Clinical Hemorheology and Microcirculation - Volume 72, issue 4

Authors: Martínez-Quintana, Efrén | Rodríguez-Hernández, Juan Lizandro | Riaño-Ruiz, Marta | Rodríguez-González, Fayna

Article Type: Research Article

Abstract: BACKGROUND: Platelet activation is linked with thrombosis, inflammation or heart failure. OBJECTIVE: To establish clinical and analytical factors that may favor high mean platelet volume (MPV) and to determine if MPV levels favor major adverse cardiovascular events (MACE). METHODS: Stable CHD patients and a control population matched for age, sex and cardiovascular factors. RESULTS: 658 CHD patients and 2092 controls were studied. Median age in CHD patients was 33 (25–41) year old with 56% of them being male. No significant differences were seen between MPV values and cardiac complexity (p  = 0.308) nor between MPV …values in the CHD and control groups (p  = 0.911). CHD patients had significant lower platelet count and MPV levels than patients in the control group. In the binary logistic regression analysis NT-pro-BNP levels above 125 pg/ml, thrombocytopenia and having atrial fibrillation/flutter reached statistical significance as predictors of MPV levels above 11 fL. The Kaplan-Meier survival analysis showed no significance between MPV levels higher than 11 fL and MACE, cardiovascular mortality and thrombotic events in a median time follow-up of 6.7(1.5–10.6) years. CONCLUSIONS: Atrial fibrillation/flutter, heart failure and thrombocytopenia are predictors of high MPV levels. A MPV above 11 fL is not associated with MACE at a median follow-up time. Show more

Keywords: Mean platelet volume, inflammation, heart failure, congenital heart disease

DOI: 10.3233/CH-180471

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 327-337, 2019

Authors: Stupin, Ana | Stupin, Marko | Baric, Lidija | Matic, Anita | Kolar, Luka | Drenjancevic, Ines

Article Type: Research Article

Abstract: OBJECTIVE: To assess sex-related differences in forearm skin microvascular reactivity to vascular occlusion and cardiovascular health in young healthy women and men. METHODS: 203 young healthy individuals (67 men/136 women) participated in this study. Post-occlusive reactive hyperemia (PORH) in skin microcirculation following 1′ , 2′ and 3′ vascular occlusion period was assessed using laser Doppler flowmetry. Anthropometric parameters, body composition, blood pressure, heart rate and biochemical parameters were measured in all participants. Correlations between PORH and measured parameters were determined by using corresponding tests. RESULTS: Women had significantly higher forearm PORH following 1′ , …2′ and 3′ vascular occlusion than men. Women had lower body mass index and waist-to-hip ratio, but higher fat mass than men. Men had significantly higher blood pressure and lower heart rate than women. Also, women had lower hemoglobin, urea, creatinine and serum uric acid, but higher HDL cholesterol level than men. PORH was negatively associated with waist-to-hip ratio and systolic blood pressure only in women. CONCLUSIONS: Young healthy women exhibit higher skin microvascular reactivity to vascular occlusion compared to age-matched men. Increased systolic blood pressure or central obesity (waist-to-hip ratio) may pose greater risk to young healthy women than men by adversely affecting peripheral microvascular function. Show more

Keywords: Sex differences, microcirculation, endothelium, laser Doppler flowmetry, post-occlusive reactive hyperemia

DOI: 10.3233/CH-180483

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 339-351, 2019

Authors: Her, Ae-Young | Shin, Eun-Seok | Zhou, Qing | Wierzbinski, Jan | Vidal-Lopez, Silvia | Saleh, Ahmed | Kim, Yong Hoon | Garg, Scot | Jung, Friedrich | Brachmann, Johannes

