Serkan ÇAY, Habibe KAFES, Elif Hande ÖZCAN ÇETİN, Nedret ÜLVAN, Özcan ÖZEKE, Fırat ÖZCAN, Serkan TOPALOĞLU, Dursun ARAS, Firdevs Ayşenur EKİZLER, Bahar TEKİN TAK

Prematür Akut Koroner Sendromlu Hastalarda Tam Kan Viskozitesinin Tıkayıcı Koroner Arter Hastalığı ile İlişkisi

Amaç: Genç bireylerde Akut Koroner sendrom (AKS) nispeten nadir görülse de son yıllarda sıklığı giderek artmaktadır. Literatürde prematür AKS veözellikle risk faktörleriyle ilgili veriler kısıtlıdır. Bu çalışmada, yeni tanı prematür AKS olan hastalarda tam kan viskozitesinin (WBV) önemi araştırıldı.Gereç ve Yöntem: Çalışmaya toplam 713 hasta (469 erkek, ortalama yaş; 38,9±2,4 yıl) dahil edildi. Çalışma popülasyonu iki gruba ayrıldı. İlk grupyeni tanı prematür (≤45 yaş) AKS ile başvuran ve koroner arterlerinde kritik lezyonlar saptanan 357 hastadan oluşurken, kontrol grubu elektif koroneranjiyografi sonrası normal koroner arterler saptanan, yaş ve cinsiyet açısından eşleştirilmiş 356 hastadan oluşmaktaydı. WBV, Simone formülünegöre hem yüksek kayma hızı hem de düşük kayma hızında hesaplandı ve diğer geleneksel risk faktörleriyle beraber iki grup arasında karşılaştırıldı.Bulgular: Prematür AKS olan hastalarda, kontrol grubuyla karşılaştırıldığında anlamlı düzeyde artmış WBV değerleri saptandı. Tek değişkenli ve çokdeğişkenli lojistik regresyon analizinde, her iki kayma hızında ölçülen WBV değerleri, diğer geleneksel kardiyovasküler risk faktörlerine göre düzeltmeyapıldıktan sonra bile bağımsız prediktör olarak saptandı.Sonuç: Sonuç olarak, artmış WBV değeri olan hastalar, kontrol grubuyla karşılaştırıldığında, kritik lezyon saptanan prematür AKS varlığı için dahayüksek risk altındadır

The Association Between Whole Blood Viscosity and Obstructive Coronary Artery Disease in Patients with Premature Acute Coronary Syndrome

Objectives: Acute Coronary syndrome (ACS) in young adults is relatively rare, but it is in an increasing trend in recent years. Few data on ACS in young adults are available in the literature, especially regarding risk factors. In the current study, the importance of whole blood viscosity (WBV) was evaluated in patients with newly diagnosed premature ACS. Materials and Methods: A total of 713 patients (469 male, mean age: 38.9±2.4 years) were included. The study population was divided into two groups. The first group included 357 patients who presented with newly diagnosed premature ACS (aged ≤45 years and were found to have critical lesions in their coronary arteries, while the control group consisted of 356 patients who were age and gender-matched controls and were found to have normal coronary arteries after elective coronary angiography. WBV was calculated according to the Simone’s formula at both high and low shear rates and compared between two groups with other traditional risk factors. Results: Patients with premature ACS were found to have significantly increased WBV values compared to controls. Univariate and multivariate logistic regression analysis revealed that the WBV at both shear rates was an independent predictor for the presence of critical CAD after adjusted for other traditional cardiovascular risk factors. Conclusion: Patients with increased WBV values were at greater risk for the presence of premature ACS with critical lesions compared with the control group

