Hemorheological abnormalities and their associations with coronary blood flow in patients with cardiac syndrome X: a comparison between males and females
Restricted accessResearch articleFirst published online January, 2017
Hemorheological abnormalities and their associations with coronary blood flow in patients with cardiac syndrome X: a comparison between males and females
The role of elevated whole blood viscosity (WBV) in the pathogenesis of atherosclerosis is well known. We sought to investigate the gender differences in the association between WBV, coronary blood flow and tissue oxygen delivery index (TODI) in cardiac syndrome X (CSX).
Methods:
Forty-six CSX patients and 14 healthy volunteers were enrolled. The coronary flow parameters were obtained with transthoracic Doppler echocardiography and WBV was measured (at high-shear and low-shear rates of 300s-1 and 5s-1, respectively) using a scanning capillary tube viscometer. TODI was determined from the ratio of hematocrit to WBV measured at a low-shear rate of 5s-1.
Results:
In male patients, the mean diastolic coronary flow velocity (CFV) and diastolic velocity time integral (VTI) were significantly decreased compared to control group (all p<0.05) and the WBV showed significant negative correlation with peak systolic CFV (r = −0.559 at 300s-1, r = −0.438 at 5s-1), mean systolic CFV (r = −0.577 at 300s-1, r = −0.488 at 5s-1), systolic VTI (r = −0.576 at 300s-1, r = −0.530 at 5s-1) and diastolic VTI (r = −0.553 at 300s-1, r = −0.551 at 5s-1) (all p<0.01). Meanwhile, although female patients showed no significant relationships between WBV and coronary flow parameters, TODI were significantly decreased compared to the control group (3.64 ± 0.34 vs. 4.07 ± 0.38%/centipoises (cP), respectively, p=0.008).
Conclusion:
Our study suggests that there are gender-related differences in the pathogenesis of microvascular angina and gender-specific approaches for CSX patients might be needed.
BaskurtOKMeiselmanHJ. Blood rheology and hemodynamics. Semin Thromb Hemost2003; 29: 435–450.
2.
FrangosSGGahtanVSumpioB. Localization of atherosclerosis: role of hemodynamics. Arch Surg1999; 134: 1142–1149.
3.
MalekAMAlperSLIzumoS. Hemodynamic shear stress and its role in atherosclerosis. JAMA1999; 282: 2035–2042.
4.
FriedmanMHBargeronCBDetersOJHutchinsGMMarkFF. Correlation between wall shear stress and intimal thickness at a coronary artery branch. Atherosclerosis1987; 68: 27–33.
5.
StonePHSaitoSTakahashiS. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation2012; 126: 172–181.
6.
StonePHCoskunAUYeghiazariansY. Prediction of sites of coronary atherosclerosis progression: in vivo profiling of endothelial shear stress, lumen, and outer vessel wall characteristics to predict vascular behavior. Curr Opin Cardiol2003; 18: 458–470.
LeeBKDurairaiAMehraAWenbyRBMeiselmanHJAlexyT. Hemorheological abnormalities in stable angina and acute coronary syndromes. Clin Hemorheol Microcirc2008; 39: 43–51.
9.
LoweGDFowkesFGDawesJDonnanPTLennieSEHousleyE. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation1993; 87: 1915–1920.
10.
LoweGDLeeAJRumleyAPriceJFFowkesFG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol1997; 96: 168–173.
11.
DaneshJCollinsRPetoRLoweGD. Haematocrit, viscosity, erythrocyte sedimentation rate: meta-analyses of prospective studies of coronary heart disease. Eur Heart J2000; 21: 515–520.
12.
BilgiMGüllüHKozanoğluİ. Evaluation of blood rheology in patients with coronary slow flow or non-obstructive coronary artery disease. Clin Hemorheol Microcirc2013; 53: 317–326.
KempHGJrVokonasPSCohnPFGorlinR. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med1973; 54: 735–742.
15.