Article Type: Research Article

Abstract: BACKGROUND: Magnetocardiography (MCG) is a non-invasive technique and to characterize the magnetic field, a pseudo-current conversion was used. The role of MCG in detecting left atrial (LA) dysfunction in patients with paroxysmal atrial fibrillation (PAF) is unknown. OBJECTIVE: The aim of this study was to evaluate LA function using MCG in patients with PAF and healthy subjects, to identify possible indices to diagnose PAF. METHODS: We enrolled a total of 70 subjects including 26 healthy volunteers (group 1) and 22 marathon runners (group 2) who did not exhibit any cardiac abnormalities, and 22 patients with PAF …(group 3) which was documented by electrocardiography (ECG). Spatiotemporal activation graph (STAG) in base-apex and left-right direction was reconstructed. The maximum value of LA pseudo-current under rest and peak exercise were measured between the end of the P wave and beginning of the Q wave. RESULTS: LA pseudo-current increase at peak exercise in PAF patients was significantly lower than in healthy volunteers and marathon runners (0.4±0.3 pT in group 3 vs. 0.8±0.3 pT in group 1 vs. 1.1±0.5 pT in group 2, p  < 0.001). PAF patients had less pseudo-current increase in STAG at peak exercise than healthy volunteers and marathon runners (46% of 26 PAF patients, 81% of 22 healthy subjects vs. 81% of 22 marathon runners, p  = 0.002). Sensitivity, specificity, and the area under the receiver-operator characteristics curve of LA pseudo-current increase at peak exercise for differentiating PAF patients from healthy subjects were 77%, 92%, and 0.896. CONCLUSIONS: MCG can provide important non-invasive information for detecting LA dysfunction in PAF patients. Therefore, MCG may help in differentiating PAF patients from healthy subjects. Show more

Keywords: Left atrium, dysfunction, magnetocardiography, paroxysmal atrial fibrillation

DOI: 10.3233/CH-180528

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 353-363, 2019

Authors: Muenchow, S. | Horch, R.E. | Dragu, A.

Article Type: Research Article

Abstract: BACKGROUND: Topical negative pressure wound therapy (TNPWT) is one of the most frequently used techniques in wound treatment. But some of the underlying mechanisms still remain unclear. One possible explanation is an improved microcirculation by TNPWT. OBJECTIVE: This study investigated the influence of TNPWT on microcirculation on intact skin in real-time. METHODS: In healthy individuals, we performed a combined tissue – laser/photo - spectrometry technique to monitor changes of 4 different microcirculation parameters in real-time: The local blood flow, the capillary-venous oxygen saturation, the blood flow velocity and the relative amount of hemoglobin. We compared these …parameters using two different protocols: a continuously (VAC ON 60/OFF 60) and discontinuously (VAC ON 30/OFF 60/ON 5) application. RESULTS: Our results demonstrate a significant increase of all four measured parameters during the active TNPWT and the pressure free period. The comparison of two different protocols shows an advantage of the examined parameters using a discontinuous TNPWT application. CONCLUSIONS: Our study demonstrated the changes of the microvascular tissue perfusion in intact human skin under the conditions of negative pressure and may thereby offer a broader understanding of mechanisms underlying the TNPWT. Show more

Keywords: Topical negative pressure wound therapy, tissue – laser/photo – spectrometry, microvascular tissue perfusion

DOI: 10.3233/CH-180536

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 365-374, 2019

Authors: Kapnisis, K. | Seidner, H. | Prokopi, M. | Pasias, D. | Pitsillides, C. | Anayiotos, A. | Kaliviotis, E.

Article Type: Research Article

Abstract:  Despite their wide clinical usage, stent functionality may be compromised by complications at the site of implantation, including early/late stent thrombosis and occlusion. Although several studies have described the effect of fluid-structure interaction on local haemodynamics, there is yet limited information on the effect of the stent presence on specific hemorheological parameters. The current work investigates the red blood cell (RBC) mechanical behavior and physiological changes as a result of flow through stented vessels. Blood samples from healthy volunteers were prepared as RBC suspensions in plasma and in phosphate buffer saline at 45% haematocrit. Self-expanding nitinol stents were inserted in …clear perfluoroalkoxy alkane tubing which was connected to a syringe, and integrated in a syringe pump. The samples were tested at flow rates of 17.5, 35 and 70 ml/min, and control tests were performed in non-stented vessels. For each flow rate, the sample viscosity, RBC aggregation and deformability, and RBC lysis were estimated. The results indicate that the presence of a stent in a vessel has an influence on the hemorheological characteristics of blood. The viscosity of all samples increases slightly with the increase of the flow rate and exposure. RBC aggregation and elongation index (EI) decrease as the flow rate and exposure increases. RBC lysis for the extreme cases is evident. The results indicate that the stresses developed in the stent area for the extreme conditions could be sufficiently high to influence the integrity of the RBC membrane. Show more

