Cecchi Emanuele, Liotta Agatina Alessandriello, Gori Anna Maria, Valente Serafina, Giglioli Cristina, Lazzeri Chiara, Sofi Francesco, Gensini Gian Franco, Abbate Rosanna, Mannini Lucia
Dipartimento di Area Critica Medico-Chirurgica, Centro Trombosi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
Int J Cardiol. 2009 May 15;134(2):189-94. doi: 10.1016/j.ijcard.2008.01.039. Epub 2008 May 20.
Previous studies explored the association between hemorheological alterations and acute myocardial infarction, pointing out the role of hematological components on microvascular flow. The aim of this study was to evaluate the association between blood viscosity and infarct size, estimated by creatine kinase (CK) peak activity and cardiac Troponin I (cTnI) peak concentration in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI).
The study population included 197 patients with diagnosis of STEMI undergoing PCI. Hemorheological studies were performed by assessing whole blood viscosity (measured at shear rates of 0.512 s(-1) and 94.5 s(-1)) and plasma viscosity using the Rotational Viscosimeter LS 30 and erythrocyte deformability index by Myrenne filtrometer.
Significant correlations between CK peak activity, cTnI peak concentration, left ventricular ejection fraction and hemorheological variables were observed. At linear regression analysis (adjusted for age, gender, traditional cardiovascular risk factors, renal dysfunction, timeliness of reperfusion, pre-PCI TIMI flow, infarct location, multivessel disease and previous coronary artery disease) leukocytes and whole blood viscosity at 0.512 s(-1) and 94.5 s(-1) were independently and positively associated with infarct size.
These results demonstrate a significant and independent association between hemorheology and infarct size in STEMI patients after PCI suggesting that blood viscosity, in a condition of low flow, might worsen myocardial perfusion leading to an increased infarct size. The measurement of whole blood viscosity in STEMI patients could help to identify those who may benefit from new therapeutic strategies.
既往研究探讨了血液流变学改变与急性心肌梗死之间的关联，指出血液成分对微血管血流的作用。本研究的目的是评估在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者中，血液黏度与梗死面积之间的关联，梗死面积通过肌酸激酶（CK）峰值活性和心肌肌钙蛋白I（cTnI）峰值浓度来估计。
研究人群包括197例诊断为STEMI并接受PCI的患者。使用旋转粘度计LS 30通过评估全血粘度（在剪切速率为0.512 s⁻¹和94.5 s⁻¹时测量）和血浆粘度以及使用Myrenne滤过仪测量红细胞变形性指数来进行血液流变学研究。
观察到CK峰值活性、cTnI峰值浓度、左心室射血分数与血液流变学变量之间存在显著相关性。在线性回归分析中（校正年龄、性别、传统心血管危险因素、肾功能不全、再灌注及时性、PCI前TIMI血流、梗死部位、多支血管病变和既往冠状动脉疾病），白细胞以及在0.512 s⁻¹和94.5 s⁻¹时的全血粘度与梗死面积独立且呈正相关。
这些结果表明，PCI术后STEMI患者的血液流变学与梗死面积之间存在显著且独立的关联，提示在低血流状态下血液粘度可能会使心肌灌注恶化，导致梗死面积增加。测量STEMI患者的全血粘度可能有助于识别那些可能从新治疗策略中获益的患者。