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1. Mandelzweig L, Battler A, Boyko V, et al. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27:2285-2293.
2. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81:741-745.
3. Panduranga P, Sulaiman K, Al-Zakwani I, et al. Acute coronary syndrome in young adults from oman: results from the gulf registry of acute coronary events. Heart Views. 2010;11:93-98.
4. Carro A, Bastiaenen R, Kaski JC. Age related issues in reperfusion of myocardial infarction. Cardiovasc Drugs Ther. 2011;25:139-148.
5. Jha AK, Li Z, Orav EJ, et al. Care in U.S. hospitals--the Hospital Quality Alliance program. N Engl J Med. 2005;353:265-274.
6. Rathod KS, Jones DA, Gallagher S, et al. Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2016;5:23-32.
7. Chatzizisis YS, Coskun AU, Jonas M, et al. 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;49:2379- 2393.
8. Cetin EH, Cetin MS, Canpolat U, et al. Prognostic significance of whole blood viscosity estimated by de Simone’s formula in ST-elevation myocardial infarction. Biomark Med. 2016;10:495-511.
9. Cetin MS, Ozcan Cetin EH, Canpolat U, et al. An overlooked parameter in coronary slow flow phenomenon: whole blood viscosity. Biomark Med. 2015;9:1311-1321.
10. Fossum E, Hoieggen A, Moan A, et al. Whole blood viscosity, blood pressure and cardiovascular risk factors in healthy blood donors. Blood Press. 1997;6:161-165.
11. De Simone G, Devereux RB, Chien S, et al. Relation of blood viscosity to demographic and physiologic variables and to cardiovascular risk factors in apparently normal adults. Circulation. 1990;81:107-117.
12. Dintenfass L, Julian DG, Miller GE. Viscosity of blood in normal subjects and in patients suffering from coronary occlusion and arterial thrombosis. An in vitro study in the absence of anticoagulants, by means of a rotational conein-cone trolley viscometer. American Heart Journal. 1966;71:587-600.
13. Wasilewski J, Turczynski B, Slowinska L, et al. Haemorheological factors and myocardial reperfusion in patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Kardiol Pol. 2007;65:778-785; discussion 786-787.
14. De Simone G, Devereux RB, Chinali M, et al. Association of blood pressure with blood viscosity in american indians: the Strong Heart Study. Hypertension. 2005;45:625-630.
15. Nwose EU. Whole blood viscosity assessment issues IV: Prevalence in acute phase inflammation. N Am J Med Sci. 2010;2:353-358.
16. Chan MY, Woo KS, Wong HB, et al. Antecedent risk factors and their control in young patients with a first myocardial infarction. Singapore Med J. 2006;47:27-30.
17. Klein LW, Agarwal JB, Herlich MB, et al. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol. 1987;60:1269-1272.
18. Cole JH, Miller JI, 3rd, Sperling LS, et al. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003;41:521- 528.
19. Cecchi E, Giglioli C, Valente S, et al. Role of hemodynamic shear stress in cardiovascular disease. Atherosclerosis. 2011;214:249-256.
20. Kim J, Chung H, Cho M, et al. The role of critical shear stress on acute coronary syndrome. Clin Hemorheol Microcirc. 2013;55:101-109.
21. Claeys MJ, Bosmans J, Veenstra L, et al. Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction: importance of microvascular reperfusion injury on clinical outcome. Circulation. 1999;99:1972-1977.
22. Silber HA, Bluemke DA, Ouyang P, et al. The relationship between vascular wall shear stress and flow-mediated dilation: endothelial function assessed by phase-contrast magnetic resonance angiography. J Am Coll Cardiol. 2001;38:1859-1865.
23. Marossy A, Svorc P, Kron I, et al. Hemorheology and circulation. Clin Hemorheol Microcirc. 2009;42:239-258.
24. Yagi H, Sumino H, Aoki T, et al. Impaired blood rheology is associated with endothelial dysfunction in patients with coronary risk factors. Clin Hemorheol Microcirc. 2016;62:139-150.
25. Tripolino C, Irace C, Carallo C, et al. Association between blood viscosity and common carotid artery elasticity. Clin Hemorheol Microcirc. 2016;62:55-62.
26. Lowe GD, Lee AJ, Rumley A, et al. Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study. Br J Haematol. 1997;96:168-173. 27. Toth A, Papp J, Rabai M, et al. The role of hemorheological factors in cardiovascular medicine. Clin Hemorheol Microcirc. 2014;56:197-204.
28. De Backer TL, De Buyzere M, Segers P, et al. The role of whole blood viscosity in premature coronary artery disease in women. Atherosclerosis. 2002;165:367-373.
29. Hoo FK, Foo YL, Lim SM, et al. Acute coronary syndrome in young adults from a Malaysian tertiary care centre. Pak J Med Sci. 2016;32:841-845.
30. Pitt B, Loscalzo J, Ycas J, et al. Lipid levels after acute coronary syndromes. J Am Coll Cardiol. 2008;51:1440-1445.
31. Tamariz LJ1, Young JH, Pankow JS, et al. Blood viscosity and hematocrit as risk factors for type 2 diabetes mellitus: the atherosclerosis risk in communities (ARIC) study. Am J Epidemiol. 2008;168:1153-1160.