Microcirculatory dysfunction in cardiac syndrome X: role of abnormal blood rheology.
OBJECTIVE
Cardiac syndrome X (CSX) is of clinical interest, yet the underlying pathophysiological mechanisms have not been fully elucidated. It is well known that elevated blood viscosity and red blood cell (RBC) aggregation can adversely affect microcirculatory blood flow. The present study was designed to explore whether CSX is associated with abnormalities of blood rheology.


METHODS
Blood samples were obtained from 152 adult angina patients undergoing diagnostic coronary angiography; geometric and flow-velocity data were obtained. Rheologic measurements were performed in a blinded manner; 21 subjects were later identified with CSX. Hemorheologic and clinical laboratory data were compared to 21 age- and gender-matched healthy controls.


RESULTS
CSX patients had markedly abnormal blood rheology: (1) higher RBC aggregation and aggregability as judged by erythrocyte sedimentation rate and Myrenne indices at stasis and low shear (p < 0.001) and (2) elevated hematocrit-corrected blood viscosity, plasma viscosity (p < 0.001), and yield stress (p < 0.01). White blood cell counts and high-sensitivity C-reactive protein levels were significantly elevated in CSX; coronary-flow velocities were below normal.


CONCLUSIONS
Abnormal hemorheologic parameters exist in subjects with CSX and may contribute to the pathophysiology of the disease, presumably via adversely affecting blood flow in the coronary microcirculation. Therapeutic measures aimed at normalizing blood rheology and hence microcirculatory flow should be explored.
Lee
Byoung Kwon
BK
Department of Physiology and Biophysics, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.
Durairaj
Azhil
A
Mehra
Anilkumar
A
Wenby
Rosalinda B
RB
Meiselman
Herbert J
HJ
Alexy
Tamas
T
D003326:Coronary Circulation; D005260:Female; D006403:Hematologic Tests / Q000379:methods; D018056:Hemorheology / Q000379:methods; D006801:Humans; D008297:Male; D008833:Microcirculation; D017566:Microvascular Angina / Q000097:blood* / Q000503:physiopathology*; D008875:Middle Aged