Editorial comment
Hemorheology, microcirculation and macrocirculation
Hemorreologia, microcirculação e macrocirculação
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The vertical lines mark when the coronary fast-track system was fully implemented throughout Portugal (2007), the implementation of the smoking ban (2008), and the implementation of the salt reduction regulation (mid-2010). ACS: acute coronary syndrome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daisy Abreu, Paulo Sousa, Carlos Matias-Dias, Fausto Pinto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Daisy" "apellidos" => "Abreu" ] 1 => array:2 [ "nombre" => "Paulo" "apellidos" => "Sousa" ] 2 => array:2 [ "nombre" => "Carlos" "apellidos" => "Matias-Dias" ] 3 => array:2 [ "nombre" => "Fausto" "apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255119304974" "doi" => "10.1016/j.repc.2019.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255119304974?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920301057?idApp=UINPBA00004E" "url" => "/21742049/0000003900000001/v1_202005161338/S2174204920301057/v1_202005161338/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204920301070" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.04.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "1490" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2020;39:17-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Whole blood viscosity in microvascular angina and coronary artery disease: Significance and utility" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "17" "paginaFinal" => "23" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Viscosidade sanguínea na angina microvascular e na doença arterial coronária: significado e viabilidade" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1318 "Ancho" => 1354 "Tamanyo" => 83065 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curve (ROC) analysis of whole blood viscosity at high shear rate and low shear rate for the prediction of coronary artery disease and microvascular angina. 95% confidence intervals for ROC curve analysis are also displayed. AUC: area under the curve; HSR: high shear rate; LSR: low shear rate; WBV: whole blood viscosity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elif Ijlal Cekirdekci, Baris Bugan" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Elif Ijlal" "apellidos" => "Cekirdekci" ] 1 => array:2 [ "nombre" => "Baris" "apellidos" => "Bugan" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255120300743" "doi" => "10.1016/j.repc.2019.04.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120300743?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920301070?idApp=UINPBA00004E" "url" => "/21742049/0000003900000001/v1_202005161338/S2174204920301070/v1_202005161338/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Hemorheology, microcirculation and macrocirculation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "26" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Carlota Saldanha" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Carlota" "apellidos" => "Saldanha" "email" => array:1 [ 0 => "carlotasaldanha@medicina.ulisboa.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Medicina Molecular João Lobo Antunes, Cento Académico de Medicina de Lisboa, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Hemorreologia, microcirculação e macrocirculação" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The article by Cekirdekci and Bugan published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> opens up new prospects for improving our knowledge of microvascular angina (MVA).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Clinical characterization of MVA and coronary artery disease (CAD) shows them to be examples of endothelial dysfunction at the level of the microcirculation and macrocirculation, respectively. There is now general consensus about both coronary microcirculation and macrocirculation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors selected biomarkers of hemorheology and inflammation and applied clinical methodology to diagnose and classify the patients and the control group. The latter were similar to the MVA and CAD patient groups regarding the presence of other associated diseases. The statistical computation performed confirmed the value of the control group used, which in my opinion is more realistic than other control groups selected without comorbidities.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As is well known, a compromised microcirculation leads to insufficient blood perfusion in arterioles, capillaries and venules, and hence poor oxygenation in tissues and organs. One cause could be a reduced ability of erythrocytes to reversibly deform (erythrocyte deformability) when they move into capillaries with a smaller diameter than the cell. Erythrocyte deformability is a hemorheological parameter which is affected by erythrocyte membrane composition, structure, internal viscosity, and signal transduction mechanisms resulting from exogenous and/or endogenous binding or compounds entering through the erythrocyte membrane.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> A large number of disorders can change this hemorheological property of erythrocytes and hence reduce their ability to deliver oxygen to the tissue microcirculation. If such a situation is accompanied by diminished oxygen diffusion to endothelial cells, this may trigger cell hypoxia, leading to the generation of reactive oxygen species.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> In tissues where the oxygen partial pressure is lower than in the lungs, the efflux of nitric oxide (NO) from the erythrocyte through its membrane protein band<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">4</span></a> is concomitant with oxygen delivery from the erythrocyte to cell tissues.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a> In situations of abnormal microcirculation, reactive nitrogen species may be formed, leading to decreased concentrations of NO and loss of its physiological vasodilator function.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to be aware of the possible existence of an inflammatory process in post-capillary venules where decreased rolling velocity and increased leukocyte adhesion retard blood flow. The presence of erythrocyte aggregates in post-capillary venules results in leukocytes remaining near the surface of the endothelium, promoting an acute inflammatory response.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> This effect was observed by us in an animal model of acute inflammation with labeled neutrophils using intravital microscopy.