Association of Indicators of Dehydration and Haemoconcentration with the Coronary Slow Flow Phenomenon

Abstract

Objectives: The coronary slow flow phenomenon (CSFP), characterized by decreased distal progression of dye to coronary arteries, is a distinct angiographic phenomenon and little is known about its pathophysiology. Although several hypotheses have been suggested, the underlying mechanism of CSFP has not been well established yet. The aim of this study was to determine the roles of indicators of dehydration and haemoconcentration in CSFP which have blood flow abnormality effects. Methods: The study consisted of 33 patients with CSFP (group 1), and 31 normal subjects as control group (group 2) detected by coronary angiography. CSFP was diagnosed by the TIMI frame count method. Serum electrolytes, osmolarity and haematological parameters were measured. Results: Compared with control subjects, patient with CSFP had increased levels of calculated osmolarity, tonicity, sodium, glucose and blood urea nitrogen (BUN). Significant differences were also observed in the haematocrit, haemoglobin concentration, and calculated osmolarity but not in total cholesterol and albumin. Conclusions: The results of the present study indicate that the markers of haemoconcentration and dehydration are significantly associated with CSFP. The markers may be important in the coronary blood flow anomaly.

Keywords

• Coronary slow flow phenomenon, haematocrit, haemoconcentration, osmolarity, tonicity.

Koroner Yavafl Ak›m Fenomeniyle Dehidratasyon ve Hemokonsantrasyon Belirteçlerinin ‹liflkisi

Abstract

Amaç: Patofizyolojik olarak az bilinen koroner yavafl ak›m fenomeni (KYAF) distal koroner arterin boyanma h›z›n›n azalmas› ile karekterize anjiografik bir fenomendir. Çeflitli hipotezler ileri sürülmüfl olsada KYAF'nin mekanizmas› tam olarak aç›klanmam›flt›r. Bu çal›flman›n amac› dehitratasyon ve hemokonsantrasyon belirteçlerinin KYAF'de kan ak›m anomalisindeki rolünü belirlemektir. Yöntemler: Çal›flmaya anjiografik olarak 33 KYAF'si olan hasta (grup 1) ile 31 normal olan kontrol grubu hasta al›nm›flt›r. KYAF tan›s› TIMI frame say›m metodu ile konmufltur. Serum elektrolit, osmolarite, ve hematolojik parametreler ölçülmüfltür. Bulgular: KYAF hastalar›nda kontrol grubuna göre hesaplanm›fl osmolarite, tonisite, sodyum, glukoz, ve kan üre nitrojen düzeyi daha yüksek saptanm›flt›r. Ayr›ca total kolesterol, albumin hariç hematokrit, hemoglobin ve hesaplanm› fl osmolarite de anlaml› fark saptanm›flt›r. Sonuç: Bu çal›flmam›z KYAF ile hemokonsantrasyon ve dehitratasyon belirteçlerinin anlaml› olarak iliflkili oldu¤unu göstermifltir. Bu belirteçler koroner kan ak›m anomalisinde önemli olabilir.

Keywords

• Koroner yavafl ak›m fenomeni, hematokrit, hemokonsantrasyon, osmolarite, tonisite.

