Increased red blood cell deformability and decreased aggregation as potential adaptive mechanisms in the slow coronary flow phenomenon

Yaylali, Yalın Tolga; Susam, İbrahim; Demir, Erdem; Bor-Küçükatay, Melek; Uludag, Burcu; Kilic‐Toprak, Emine; Erken, Gülten; Dursunoğlu, Dursun

doi:10.1097/mca.0b013e32835b0bdf

Cited by 21 publications

(15 citation statements)

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“…In large vessels blood flow is mainly determined by hematocrit, and it decreases inversely with the vessel diameter causing blood viscosity to remain steady 13). Because, increased blood viscosity results in slowing down the blood flow stasis,21) it has been hypothesized that to sustain normal blood stream within the arterial system, blood viscosity must decrease, and erythrocyte deformability must increase 22). Therefore, in addition to RBC deformability, WBV takes an active role in the perfusion of the capillaries.…”

Section: Discussionmentioning

confidence: 99%

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

Çetin

Balcı

et al. 2016

Korean Circ J

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Background and ObjectivesCoronary 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 MethodsA 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).ResultsPatients with poor CCC had higher WBV values for a low-shear rate (LSR) (69.5±8.7 vs. 60.1±9.8, p<0.001) and high-shear rate (HSR) (17.0±2.0 vs. 16.4±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 (β=0.597, p<0.001) and HSR (β=0.494, p<0.001). WBV for LSR (β=0.476, p<0.001) and HSR (β=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).ConclusionWBV 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.

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Section: Discussionmentioning

confidence: 99%

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

Çetin

Balcı

et al. 2016

Korean Circ J

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“…The enhanced RBC aggregation after stent implantation may contribute to impaired microvascular perfusion. In postmortem analysis of myocardium from patients with pronounced forms of slow‐flow and in a porcine model of ischemia/reperfusion in the no‐reflow area, RBC aggregates have been reported to obstruct capillaries …”

Section: Discussionmentioning

confidence: 99%

Influence of stent implantation on erythrocyte aggregation in human native coronary arteries and saphenous vein grafts

Baars

Preibsch³

et al. 2016

Microcirculation

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“…Hyperviscosity is assumed to be a pathological factor in impaired exchange between tissues and blood. Several studies reported that an elevated hematocrit leads to increased aggregation of red blood cells (RBCs) and increased blood viscosity, which might lead to decreased perfusion in tissues [4,5,22,24,30]. In one echocardiographic study, an increased hematocrit in healthy individuals was shown to reduce the coronary flow reserve [25].…”

Section: Discussionmentioning

confidence: 99%

Correlation between the hematocrit and slow coronary flow

Wang

Zhang

Cheng

et al. 2014

Clinical Hemorheology and Microcirculation

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BACKGROUND: Whether the hematocrit is implicated in the pathogenesis of slow coronary flow (SCF) is not known. METHODS: To evaluate the correlation between the hematocrit and SCF, we studied 367 patients with angiographically near-normal coronary arteries. They were divided into four quartiles based on the hematocrit. The corrected thrombolysis in myocardial infarction frame count (TFC) was used to document velocity of coronary flow. RESULTS: From the first through to the fourth quartile, the percentage of males and those who smoked as well as serum levels of creatinine, uric acid and triglyceride increased (p < 0.001), whereas the age and level of high-density lipoprotein-cholesterol decreased (p < 0.05). The proportions of SCF in the quartiles increased (55.4, 60.9, 77.2 and 85.7%, respectively, p < 0.001). Multivariate analyses revealed that the corrected TFC for the left anterior descending artery (LAD) (p < 0.001; B = 0.065; 95% confidence interval (CI), 0.038-0.093; beta = 0.199) and the proportion of SCF in the LAD (p < 0.001; B = 1.343; 95% CI 0.704-1.983; beta = 0.174) were correlated with the hematocrit after adjustment for confounding factors. CONCLUSION: The hematocrit is positively correlated with the corrected TFC for the LAD, which suggested that an increase in the hematocrit may contribute to the pathophysiology of SCF.

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Increased red blood cell deformability and decreased aggregation as potential adaptive mechanisms in the slow coronary flow phenomenon

Abstract: The SCFP is associated with increased RBC deformability and decreased RBC aggregation. These hemorheological alterations, possibly also contributing factors in limiting the pathogenesis, can especially serve as beneficial adaptive mechanisms in the SCFP.

Cited by 21 publications

References 0 publications

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

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

Influence of stent implantation on erythrocyte aggregation in human native coronary arteries and saphenous vein grafts

Correlation between the hematocrit and slow coronary flow

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