The Association between Whole Blood Viscosity and Coronary Collateral Circulation in Patients with Chronic Total Occlusion.
OBJECTIVE
Coronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion.


METHODS
A total of 371 patients diagnosed as having at least one major, chronic total occluded coronary artery were included. 197 patients with good CCC (Rentrop 2 and 3) composed the patient group. The poor collateral group consisted of 174 patients (Rentrop grade 0 and 1).


RESULTS
Patients with poor CCC had higher WBV values for a low-shear rate (LSR) (69.5±8.7 vs. 60.1±9.8, p<0.001) and high-shear rate (HSR) (17.0±2.0 vs. 16.4±1.8, p<0.001) than the good collateral group. Correlation analysis demonstrated a significant negative correlation between the grade of CCC and WBV for LSR (β=0.597, p<0.001) and HSR (β=0.494, p<0.001). WBV for LSR (β=0.476, p<0.001) and HSR (β=0.407, p<0.001) had a significant correlation with the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. A multivariate analysis showed that the WBV for both shear rates were independent risk factors of poor CCC (WBV at LSR, OR: 1.362 CI 95%: 1.095-1.741 p<0.001 and WBV at HSR, 1.251 CI 95%: 1.180-1.347 p<0.001).


CONCLUSIONS
WBV has been demonstrated as the overlooked predictor of poor coronary collateralization. WBV seemed to be associated with microvascular perfusion and angiogenesis process impairing CCC development.
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Mehmet Serkan
MS
Cetin
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Elif Hande
EH
Ozcan Cetin
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Kevser Gülcihan
KG
Balcı
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Selahattin
S
Aydin
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Emek
E
Ediboglu
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Muhammed Fatih
MF
Bayraktar
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Mustafa Mücahit
MM
Balcı
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Orhan
O
Maden
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Ahmet
A
Temizhan
Department of Cardiology, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Sinan
S
Aydogdu
Coronary collateral circulation; SYNTAX score; Whole blood viscosity