References

1. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E: Angina pectoris and slow flow velocity of dye in coronary arte- ries. A new angiographic finding. Am Heart J 1972; 84:66-71. 22.. Mosseri M, Yarom R, Gotsman MS, Hasin Y: Histologic evi- dence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986; 5:964-972.
2. Mangieri E, Macchiarelli G, Ciavolella M, Barillà F, Avella A, Martinotti A, et al: Slow coronary flow: Clinical and histopatho- logical features in patients with otherwise normal epicardial co- ronary arteries. Cathet Cardiovase Diagn. 1996; 37(4): 375-81. 44.. Sezgin AT, Sigirci A, Barutcu I, Topal E, Sezgin N, Ozdemir R, et al: Vascular endothelial function in patients with slow co- ronary flow. Coronary Artery Dis 2003; 14:155-161.
3. Lowe GD, Rumley A, Whincup PH, Danesh J. Hemostatic and rheological variables and risk of cardiovascular disease. Semin Vasc Med 2002; 2: 429–39.
4. Danesh J, Collins R, Peto R, Lowe GD. Haematocrit, visco- sity, erythrocyte sedimentation rate: Meta-analyses of pros- pective studies of coronary heart disease. Eur Heart J 2000; 21: 515–20.
5. Hell KM, Balzereit A, Diebold U, Bruhn HD. Importance of blood viscoelasticity in arteriosclerosis. Angiology 1989; 40: 539-46.
6. Costill DL, Fink W. Plasma volume changes following exerci- se and thermal dehydration. J Appl Physiol 1974; 37: 521–5.
7. Greenleaf JE, Convertino VA, Mangseth GR. Plasma volume during stres in man: Osmolarity and red cell volume. J Appl Physiol 1979; 47: 1031–8.
8. Rasouli M, Kalantari KR. Comparison of methods for calcu- lating serum osmolarity: Multivariate linear regression analysis. Clin Chem Lab Med 2005; 43: 635–40.

