Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

The Association between Whole Blood Viscosity and Coronary Collateral Circulation in Patients with Chronic Total Occlusion

  • Cetin, Mehmet Serkan (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Cetin, Elif Hande Ozcan (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Balci, Kevser Gulcihan (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Aydin, Selahattin (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Ediboglu, Emek (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Bayraktar, Muhammed Fatih (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Balci, Mustafa Mucahit (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Maden, Orhan (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Temizhan, Ahmet (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital) ;
  • Aydogdu, Sinan (Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital)
  • Received : 2016.01.25
  • Accepted : 2016.04.05
  • Published : 2016.11.30
⟨ Previous Next ⟩

Abstract

Background and Objectives: Coronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion. Subjects and Methods: A total of 371 patients diagnosed as having at least one major, chronic total occluded coronary artery were included. 197 patients with good CCC (Rentrop 2 and 3) composed the patient group. The poor collateral group consisted of 174 patients (Rentrop grade 0 and 1). Results: Patients with poor CCC had higher WBV values for a low-shear rate (LSR) ($69.5{\pm}8.7$ vs. $60.1{\pm}9.8$, p<0.001) and high-shear rate (HSR) ($17.0{\pm}2.0$ vs. $16.4{\pm}1.8$, p<0.001) than the good collateral group. Correlation analysis demonstrated a significant negative correlation between the grade of CCC and WBV for LSR (${\beta}=0.597$, p<0.001) and HSR (${\beta}=0.494$, p<0.001). WBV for LSR (${\beta}=0.476$, p<0.001) and HSR (${\beta}=0.407$, p<0.001) had a significant correlation with the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. A multivariate analysis showed that the WBV for both shear rates were independent risk factors of poor CCC (WBV at LSR, OR: 1.362 CI 95%: 1.095-1.741 p<0.001 and WBV at HSR, 1.251 CI 95%: 1.180-1.347 p<0.001). Conclusion: WBV has been demonstrated as the overlooked predictor of poor coronary collateralization. WBV seemed to be associated with microvascular perfusion and angiogenesis process impairing CCC development.

