simply wished to ask if you happen to possess any issues with hackers?
    My last blog (wordpress) was hacked and i also ended
    up losing months of effort as a result of no back up. Have you
    got any solutions to control hackers?

  26. BreeRShadfar says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 8.1

    This design is spectacular! You obviously understand how
    to keep a reader amused. Between your wit as well as your videos, I
    used to be almost moved to start my blog (well,
    almost…HaHa!) Wonderful job. I seriously enjoyed everything
    you had to say, and over that, how you presented it.
    Too cool!

  27. NolanYDickel says:

    Firefox Windows 8.1

    I’m gone to tell my little brother, that he should also visit this
    weblog on regular basis to take updated from latest information.

  28. KirkLDesousa says:

    Chrome 41.0.2220.0 Windows 8.1

    Many thanks for the auspicious writeup. It actually had been a amusement account it.
    Look advanced to far added agreeable from you!

    However, how can we communicate?

  29. ManYBruderer says:

    Firefox Windows 8

    I love everything you guys are up too. Such clever work and exposure!
    Keep up to date the fantastic works guys I’ve you guys to my very own blogroll.

  30. JerrieFTures says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 7

    Heya i am for the main time here. I discovered this board and i also to get It really helpful & it helped me out a lot.

    I’m hoping to show something back and aid others including you
    aided me.

  31. StasiaYSiska says:

    MozillaWindowsNTWOWTridentrvlikeGecko Windows 7

    Its not my first time to pay a visit this site, i am just browsing this site dailly and take pleasant data from this point everyday.

  32. suba buba says:

    MSIE 6.0 Windows XP

    ukcjN9 Thanks for sharing, this is a fantastic blog. Really Cool.

  33. JarodHLile says:

    Firefox Windows 7

    Hello there, just became aware about your website through Google, and located
    that it is actually really informative. I am just likely to be cautious
    about brussels. I will be grateful should you continue this in the future.
    A great deal of individuals will be took advantage of your writing.
    Cheers!

  34. CecilMDesola says:

    Maxthon Windows 7

    I’m gone to convey my little brother, that he should also go to see this
    webpage on regular basis to take updated from latest news.

  35. AlMMorford says:

    Chrome 39.0.2171.95 Windows 7

    Thanks for sharing your thoughts on coronary. Regards

  36. EdisonLMerck says:

    Chrome 39.0.2171.95 Windows 7

    I’m really enjoying the theme/design of your weblog.
    Have you ever come upon any browser compatibility
    issues? A few of my blog readers have complained about my blog not working correctly in Explorer but looks
    great in Safari. Do you possess any recommendations
    to aid fix this issue?

  37. MagenQSpieth says:

    Chrome 36.0.1985.125 Windows 7

    Fantastic website. Plenty of helpful information here. I’m sending
    it to some friends ans additionally sharing in delicious.

    And certainly, thanks to the sweat!

  38. TishUWormley says:

    Chrome 34.0.1847.116 Windows 7

    You could definitely watch your enthusiasm in the article you write.
    The arena hopes for more passionate writers such as you who aren’t afraid to state the way that they believe.
    At all times go after your heart.

  39. LeifHSalonek says:

    Chrome 34.0.1847.116 Windows 7

    Every weekend i accustomed to pay a brief visit this site, as i would like enjoyment, for the reason that
    this this internet site conations actually pleasant funny material too.

  40. MerleHRishor says:

    Firefox Windows Vista

    I want to thank you for the efforts you may have devote
    penning this website. I’m hoping to check out the same high-grade
    content from you later on at the same time. The truth is, your creative writing abilities has
    motivated me to acquire my unique blog now 😉

  41. AmadaAVriens says:

    Firefox Windows XP

    It is a topic which happens to be near to my heart…
    Be mindful! Where are the contact info though?

  42. AsaDNiskanen says:

    Chrome 39.0.2171.99 Windows XP

    Maybe you have thought about adding a little bit more than merely your articles?

    I am talking about, the things you say is fundamental and all.

    But think about in the event you added some great images or videos to provide your posts more, “pop”!
    Your posts is extremely good though with pics and clips, this
    site could definitely be one of several best in its niche.
    Terrific blog!

  43. OmerOOnwunli says:

    Firefox Windows 8

    Hello everyone, it’s my first go to see at this web site,
    and piece of writing is truly fruitful for me,
    keep up posting these articles.

  44. JuttaUVanham says:

    Firefox Windows 8

    Hello i am kavin, its my first time to commenting anywhere, when i read this
    article i thought i could also make comment due to this good paragraph.

  45. EmmieYEccles says:

    Chrome 39.0.2171.95 Windows 8

    Unquestionably consider that that you stated. Your favorite reason seemed to
    be about the web the easiest thing to remember of.
    I only say to you personally, I certainly get irked whilst other individuals consider concerns that they plainly don’t realize about.
    You managed going to the nail upon the highest as neatly as outlined out the whole
    thing with no need side-effects , people could go on a signal.

    Will likely be again to obtain more. Thanks

  46. DawneAAzer says:

    Chrome 39.0.2171.99 Windows 8

    Awesome! Its really awesome paragraph, I have got much clear
    idea on the topic of from this paragraph.

  47. Opera 12.17 Windows 8

    It’s enormous that you are getting thoughts from this article
    as well as from our argument made at this place.

Leave a Reply to StasiaYSiska Cancel reply

Your email address will not be published. Required fields are marked *

↓