Araştırma Makalesi
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Relationship Between Whole Blood Viscosity and Lower Extremity Peripheral Artery Disease Severity

Yıl 2021, , 66 - 74, 23.04.2021
https://doi.org/10.30565/medalanya.828026

Öz

Aim: Increased blood viscosity (BV) has good correlaton with lower extremity peripheral artery disease (LEAD). However, the relationship between BV and peripheral arterial disease (PAD) severity has not been studied adequately so far. The aim of the present study was to assess the relationship between whole blood viscosity (WBV) and LEAD severity.


Methods: The study included 240 consecutive patients with suspected PAD who had lower extremity peripheral angiography between March 2016 and March 2020. A Transatlantic İntersociety Consensus II (TASC II) A-B lesion was defined as simple LEAD, and a TASC II C-D lesion was defined as prevalent and complex LEAD. Symptom severity of all patients were categorized from 0 to 6 according to Rutherford classification. WBV was assessed using a validated calculation formula derived from hematocrit and total plasma protein levels, both at low (LSR) and high (HSR) shear rate.


Results: TASC II C-D group presented significantly higher WBV values both at LSR (40.2 ± 9.5 vs. 46.5 ± 13.2; p < 0.001) and HSR (15.9 ± 0.5 vs. 16.5 ± 0,7; p < 0.001). In ROC analysis, a cut-off value of 16.1 WBV at HSR had 73.4% sensitivity and 68.0% specificity for predicting TASC II C-D (AUC: 76.2%, p < 0.001) and a cut-off value of 42.9 WBV at LSR had 73.4% sensitivity and 66.6% specificity for predicting TASC II C-D (AUC: 74.2%, p < 0.001). In multivariate analysis, both high WBV at LSR (OR: 2.121, 95% CI: 1.079 – 3.164, p < 0.001) and high WBV at HSR (OR: 2.737, 95% CI: 1.671 – 4.483, p < 0.001) were independent predictors for TASC II C-D. There was a significant positive correlation between WBV at LSR and Rutherford symptom category (0-6) (r = 0.412, p <0.001) and WBV at HSR and Rutherford symptom category (0-6) (r = 0.402, p <0.001).


Conclusion: Our data suggests that; increased WBV values may be associated with TASC II C-D lesions, which indicated more prevalent and complex LEAD. Also WBV values positively correlated with Rutherford symptom severity.