Keywords

References

  1. Cohen M, Rentrop KP. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation 1986;74:469-76. https://doi.org/10.1161/01.CIR.74.3.469
  2. Kilian JG, Keech A, Adams MR, Celermajer DS. Coronary collateralization: determinants of adequate distal vessel filling after arterial occlusion. Coron Artery Dis 2002;13:155-9. https://doi.org/10.1097/00019501-200205000-00004
  3. van Royen N, Piek JJ, Buschmann I, Hoefer I, Voskuil M, Schaper W. Stimulation of arteriogenesis; a new concept for the treatment of arterial occlusive disease. Cardiovasc Res 2001;49:543-53. https://doi.org/10.1016/S0008-6363(00)00206-6
  4. Papaioannou TG, Stefanadis C. Vascular wall shear stress: basic principles and methods. Hellenic J Cardiol 2005;46:9-15.
  5. Sloop G, Holsworth RE Jr, Weidman JJ, St Cyr JA. The role of chronic hyperviscosity in vascular disease. Ther Adv Cardiovasc Dis 2015;9:19-25. https://doi.org/10.1177/1753944714553226
  6. Cho YI, Cho DJ, Rosenson RS. Endothelial shear stress and blood viscosity in peripheral arterial disease. Curr Atheroscler Rep 2014;16:404. https://doi.org/10.1007/s11883-014-0404-6
  7. de Simone G, Devereux RB, Chien S, Alderman MH, Atlas SA, Laragh JH. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation 1990;81:107-17. https://doi.org/10.1161/01.CIR.81.1.107
  8. Shah PB. Management of coronary chronic total occlusion. Circulation 2011;123:1780-4. https://doi.org/10.1161/CIRCULATIONAHA.110.972802
  9. Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985;5:587-92. https://doi.org/10.1016/S0735-1097(85)80380-6
  10. Sloop GD, Garber DW. The effects of low-density lipoprotein and highdensity lipoprotein on blood viscosity correlate with their association with risk of atherosclerosis in humans. Clin Sci (Lond) 1997;92:473-9. https://doi.org/10.1042/cs0920473
  11. Blann A, Bignell A, McCollum C. von Willebrand factor, fibrinogen and other plasma proteins as determinants of plasma viscosity. Atherosclerosis 1998;139:317-22. https://doi.org/10.1016/S0021-9150(98)00090-2
  12. Muggeo M, Calabro A, Businaro V, Moghetti P, Padovan D, Crepaldi G. Correlation of metabolic and hemorrheological parameters in diabetes and hyperlipidemia. Ric Clin Lab 1983;13(Suppl 3):165-79.
  13. Wasilewski J, Turczynski B, Slowinska L, Kowalik V, Osadnik T, Polonski L. Haemorheological factors and myocardial reperfusion in patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Kardiol Pol 2007;65:778-85; discussion 786-7.
  14. Empen K, Geiss HC, Lehrke M, Otto C, Schwandt P, Parhofer KG. Effect of atorvastatin on lipid parameters, LDL subtype distribution, hemorrheological parameters and adhesion molecule concentrations in patients with hypertriglyceridemia. Nutr Metab Cardiovasc Dis 2003;13:87-92. https://doi.org/10.1016/S0939-4753(03)80023-6
  15. Mellwig KP, Baller D, Schmidt HK, et al. Myocardial perfusion under H.E.L.P.-apheresis. Objectification by PET. Z Kardiol 2003;92(Suppl 3):III30-7. https://doi.org/10.1007/s00392-003-1303-y
  16. Arntz HR, Perchalla G, Roll D, Heitz J, Schafer JH, Schroder R. Blood rheology in acute myocardial infarction: effects of high-dose i.v. streptokinase compared to placebo. Eur Heart J 1992;13:275-80. https://doi.org/10.1093/oxfordjournals.eurheartj.a060159
  17. Mohandas N, Chasis JA, Shohet SB. The influence of membrane skeleton on red cell deformability, membrane material properties, and shape. Semin Hematol 1983;20:225-42.
  18. Hansen JF. Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion. Am Heart J 1989;117:290-5. https://doi.org/10.1016/0002-8703(89)90771-0
  19. Nacar AB, Erayman A, Kurt M, et al. The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion. Med Princ Pract 2015;24:65-9. https://doi.org/10.1159/000365734
  20. Borekçi A, Gur M, Şeker T, et al. Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score. Perfusion 2015;30:457-64. https://doi.org/10.1177/0267659114558287
  21. Yaylali YT, Susam I, Demir E, et al. Increased red blood cell deformability and decreased aggregation as potential adaptive mechanisms in the slow coronary flow phenomenon. Coron Artery Dis 2013;24:11-5. https://doi.org/10.1097/MCA.0b013e32835b0bdf
  22. Soulis JV, Farmakis TM, Giannoglou GD, et al. Molecular viscosity in the normal left coronary arterial tree. Is it related to atherosclerosis? Angiology 2006;57:33-40. https://doi.org/10.1177/000331970605700105
  23. Biro GP, Beresford-Kroeger D, Hendry P. Early deleterious hemorheologic changes following acute experimental coronary occlusion and salutary antihyperviscosity effect of hemodilution with stroma-free hemoglobin. Am Heart J 1982;103:870-8. https://doi.org/10.1016/0002-8703(82)90402-1
  24. Biro GP, Beresford-Kroeger D. The effect of hemodilution with stroma-free hemoglobin and dextran on collateral perfusion of ischemic myocardium in the dog. Am Heart J 1980;99:64-75. https://doi.org/10.1016/0002-8703(80)90315-4
  25. Doi H, Kaburaki M, Inoue H, Suzumura K, Narita H. Protective effect of TA-993, a novel therapeutic agent for peripheral circulatory insufficiency, on skeletal muscle fatigue in a rat model of hindlimb ischemia. Jpn J Pharmacol 2000;83:73-81. https://doi.org/10.1254/jjp.83.73
  26. van Gaal WJ, Ponnuthurai FA, Selvanayagam J, et al. The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol 2009;135:60-5. https://doi.org/10.1016/j.ijcard.2008.03.033
  27. Kyriakides ZS, Kremastinos DT, Michelakakis NA, Matsakas EP, Demovelis T, Toutouzas PK. Coronary collateral circulation in coronary artery disease and systemic hypertension. Am J Cardiol 1991;67:687-90. https://doi.org/10.1016/0002-9149(91)90522-M
  28. Junker R, Heinrich J, Ulbrich H, et al. Relationship between plasma viscosity and the severity of coronary heart disease. Arterioscler Thromb Vasc Biol 1998;18:870-5. https://doi.org/10.1161/01.ATV.18.6.870

Cited by

  1. Association between SYNTAX Score and Coronary Collateral Circulation vol.109, pp.5, 2016, https://doi.org/10.5935/abc.20170156
  2. Does Blood Flow Change according to Mood? Blood Rheology in Bipolar Disorder vol.16, pp.3, 2016, https://doi.org/10.9758/cpn.2018.16.3.310
  3. Serum osmolarity and blood viscosity in neuroleptic malignant syndrome vol.29, pp.suppl1, 2019, https://doi.org/10.1016/j.euroneuro.2018.11.696
  4. Blood Viscosity Should Not Be Overlooked When Evaluating the Fibrinogen to Albumin Ratio vol.70, pp.5, 2016, https://doi.org/10.1177/0003319718822244
  5. Serum osmolarity and blood viscosity as a potential explanation for the pathophysiology of neuroleptic malignant syndrome vol.23, pp.4, 2019, https://doi.org/10.1080/13651501.2019.1617884
  6. Lipoprotein(a) as a marker for predicting coronary collateral circulation in patients with acute myocardial infarction vol.17, pp.1, 2020, https://doi.org/10.2217/pme-2018-0127
  7. The Relationship between Blood Viscosity and Acute Arterial Occlusion vol.6, pp.1, 2016, https://doi.org/10.2478/jce-2020-0002
  8. Intraoperative changes in whole-blood viscosity in patients undergoing robot-assisted laparoscopic prostatectomy in the steep Trendelenburg position with pneumoperitoneum: a prospective nonrandomized vol.20, pp.1, 2016, https://doi.org/10.1186/s12871-019-0919-z
  9. Relationship between blood viscosity and no-reflow phenomenon in ST-segment elevation myocardial infarction performed in primary percutaneous coronary interventions vol.15, pp.9, 2021, https://doi.org/10.2217/bmm-2020-0772