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[Effects of hemodilution on the ventricular function of the coronary patient]
Insights
Normovolaemic haemodilution effectively reduced blood viscosity and red blood cell aggregation in coronary heart disease patients. This procedure did not negatively impact ventricular function or myocardial perfusion, suggesting it is a safe treatment for peripheral artery disease.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Medical Treatment
Background:
- Coronary heart disease (CHD) patients often have comorbidities like peripheral artery disease (PAD).
- Normovolaemic haemodilution is a potential treatment to improve hemorheology in PAD.
- Assessing the impact of haemodilution on cardiac function in CHD patients is crucial.
Purpose of the Study:
- To evaluate the effects of normovolaemic haemodilution on hemorheological parameters and cardiac function in CHD patients undergoing treatment for lower limb arteritis.
- To determine the safety and efficacy of this procedure in a specific patient cohort.
Main Methods:
- Ten stabilized CHD patients (free of cardiac failure) underwent normovolaemic haemodilution using a 5% albumin solution.
- Cardiac function was assessed using radioisotope methods: thallium-201 and dipyridamole myocardial perfusion scans, and technetium-99m angiography for left ventricular contraction.
- Blood viscosity, plasma viscosity, red blood cell aggregation, and filtration indices were measured before and 24 hours after haemodilution.
Main Results:
- Haemodilution significantly reduced mean hematocrit from 0.42 to 0.32 (p<0.01) and decreased blood viscosity, particularly at low shear rates.
- Red blood cell aggregation index also showed a reduction.
- Left ventricular contraction and basal myocardial perfusion (thallium scan) remained unchanged, with some cases showing improvement.
- Dipyridamole-induced myocardial perfusion showed no change in most patients, resolved ischemia in two, and slightly increased it in one.
Conclusions:
- Normovolaemic haemodilution is well-tolerated in CHD patients with PAD.
- The procedure improves hemorheological parameters without compromising ventricular function or myocardial perfusion.
- This suggests haemodilution is a potentially safe and beneficial therapeutic option for PAD in this patient group.
Abstract:
Ten patients (9 males and 1 female: mean age: 64.8 +/- 7 yr) were studied. They were all stabilized coronary heart disease patients free of cardiac failure who where to undergo normovolaemic haemodilution as medical treatment of lower limb arteritis. Ventricular function was assessed by a radioisotope method: myocardial perfusion (thallium-201 and dipyridamole scintillation scan) and left ventricular contraction by technetium-99m angiography. Blood volume was measured by iodine-131 marked albumin. The following parameters were also measured: plasma viscosity, blood viscosity at seven different speeds, red blood cell aggregation index and filtration index. These were all measured before and 24 h after normovolaemic haemodilution which was carried out with à 5% albumin solution. This haemodilution was well tolerated: 1,062 +/- 335 ml of blood were sampled, the same volume of albumin being transfused, thus reducing the mean haematocrit from 0.42 +/- 0.05 to 0.32 +/- 0.02 (p less than 0.01). Normovolaemia was respected. Blood viscosity was reduced, especially at low speeds and the red blood cell aggregation index was also reduced. Ventricular contraction did not vary. Moreover, the basal myocardial state as assessed by the thallium scintillation count was not modified by the haemodilution, even being improved in three cases. The dipyridamole perfusion (the equivalent of an effort test) gave no changes in seven patients, resolved the ischaemic signs in two patients and slightly increased ischaemia in one case.