Kaynakça

  • 1. Campia U, Gerhard-Herman M, Piazza G, Goldhaber SZ. Peripheral Artery Disease: Past, Present, and Future.  Am J Med. 2019;132(10):1133-41. doi:10.1016/j.amjmed.2019.04.043.
  • 2. Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol. 2014;31(4):378-88. doi:10.1055/s-0034-1393976.
  • 3. Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone PH. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007;49(25):2379-93. doi: 10.1016/j.jacc.2007.02.059.
  • 4. Lowe G, Rumley A, Norrie J, Ford I, Shepherd J, Cobbe S, et al. Blood rheology, cardiovascular risk factors, and cardiovascular disease: the West of Scotland Coronary Prevention Study Thromb Haemost. 2000;84(4):553-8. PMID: 11057849.
  • 5. Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96(1):168-73. doi: 10.1046/j.1365-2141.1997.8532481.x.
  • 6. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67. doi: 10.1016/j.jvs.2006.12.037.
  • 7. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38. doi:10.1016/s0741-5214(97)70045-4.
  • 8. 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(1):107-17. doi: 10.1161/01.cir.81.1.107.
  • 9. Nwose EU, Richards RS. Whole blood viscosity extrapolation formula: Note on appropriateness of units. N Am J Med Sci. 2011;3(8):384-86. doi:10.4297/najms.2011.3384.
  • 10. Daniel J. Cho. Blood Viscosity Abnormalities in Large and Small Vessel Diseases: Future Directions for Plasma Medicine. 2012;2: 221–235. doi: 10.1615/PlasmaMed.2014010786.
  • 11. Cetin EH, Cetin MS, Canpolat U, Aydin S, Aras D, Topaloglu S, et al. Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction. Biomark Med. 2016;10(5):495–511. doi: 10.2217/bmm.16.10.
  • 12. Çekici Y, Kılıç S, Saraçoğlu E, Çetin M, Veysel Düzen İ, Yılmaz M. The Relationship between Blood Viscosity and Isolated Coronary Artery Ectasia. Acta Cardiol Sin. 2019;35(1):20-6. doi:10.6515/ACS.201901_35(1).20180701A.
  • 13. Erdogan G, Yenercag M, Arslan U.The Relationship between Blood Viscosity and Acute Arterial Occlusion. Journal of Cardiovascular Emergencies. 2020;6:7-12. doi: 10.2478/jce-2020-0002.
  • 14. Ozcan Cetin EH, Cetin MS, Çağlı K, Temizhan A, Özbay MB, Ediboglu E, et al. The association of estimated whole blood viscosity with hemodynamic parameters and prognosis in patients with heart failure. Biomark Med. 2019;13(2):69-82. doi: 10.2217/bmm-2018-0309.
  • 15. K Dolu A, Korkmaz A, Kundi H, Guray U. Whole blood viscosity predicts nondipping circadian pattern in essential hypertension. Biomark Med. 2020;14(14):1307-16. doi: 10.2217/bmm-2020-0249.
  • 16. Cunningham KS, Gotlieb AI. The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest. 2005;85(1):9-23. doi: 10.1038/labinvest.3700215.
  • 17. Celik T, Balta S, Ozturk C, Iyisoy A. Whole Blood Viscosity and Cardiovascular Diseases: A Forgotten Old Player of the Game. Med Princ Pract. 2016;25(5):499-500. doi: 10.1159/000446916.
  • 18. Celik T, Yilmaz MI, Balta S, Ozturk C, Unal HU, Aparci M, et al. The Relationship Between Plasma Whole Blood Viscosity and Cardiovascular Events in Patients With Chronic Kidney Disease. Clin Appl Thromb Hemost. 2017;23(6):663-70. doi: 10.1177/1076029616634888.
  • 19. Stone PH, Saito S, Takahashi S, Makita Y, Nakamura S, Kawasaki T, et al. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation. 2012;126(2):172-81. doi: 10.1161/CIRCULATIONAHA.112.096438.
  • 20. Lee AJ, Mowbray PI, Lowe GD, Rumley A, Fowkes FG, Allan PL. Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. Circulation. 1998;97(15):1467-73. doi: 10.1161/01.cir.97.15.1467.
  • 21. Smith FB, Lowe GD, Lee AJ, Rumley A, Leng GC, Fowkes FG. Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication. J Vasc Surg. 1998;28(1):129-35. doi: 10.1016/s0741-5214(98)70208-3. 
  • 22. Cho YI, Cho DJ, Rosenson RS. Endothelial shear stress and blood viscosity in peripheral arterial disease. Curr Atheroscler Rep. 2014;16(4):404. doi: 10.1007/s11883-014-0404-6.
  • 23. Lowe GD, Fowkes FG, Dawes J, Donnan PT, Lennie SE, Housley E, et al. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation. 1993;87(6):1915-20. doi: 10.1161/01.cir.87.6.1915. 
  • 24. Dormandy JA, Hoare E, Khattab AH, Arrowsmith DE, Dormandy TL, et al. Prognostic significance of rheological and biochemical findings in patients with intermittent claudication. Br Med J. 1973;4(5892):581-3. doi: 10.1136/bmj.4.5892.581.
  • 25. Dormandy JA, Hoare E, Colley J, Arrowsmith DE, Dormandy TL, et al. Clinical, haemodynamic, rheological, and biochemical findings in 126 patients with intermittent claudication. Br Med J. 1973;4(5892):576-81. doi: 10.1136/bmj.4.5892.576.
  • 26. Dormandy JA, Hoare E, Postlethwaite J. Importance of blood viscosity. Rheological claudication. Proc R Soc Med. 1974;67(6 Pt 1):446-7. PMID: 4852367.
  • 27. Shimada S, Hasegawa K, Wada H, Terashima S, Satoh-Asahara N, Yamakage H, Kitaoka S, Akao M, Shimatsu A, Takahashi Y. High blood viscosity is closely associated with cigarette smoking and markedly reduced by smoking cessation. Circ J. 2011;75(1):185-9. doi: 10.1253/circj.cj-10-0335

Tam Kan Akışkanlığı ile Alt Ekstremite Periferik Arter Hastalığı Şiddeti Arasındaki İlişki

Yıl 2021, , 66 - 74, 23.04.2021
https://doi.org/10.30565/medalanya.828026

Öz

Amaç: Artmış kan viskozitesinin (BV) alt ekstremite periferik arter hastalığı (LEAD) ile iyi korelasyonu vardır. Ancak, BV ve peripherik arter hastalığı (PAD) şiddeti arasındaki ilişki şu ana kadar yeterince çalışılmamıştır. Bu çalışmanın amacı, tam kan viskozitesi (WBV) ve LEAD şiddeti arasındaki ilişkiyi değerlendirmektir.