BugiardiniRBairey MerzCN. Angina with “normal” coronary arteries: a changing philosophy. JAMA2005; 293: 477–484.
16.
National Center for Health Statistics. Vital Statistics of the United States 1990, Vol. 2, Mortality. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics, DHHS Publication1994; N0. (PHS): 95–1102.
17.
KamenevaMVWatachMJBorovetzHS. Gender difference in rheologic properties of blood and risk of cardiovascular diseases. Clin Hemorheol Microcirc1999; 21: 357–363.
18.
WaltzXHardy-DessourcesMDLemonneN. Is there a relationship between the hematocrit-to-viscosity ratio and microvascular oxygenation in brain and muscle?Clin Hemorheol Microcirc2015; 59: 37–43.
19.
KenyeresPJuricskayITarsolyP. Low hematocrit per blood viscosity ratio as a mortality risk factor in coronary heart disease. Clin Hemorheol Microcirc2008; 38: 51–56.
20.
KamenevaMVWatahMJBorovetzHS. Gender difference in oxygen delivery index; potential link to development of cardiovascular diseases. Applied Cardiopulmonary Pathophysiology2000; 9: 382–387.
21.
MarkDBShawLHarrellFEJr.. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med1991; 325: 849–853.
22.
GibsonCMCannonCPDaleyWL. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation1996; 93: 879–888.
23.
OkumuraKYasueHHorioY. Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation1988; 77: 535–542.
24.
LangRMBadanoLPMor-AviV. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr2015; 16: 233–270.
25.
YounHJFosterE. Demonstration of coronary artery flow using transthoracic Doppler echocardiography. J Am Soc Echocardiogr2004; 17: 178–185.
26.
KimSHChoYIJeonAHHogenauerBKenseyKR. A new method for blood viscosity measurement. J Non-Newton Fluid2000; 94: 47–56.
27.
MelikianNDe BruyneBFearonWFMacCarthyPA. The pathophysiology and clinical course of the normal coronary angina syndrome (cardiac syndrome X). Prog Cardiovasc Dis2008; 50: 294–310.
28.
LeeBKDurairaiAMehraAWenbyRBMeiselmanHJAlexyT. Microcirculatory dysfunction in cardiac syndrome X: role of abnormal blood rheology. Microcirculation2008; 15: 451–459.
29.
ChoYIChoDJ. Hemorheology and microvascular disorders. Korean Circ J2011; 41: 287–295.
30.
LoweGDDrummondMMLorimerAR. Relation between extent of coronary artery disease and blood viscosity. Br Med J1980; 280: 673–674.
31.
RainerCKawanishiDTChandraratnaPA. Changes in blood rheology in patients with stable angina pectoris as a result of coronary artery disease. Circulation1987; 76: 15–20.
32.
FowkesFGPellJPDonnanPT. Sex differences in susceptibility to etiologic factors for peripheral atherosclerosis. Importance of plasma fibrinogen and blood viscosity. Arterioscler Thromb1994; 14: 862–868.
33.
WoodwardMRumleyATunstall-PedoeHLoweGD. Does sticky blood predict a sticky end? Associations of blood viscosity, haematocrit and fibrinogen with mortality in the West of Scotland. Br J Haematol2003; 122: 645–650.
34.
EpsteinSECannonROTalbotTL. Hemodynamic principles in the control of coronary blood flow. Am J Cardiol1985; 56: 4E–10E.
35.
EpsteinSETalbotTL. Dynamic coronary tone in precipitation, exacerbation and relief of angina pectoris. Am J Cardiol1981; 48: 797–803.
36.
MehtaJMehtaPBurgerCPepineCJ. Platelet aggregation studies in coronary artery disease. Part 4. Effect of aspirin. Atherosclerosis1978; 31: 169–175.
37.
BuchananMRBristerSJ. Individual variation in the effects of ASA on platelet function: implications for the use of ASA clinically. Can J Cardiol1995; 11: 221–227.