9. Kumar S, Berl T. Sodium. Lancet 1998; 352: 220–8.
10. Kesmarky G, Toth K, Habon L, Vajda G, Juricskay I. Hemor- heological parameters in coronary artery disease. Clin Hemor- heol Microcirc 1998; 18: 245–51.
11. Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease: The Framingham study. A 34-year followup. Am Heart J 1994; 127: 674–82.
12. Sorlie PD, Garcia-Palmieri MR, Costas R, Havlik RJ. Hema- tocrit and risk of coronary heart disease: The Puerto Rico He- alth Program. Am Heart J 1981; 101: 456–61.
13. Arant CB, Wessel TR, Olson MB, Bairey Merz CN, Sopko G, Rogers WJ, et al. Hemoglobin level is an independent predic- tor for adverse cardiovascular outcomes in women undergo- ing evaluation for chest pain. J Am Coll Cardiol. 2004; 43: 2009–14.
14. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H. et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography: Ame- rican Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocar- diograms. J Am Soc Echocardiogr 1989;2:358–67.
15. Gibson CM, Cannon CP, Delay WL: TIMI frame count. A qu- antitative method of assessing coronary artery flow. Circulation 1996; 93:879-883.
16. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 1996; 93:879-88. 1199.. Lente FV. Markers of inflammation as predictors in cardi- ovascular disease. Clin Chim Acta 2000; 293: 31–52.
17. Mosseri M, Yarom R, Gotsman MS, Hasin Y. Histologic evi- dence for small vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986;74:964–72.
18. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arte- riesa new angiographic finding. Am Heart J 1972;84:66–71.
19. Rim SJ, Leong-Poi H, Lindner JR, Wei K, Fisher NG, Kaul S. Decrease in coronary blood flow reserve during hyperlipide- mia is secondary to an increase in blood viscosity. Circulation 2001;104:2704–9.
20. Pekdemir H, Polat G, Cin VG, Camsari A, Cicek D, Akkus MN, et al. Elevated plasma endothelin-1 levels in coronary si- nus during rapid right atrial pacing in patients with slow coro- nary flow. Int J Cardiol 2004;97:35–41.
21. Camsari A, Pekdemir H, Cicek D, Polat G, Akkus MN, Dö- ven O, et al. Endothelin-1 and nitric oxide concentrations and their response to exercise in patients with slow coronary flow. Circ J 2003;67:1022–8.
22. Sezgin N, Barutcu I, Sezgin AT, Gullu H, Turkmen M, Esen AM, et al. Plasma nitric oxide level and its role in slow coronary phenomenon. Int Heart J 2005;46:373–82.
23. Jian-Jun Li, Bo Xu, Zi-Cheng Li, Jie Qian, Bing-Qi Wei. Is slow coronary flow associated with inflammation? Medical Hypotheses 2006;66:504–8
24. Lanza GA, Andreotti F, Sestio A, Sciahbasi A, Crea F, Ma- seri A. Platelet aggregability in cardiac syndrome X. Eur Heart J 2001;22:1924–30.
25. Gokce M, Kaplan S, Tekelioglu Y, Erdoğan T, Küçükosma- noğlu M. Platelet function disorder in patients with coronary slow flow. Clin Cardiol 2005;28:145–8.
26. Evrengul H, Tanriverdi H, Enli Y, Kuru O, Seleci D, Bastemir M, et al. Interaction of Plasma Homocysteine and Thyroid Hor- mone Concentrations in the Pathogenesis of the Slow Coro- nary Flow Phenomenon. Cardiology 2007;108:186–192
27. Julius S, Palatini P, Nesbitt SD. Tachycardia: an important determinant of coronary risk in hypertension. J Hypertens Suppl 1998;16:S9–15.
28. Finch CA, Lenfant C. Oxygen transport in man. N Engl J Med 1972;286:407–15.
29. Becker RC. Seminars in thrombosis, thrombolysis, and vascular biology. Part 5. Cellular-rheology and plasma visco- sity. Biorheology 1991;79:265–70.
30. Koenig W, Ernst E. The possible role of hemorheology in at- herothrombogenesis. Atherosclerosis 1992;94:93–107.
31. Yasaka M, Yamaguchi T, Oitia J, Sawada T, Shichiri M, Omae T, et al. Clinical features of recurrent embolization in acute cardioembolic stroke. Strong disposing factors: low plasma levels of antithrombin II. Stroke 1993;24:1681–5.
32. Ellsworth ML, Forrester T, Ellis CG, Dietrich HH. The eryt- hrocyte as a regulator of vascular tone. Am J Physiol. 1995 Dec; 269(6 Pt 2): H2155-61.
33. Cosby K, Partovi KS, Crawford JH, Patel RP, Reiter CD, Martyr S, Yang BK, Waclawiw MA, Zalos G, Xu X, Huang KT, Shields H, Kim-Shapiro DB, Schechter AN, Cannon RO 3rd, Gladwin MT. Nitrite reduction to nitric oxide by deoxyhemog- lobin vasodilates the human circulation. Nat Med. 2003 Dec;9(12):1498-505.
34. Gonzalez-Albarran O, Ruilope LM, Villa E, Robles RG. Salt sensitivity: Concept and pathogenesis. Diabet Res Clin Pract 1998; 39 (Suppl.): S15–26.
35. Safar ME, Thuilliez CH, Richard V, Benetos A. Pressure-in- dependent contribution of sodium to large artery structure and function in hypertension. Cardiovasc Res 2000; 46: 269–76.
36. Haffner SJ, Cassells H. Hyperglycemia as a cardiovascular risk factor. Am J Med 2003; 115: S6–11.
37. Hoogwerf BJ, Sprecher DL, Pearce GL, Acevedo M, Frolkis JP, Foody JM, et al. Blood glucose concentrations < 125 mg/dL and coronary heart disease risk. Am J Cardiol 2002; 89: 596–9.
38. Lowe GDO, Rumley A, Sweetnam P, Yarnell JWG, Rum- leyJ. Fibrin D-dimer, markers of coagulation activation, and the risk of major ischaemic heart disease in the Caerphilly Study. Thromb Haemost 2001;86:822–827
39. Cooper JA, Miller GJ, Bauer KA, Morrissey JH, Meade TW, Howarth DJ, et al. Comparison of novel haemostatic factors and conventional risk factors for prediction of coronary heart disease. Circulation 2000;102:2816– 2822
40. Abaci A, Oguzhan A, Eryol NK, Ergin A. Effect of Potential Confounding Factors on the Thrombolysis in Myocardial In- farction (TIMI) Trial Frame Count and Its Reproducibility Circu- lation 1999;100;2219-2223
41. Kofluyolu Heart Journal