Yöntem: Çalışmaya Mart 2016 ile Mart 2020 tarihleri arasında alt ekstremite periferik anjiyografisi yapılan ve PAD şüphesi olan 240 ardışık hasta dahil edildi. Transatlantic Intersociety Consensus II (TASC II) A-B lezyonu basit LEAD olarak, TASC II C-D lezyonu yaygın ve karmaşık LEAD olarak tanımlandı. Tüm hastaların semptom şiddeti Rutherford sınıflandırmasına göre 0 ile 6 arasında kategorize edildi. WBV, hem düşük (LSR) hem de yüksek (HSR) kayma hızında hematokrit ve toplam plazma protein seviyelerinden türetilen doğrulanmış bir hesaplama formülü kullanılarak değerlendirildi.


Bulgular: TASC II C-D grubu hem LSR'de (40.2 ± 9.5'e karşı 46.5 ± 13.2; p <0.001) hem de HSR'de (15.9 ± 0.5'e karşı 16.5 ± 0,7; p <0.001) anlamlı olarak daha yüksek WBV değerleri gösterdi. ROC analizinde, HSR'de 16,1 WBV'lik bir kesme değeri TASC II C-D'yi tahmin etmek için% 73,4 duyarlılık ve% 68,0 özgüllük (AUC: % 76,2, p <0,001) ve LSR'de 42,9 WBV kesme değeri 73,4'tür. TASC II C-D'yi tahmin etmek için% duyarlılık ve% 66.6 özgüllük (AUC: % 74.2, p <0.001). Çok değişkenli analizde, hem LSR'de yüksek WBV (OR: 2.121, % 95 CI: 1.079 - 3.164, p <0.001) hem de HSR'de yüksek WBV (OR: 2.737, % 95 CI: 1.671 - 4.483, p <0.001) TASC II C-D için bağımsız prediktördü. LSR'deki WBV ile HSR’deki WBV değerleri Rutherford semptom kategorisi ile (0-6) anlamlı pozitif korelasyon gösterdi (r = 0.412, p <0.001; r = 0.402, p <0.001, sırasıyla).


Sonuç: Verilerimiz gösteriyor ki; artmış WBV değerleri, daha yaygın ve karmaşık LEAD'i gösteren TASC II C-D lezyonları ile ilişkili olabilir. Ayrıca WBV değerleri, Rutherford semptom şiddeti ile pozitif korelasyon gösterdi.

