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Hemorheological Disorders and Arteriolar Resistance
During Ischemic Heart Disease
T. 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.
The most pronounced hemorheological disorders were found in the patients with the 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 available. We
concludes that the blood rheological disorders represent themselves a factor that plays a significant role in
pathogenesis of development of the heart 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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