Keywords: Cardiovascular stent, blood viscosity, red blood cell deformability, red blood cell aggregation, lysis

DOI: 10.3233/CH-180540

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 375-393, 2019

Authors: Fang, Liang | Huang, Bei-Jian | Ding, Hong | Mao, Feng | Li, Chao-Lun | Zeng, Meng-Su | Zhou, Jian-Jun | Chen, Yue | Wang, Wen-Ping

Article Type: Research Article

Abstract: AIM: To investigate the specific findings and characteristics of real-time contrast-enhanced ultrasound (CEUS) in hypoechoic hepatic hemangioma. METHODS: A total of 101 lesions in 83 patients were included. Analysis was made of the relationship between tumor size and CEUS enhance patterns in arterial phase, portal phase and delayed phase, phase changes, echoic changes in perfusion regression stage and filling defect. RESULTS: CEUS showed a lesion detection rate of 92.7%. In regression stage, only 46.5% lesions were fully filled. Enhancement of the lesions was categorized into Pattern I, peripheral nodular enhancement and centripetal filling (68.3%); Pattern II, …peripheral ring enhancement and centripetal filling (27.7%); and Pattern III, overall rapid enhancement (4.0%). The most common phase changes were “fast-in slow-out” (74.3%). More than half (61.4%) lesions were hyperechoic in regression stage. Among all the lesions, 4 (3.9%) lesions regressed to hypo-echo in portal phase and 2(2.0%) in delayed phase). The frequent enhancement in tumors >3.0 cm was of Pattern I or II, “fast-in slow-out” or “slow-in slow-out” phase change, and hyperechoic or isoechoic change in perfusion regression stage, but in those ≤3.0 cm, the enhancement was of Pattern III, “fast-in fast-out” phase change and hypoechoic change in perfusion regression stage. The differences were statistically significant (p  < 0.05). The percentage of lesions with complete filling on CEUS in the larger hypoechoic hepatic hemangiomas was significantly lower than that of smaller ones (p  < 0.01). CONCLUSIONS: CEUS has high diagnostic value in hypoechoic hepatic hemangiomas mainly characterized by peripheral nodular or ring enhancement, centripetal filling, and “fast-in slow-out” and “slow-in slow-out” phase changes. Show more

Keywords: Hypoechoic hepatic hemangioma, contrast-enhanced ultrasound (CEUS), enhancement pattern

DOI: 10.3233/CH-190558

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 395-405, 2019

Authors: Ulker, Pinar | Özen, Nur | Abduleyeva, Günel | Köksoy, Sadi | Yaraş, Nazmi | Basralı, Filiz

Article Type: Research Article

Abstract: BACKGROUND: Rho-kinase, an effector of the small GTPase RhoA, is known to be a novel inhibitory regulator of eNOS in endothelial cells under basal conditions and disease states. However, although RBC possesses active RhoA/Rho-kinase pathway, Rho-kinase mediated eNOS regulation has not been investigated in RBC, so far. OBJECTIVE: The aim of the present study is to investigate whether eNOS activity is regulated by Rho-kinase under basal conditions and to evaluate whether inhibition of this enzyme causes eNOS activation and intracellular NO production in RBC. METHODS: RBC packeds were isolated from healthy volunteers and resuspended in Hepes …solution at a hematocrit of 0.01 l/l. Intracellular NO and Ca+2 levels and eNOS activation measured by flow cytometry in response to Rho-kinase inhibitors, fasudil and Y-27632, in the absence and presence of NOS, and PI3K inhibitors. RESULTS: Rho-kinase inhibitors fasudil and Y-27632 found to increase intracellular NO concentrations. These inhibitors also cause enhancement of intracellular Ca+2 and serine 1177 phosphorylated eNOS levels. Besides, although these responses have shown to be suppressed by NOS enzyme, PI3K inhibition had no effect on this mechanism. CONCLUSIONS: The results of the present study demonstrated that RBC eNOS enzyme activity is regulated by inhibitory Rho-kinase pathway under basal conditions and inhibition of this pathway enhances the activity of eNOS in RBC. This activation is mediated by both intracellular Ca+2 and Serine 1177 phosphorylated eNOS increment, with no contribution of AKT activation, in RBC. The mechanism we described here gives first evidences about Rho-kinase mediated eNOS regulation in RBC under basal conditions. This pathway could also be more important under disease states. Show more

Keywords: Red blood cells, Rho-kinase, nitric oxide, nitric oxide synthase

DOI: 10.3233/CH-190578

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 407-419, 2019

Authors: Ludolph, Ingo | Cai, Aijia | Arkudas, Andreas | Lang, Werner | Rother, Ulrich | Horch, Raymund E.