Kaynakça

  • 1. Campia U, Gerhard-Herman M, Piazza G, Goldhaber SZ. Peripheral Artery Disease: Past, Present, and Future.  Am J Med. 2019;132(10):1133-41. doi:10.1016/j.amjmed.2019.04.043.
  • 2. Hardman RL, Jazaeri O, Yi J, Smith M, Gupta R. Overview of classification systems in peripheral artery disease. Semin Intervent Radiol. 2014;31(4):378-88. doi:10.1055/s-0034-1393976.
  • 3. Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone PH. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007;49(25):2379-93. doi: 10.1016/j.jacc.2007.02.059.
  • 4. Lowe G, Rumley A, Norrie J, Ford I, Shepherd J, Cobbe S, et al. Blood rheology, cardiovascular risk factors, and cardiovascular disease: the West of Scotland Coronary Prevention Study Thromb Haemost. 2000;84(4):553-8. PMID: 11057849.
  • 5. Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96(1):168-73. doi: 10.1046/j.1365-2141.1997.8532481.x.
  • 6. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67. doi: 10.1016/j.jvs.2006.12.037.
  • 7. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38. doi:10.1016/s0741-5214(97)70045-4.
  • 8. 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(1):107-17. doi: 10.1161/01.cir.81.1.107.
  • 9. Nwose EU, Richards RS. Whole blood viscosity extrapolation formula: Note on appropriateness of units. N Am J Med Sci. 2011;3(8):384-86. doi:10.4297/najms.2011.3384.
  • 10. Daniel J. Cho. Blood Viscosity Abnormalities in Large and Small Vessel Diseases: Future Directions for Plasma Medicine. 2012;2: 221–235. doi: 10.1615/PlasmaMed.2014010786.
  • 11. Cetin EH, Cetin MS, Canpolat U, Aydin S, Aras D, Topaloglu S, et al. Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction. Biomark Med. 2016;10(5):495–511. doi: 10.2217/bmm.16.10.
  • 12. Çekici Y, Kılıç S, Saraçoğlu E, Çetin M, Veysel Düzen İ, Yılmaz M. The Relationship between Blood Viscosity and Isolated Coronary Artery Ectasia. Acta Cardiol Sin. 2019;35(1):20-6. doi:10.6515/ACS.201901_35(1).20180701A.
  • 13. Erdogan G, Yenercag M, Arslan U.The Relationship between Blood Viscosity and Acute Arterial Occlusion. Journal of Cardiovascular Emergencies. 2020;6:7-12. doi: 10.2478/jce-2020-0002.
  • 14. Ozcan Cetin EH, Cetin MS, Çağlı K, Temizhan A, Özbay MB, Ediboglu E, et al. The association of estimated whole blood viscosity with hemodynamic parameters and prognosis in patients with heart failure. Biomark Med. 2019;13(2):69-82. doi: 10.2217/bmm-2018-0309.
  • 15. K Dolu A, Korkmaz A, Kundi H, Guray U. Whole blood viscosity predicts nondipping circadian pattern in essential hypertension. Biomark Med. 2020;14(14):1307-16. doi: 10.2217/bmm-2020-0249.
  • 16. Cunningham KS, Gotlieb AI. The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest. 2005;85(1):9-23. doi: 10.1038/labinvest.3700215.
  • 17. Celik T, Balta S, Ozturk C, Iyisoy A. Whole Blood Viscosity and Cardiovascular Diseases: A Forgotten Old Player of the Game. Med Princ Pract. 2016;25(5):499-500. doi: 10.1159/000446916.
  • 18. Celik T, Yilmaz MI, Balta S, Ozturk C, Unal HU, Aparci M, et al. The Relationship Between Plasma Whole Blood Viscosity and Cardiovascular Events in Patients With Chronic Kidney Disease. Clin Appl Thromb Hemost. 2017;23(6):663-70. doi: 10.1177/1076029616634888.
  • 19. Stone PH, Saito S, Takahashi S, Makita Y, Nakamura S, Kawasaki T, et al. Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study. Circulation. 2012;126(2):172-81. doi: 10.1161/CIRCULATIONAHA.112.096438.
  • 20. Lee AJ, Mowbray PI, Lowe GD, Rumley A, Fowkes FG, Allan PL. Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh Artery Study. Circulation. 1998;97(15):1467-73. doi: 10.1161/01.cir.97.15.1467.
  • 21. Smith FB, Lowe GD, Lee AJ, Rumley A, Leng GC, Fowkes FG. Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication. J Vasc Surg. 1998;28(1):129-35. doi: 10.1016/s0741-5214(98)70208-3. 
  • 22. Cho YI, Cho DJ, Rosenson RS. Endothelial shear stress and blood viscosity in peripheral arterial disease. Curr Atheroscler Rep. 2014;16(4):404. doi: 10.1007/s11883-014-0404-6.
  • 23. Lowe GD, Fowkes FG, Dawes J, Donnan PT, Lennie SE, Housley E, et al. Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh Artery Study. Circulation. 1993;87(6):1915-20. doi: 10.1161/01.cir.87.6.1915. 
  • 24. Dormandy JA, Hoare E, Khattab AH, Arrowsmith DE, Dormandy TL, et al. Prognostic significance of rheological and biochemical findings in patients with intermittent claudication. Br Med J. 1973;4(5892):581-3. doi: 10.1136/bmj.4.5892.581.
  • 25. Dormandy JA, Hoare E, Colley J, Arrowsmith DE, Dormandy TL, et al. Clinical, haemodynamic, rheological, and biochemical findings in 126 patients with intermittent claudication. Br Med J. 1973;4(5892):576-81. doi: 10.1136/bmj.4.5892.576.
  • 26. Dormandy JA, Hoare E, Postlethwaite J. Importance of blood viscosity. Rheological claudication. Proc R Soc Med. 1974;67(6 Pt 1):446-7. PMID: 4852367.
  • 27. Shimada S, Hasegawa K, Wada H, Terashima S, Satoh-Asahara N, Yamakage H, Kitaoka S, Akao M, Shimatsu A, Takahashi Y. High blood viscosity is closely associated with cigarette smoking and markedly reduced by smoking cessation. Circ J. 2011;75(1):185-9. doi: 10.1253/circj.cj-10-0335
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Mustafa Yenerçağ 0000-0002-0933-7852

Uğur Arslan 0000-0001-8572-3571

Metin Çoksevim 0000-0001-6907-6941

Seçkin Dereli 0000-0003-0090-3835

Mustafa Doğduş 0000-0002-3895-1923

Güney Erdoğan 0000-0001-5205-1326

Yayımlanma Tarihi 23 Nisan 2021
Gönderilme Tarihi 20 Kasım 2020
Kabul Tarihi 23 Aralık 2020
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

Vancouver Yenerçağ M, Arslan U, Çoksevim M, Dereli S, Doğduş M, Erdoğan G. Relationship Between Whole Blood Viscosity and Lower Extremity Peripheral Artery Disease Severity. Acta Med. Alanya. 2021;5(1):66-74.

9705 

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