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> Impaired erythrocyte deformability and decreased NO efflux from erythrocytes during the acute phase of inflammation were observed.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> As the in vivo study was performed with mice, the quantity of blood was insufficient for whole blood viscosity (WBV) assessment, but according to other studies, WBV is likely to be increased.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to its function as an acute phase protein in inflammatory diseases, fibrinogen is involved in the mechanism of the coagulation cascade, the ability of erythrocytes to scavenge or donate NO, and erythrocyte aggregation.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Erythrocyte aggregation and deformability are hemorheological parameters that influence WBV as a function of shear rates and hematocrit (HCT).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> In blood samples from healthy humans, when subjected to low shear rates erythrocyte aggregation takes place at higher WBV values in an HCT-dependent fashion, in contrast to erythrocyte deformability, which is increased by high shear rates and lower WBV values, and is little influenced by HCT.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Cekirdekci and Bugan chose WBV and C-reactive protein (CRP) as hemorheological and inflammatory biomarkers, respectively, of cardiovascular disease, as has been previously demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,10</span></a> The levels of both parameters were increased in the MVA and CAD groups, confirming the existence of inflammation in patients with CAD and suggesting the presence of a subclinical inflammatory state in patients with MVA. The present study illustrates the need for studies that include microcirculation observations. The microcirculation can be monitored non-invasively, the sublingual region being the area of choice to apply hand-held microscopy.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> In addition, assessment of NO efflux from erythrocytes obtained from patients with MVA and CAD will be helpful for monitoring the effects of drugs on the microcirculation and macrocirculation, respectively. Our team observed that NO efflux from erythrocytes of patients with systemic lupus erythematosus and rheumatoid arthritis is negatively associated with both intima-media thickness (IMT) and the presence of atherosclerosis plaques, and is an independent predictor of carotid IMT.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Systemic inflammation occurs in both the macrocirculation and the microcirculation, and endothelial dysfunction in resistance coronary vessels contributes to coronary microvascular disease and vice versa.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> Before the achievement of this consensus we found that disturbances in microcirculation in the eye are associated with endothelial dysfunction in patients suffering from macrocirculatory diseases such as the accelerated phase of hypertension.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The authors of the present article pointed out the need to quantify WBV by specialized equipment rather than through a formula based on a mathematical model.</p><p id="par0050" class="elsevierStylePara elsevierViewall">WBV is a hemorheological parameter dependent on erythrocyte aggregation and deformability, as well as on plasma viscosity, and not only hematocrit. The intricacies of the vascular network, with variations in vessel length and diameter and number of ramifications, have implications for the differing values of HCT. All hemorheological parameters can be determined in appropriate laboratories with specialized equipment, which will help provide a better understanding of the pathophysiology. Follow-up studies conducted in patients with acute myocardial infarction demonstrated that patients with lower erythrocyte aggregation and CRP values at hospital discharge present higher recurrent event and mortality rates than patients with normal values.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The development of new hemorheological microfluidic devices to be used at the bedside<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> and microcirculatory apparatus means that MVA and CAD patients can be subdivided according to the associated pathology, and as well as WBV and HCT, erythrocyte deformability and aggregation, NO efflux from erythrocytes and microcirculatory parameters can be assessed. In the near future, new questions will be asked that will lead to multiple scientific discoveries.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Whole blood viscosity in microvascular angina and coronary artery disease: significance and feasibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I.E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 2 | 9 |
| 2024 October | 53 | 31 | 84 |
| 2024 September | 62 | 24 | 86 |
| 2024 August | 52 | 34 | 86 |
| 2024 July | 40 | 31 | 71 |
| 2024 June | 35 | 26 | 61 |
| 2024 May | 37 | 17 | 54 |
| 2024 April | 31 | 26 | 57 |
| 2024 March | 32 | 23 | 55 |
| 2024 February | 38 | 21 | 59 |
| 2024 January | 29 | 25 | 54 |
| 2023 December | 18 | 27 | 45 |
| 2023 November | 32 | 26 | 58 |
| 2023 October | 21 | 17 | 38 |
| 2023 September | 23 | 19 | 42 |
| 2023 August | 32 | 14 | 46 |
| 2023 July | 22 | 9 | 31 |
| 2023 June | 22 | 12 | 34 |
| 2023 May | 44 | 30 | 74 |
| 2023 April | 23 | 6 | 29 |
| 2023 March | 30 | 14 | 44 |
| 2023 February | 23 | 17 | 40 |
| 2023 January | 28 | 17 | 45 |
| 2022 December | 32 | 27 | 59 |
| 2022 November | 34 | 27 | 61 |
| 2022 October | 38 | 20 | 58 |
| 2022 September | 30 | 29 | 59 |
| 2022 August | 29 | 31 | 60 |
| 2022 July | 32 | 41 | 73 |
| 2022 June | 22 | 32 | 54 |
| 2022 May | 21 | 31 | 52 |
| 2022 April | 35 | 33 | 68 |
| 2022 March | 27 | 41 | 68 |
| 2022 February | 36 | 38 | 74 |
| 2022 January | 33 | 29 | 62 |
| 2021 December | 18 | 31 | 49 |
| 2021 November | 39 | 29 | 68 |
| 2021 October | 52 | 47 | 99 |
| 2021 September | 29 | 25 | 54 |
| 2021 August | 26 | 24 | 50 |
| 2021 July | 19 | 18 | 37 |
| 2021 June | 25 | 15 | 40 |
| 2021 May | 56 | 36 | 92 |
| 2021 April | 87 | 26 | 113 |
| 2021 March | 42 | 14 | 56 |
| 2021 February | 38 | 11 | 49 |
| 2021 January | 24 | 17 | 41 |
| 2020 December | 42 | 17 | 59 |
| 2020 November | 35 | 10 | 45 |
| 2020 October | 30 | 15 | 45 |
| 2020 September | 42 | 17 | 59 |
| 2020 August | 21 | 14 | 35 |
| 2020 July | 18 | 9 | 27 |
| 2020 June | 18 | 19 | 37 |
| 2020 May | 16 | 5 | 21 |
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