Article Type: Research Article

Abstract: BACKGROUND: Free tissue transfer has become a routine procedure with low failure. In case of a compromised vascular pedicle, flap survival is time dependantly possible due to flap autonomization. However it remains unknown at what time and to which degree different factors influence flap autonomization. METHODS: We investigated 16 patients after free flap reconstruction at different anatomic locations who eventually presented for other medical reasons. To assess the perfusion pattern we performed Indocyanine Green angiography. RESULTS: The mean follow-up after free flap reconstruction was 58,1 month. A total of 16 flaps were examined at different anatomic …locations. In 2 cases digital subtraction angiography demonstrated an occlusion of the anastomosis after arteriovenous loop despite vital flaps. Indocyanine Green angiography showed no signs of mal-perfusion or non-perfusion in the transplanted flaps and capillaries across the flap borders in 9 cases. CONCLUSION: Flap autonomization is possible even in patients with problem wounds and poorly vascularized wound beds independent from the anatomic localization. Multiple factors exist, that influence the autonomization process over time. Indocyanine Green angiography seems to be a promising tool to visualize and study the skin perfusion pattern of free flaps over longer periods. Show more

Keywords: Vascular autonomization, free flaps, indocyanine green angiography, microcirculation

DOI: 10.3233/CH-180544

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 421-430, 2019

Authors: Wang, Minxin | Sui, Jingshu | Wang, Shuang | Wang, Xiaoting

Article Type: Research Article

Abstract: OBJECTIVE: To investigate the correlation of carotid intima-media thickness (IMT) with endothelial function and atherosclerosis degree in patients with type 2 diabetes mellitus. METHODS: A total of 80 patients with type 2 diabetes mellitus admitted and treated in our hospital from January 2017 to January 2018 were selected and randomly divided into two groups (n  = 40). Patients who were definitely diagnosed with type 2 diabetes mellitus were selected as observation group, and individuals who received health examination and were excluded from type 2 diabetes mellitus were enrolled as control group. The diagnosed proportions of carotid plaque, Crouse scores, …endothelial-dependent flow-mediated vasodilation (FMD) function and nitroglycerin-mediated dilation (NMD) function of the brachial arteries in the two groups were compared. The indexes related to vascular endothelial functions [vascular endothelial growth factor (VEGF), endothelin-1 (ET-1) and nitric oxide (NO) levels] in the two groups were detected. The correlations of Crouse score with brachial arterial FMD value, VEGF level, ET-1 level and NO level in observation group were analyzed. RESULTS: The diagnosed proportion of carotid plaque in observation group was significantly higher than that in control group (P  < 0.05), and the Crouse score in observation group was higher than that in control group (P  < 0.05). The brachial arterial FMD value in observation group was remarkably lower than that in control group (P  < 0.05). Compared with control group, VEGF and ET-1 levels were significantly reduced in observation group (P  < 0.05), with the statistical increase of NO level (P  < 0.05). In observation group, the Crouse score was negatively correlated with the brachial arterial FMD value, VEGF level and ET-1 level, whereas positively correlated with the NO level (P  < 0.05). CONCLUSION: Our data show that the carotid IMT is increased significantly among patients with type 2 diabetes mellitus, and the vascular endothelial function is impaired. Moreover, after the occurrence of atherosclerosis, we found the carotid IMT is negatively correlated with endothelial-dependent FMD, as well as levels of VEGF and ET-1, whereas shows positive correlation with the vasodilative factor NO. Show more

Keywords: Type 2 diabetes mellitus, carotid intima-media thickness, endothelial function, carotid plaque

DOI: 10.3233/CH-180486

Citation: Clinical Hemorheology and Microcirculation, vol. 72, no. 4, pp. 431-439, 2019