Hemorheological, microvascular and hemodynamic disorders during coronary heart disease

Significance of the hemorheological disorders in development of acute vascular syndromes is presently well known, but their role in pathogenesis of chronic coronary heart disease has not been yet sufficiently analyzed. Aim of the present study was the investigation of the relationship between the hemorheological, vascular and hemo-dynamic factors responsible for development of the coronary heart disease. We investigated 64 patients with coronary heart disease of the functional classes I-IV with and without the heart failure. For evaluation of the hemorheological disorders we investigated its most significant symptom, the erythrocyte aggregability, with the "Georgian technique" that provided us with direct and quantitative data. We investigated also the tone of the hand's resistance arteries with an original non-invasive technique based on measurement of the flow velocity changes in the patients and in the healthy controls radial arteries by using the Doppler technique during standardized postischemic hyperemia. Echocardiographically we studied the standard characteristics of left ventricular function (systolic and diastolic volume, its mass and ejection fraction). ECG by standard leads and the blood pressure were investigated in all patients. We found that the rheological disorders are manifested in the early stages of the disease before its functional manifestation. The most pronounced hemorheological disorders were in evidence in the patients with unstable angina and heart failure. As to the arteriolar resistance index, it was increased only in 45 per cent of all the investigated patients and no significant difference between the patients with the heart failure and without it was found. There was a negative relationship between erythrocyte aggregability and the ejection fraction of the left ventricle and the positive correlation between erythrocyte aggregability and left ventricle hypertrophy (p<0.01). We concluded that the blood rheological disorders represent themselves a factor that plays a significant role in pathogenesis of the coronary heart disease. They are predictors of the disease and not only risk factors as it is generally believed. Measurement and correction of these disturbances in its early stages have a high clinical significance.