Impaired Red Blood Cell Deformability in Patients with Coronary Artery Disease and Diabetes Mellitus

S. Keymel; C. Heiss; P. Kleinbongard; M. Kelm; T. Lauer

doi:10.1055/s-0031-1286325

Hormone and Metabolic Research, Inhaltsverzeichnis

Horm Metab Res 2011; 43(11): 760-765
DOI: 10.1055/s-0031-1286325

Original Basic

Impaired Red Blood Cell Deformability in Patients with Coronary Artery Disease and Diabetes Mellitus

Autor*innen

S. Keymel

¹University Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
C. Heiss

¹University Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
P. Kleinbongard

²Institute of Pathophysiology, University of Essen Medical School, Essen, Germany
M. Kelm

¹University Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
T. Lauer

¹University Düsseldorf, Medical Faculty, Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany

Abstract

Patients with diabetes mellitus (DM) have an increased cardiovascular morbidity and mortality. There is increasing evidence that diabetes mellitus is associated with pathological hemorheological alterations, which might contribute to impaired coronary blood flow in coronary artery disease (CAD). We hypothesize that red blood cell (RBC) deformability is impaired in diabetic patients with CAD in comparison to nondiabetic patients with CAD. RBC deformability was measured in 21 patients with CAD and type 2 diabetes mellitus (CAD + DM) and 24 patients with CAD (CAD – DM). RBC deformability was measured by the Laser-assisted optical rotational cell analyzer by determining the elongation index (EI). RBC deformability was reduced in patients with CAD + DM in comparison to patients with CAD – DM (EI @ 1.12 Pa 0.236±0.008 vs. 0.260±0.005, p=0.007). Inverse univariate correlations were found between the EI @ 1.12 Pa and plasma glucose concentration (r=− 0.57; p<0.001) and HbA_1c (r=− 0.45; p=0.002). Multivariate linear regression analysis identified plasma glucose concentration as the independent predictor of RBC deformability (β=− 0.58; p=0.007) thereby indicating that increased glucose concentrations determine RBC deformability in diabetic patients with CAD. In patients with CAD, diabetes mellitus leads to an impairment of RBC deformability which might contribute to increased morbidity of diabetic patients with CAD.

Key words

hemorheology - diabetic complications - atherosclerosis

Volltext

Referenzen

References
1 Franco OH, Steyerberg EW, Hu FB, Mackenbach J, Nusselder W. Associations of diabetes mellitus with total life expectancy and life expectancy with and without cardiovascular disease. Arch Intern Med 2007; 167: 1145-1151
2 Fox CS, Coady S, Sorlie PD, Levy D, Meigs JB, D’Agostino Sr RB, Wilson PW, Savage PJ. Trends in cardiovascular complications of diabetes. JAMA 2004; 292: 2495-2499
3 van der Schaaf RJ, Henriques JP, Wiersma JJ, Koch KT, Baan Jr J, Mulder KJ, Durrer JD, Tijssen JG, Piek JJ, de Winter RJ. Primary percutaneous coronary intervention for patients with acute ST elevation myocardial infarction with and without diabetes mellitus. Heart 2006; 92: 117-118
4 Herlitz J, Wognsen GB, Karlson BW, Sjoland H, Karlsson T, Caidahl K, Hartford M, Haglid M. Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus. Coron Artery Dis 2000; 11: 339-346
5 Mathew V, Gersh BJ, Williams BA, Laskey WK, Willerson JT, Tilbury RT, Davis BR, Holmes DRJ. Outcomes in Patients With Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in the Current Era: A Report From the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial Circulation 2004; 109: 476-480
6 Jax TW, Peters AJ, Plehn G, Schoebel FC. Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes – a two year follow-up of 243 patients. Cardiovasc Diabetol 2009; 8: 48-57
7 Thompson S, Kienast J, Pyke S, Haverkate F, Van de Loo J. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. N Engl J Med 1995; 332: 635-641
8 Chien S. Red cell deformability and its relevance to blood flow. Annu Rev Physiol 1987; 49: 177-192
9 Mohandas N, Chasis JA, Shohet SB. The influence of membrane skeleton on red cell deformability, membrane material properties, and shape. Semin Hematol 1983; 20: 225-242
10 Yedgar S, Kosckaryev A, Barshtein G. The red blood cell in vascular occlusion. Pathophysiology of Haemostasis and Thrombosis 2002; 32: 263-268
11 Babu N. Influence of hypercholesterolemia on deformability and shape parameters of erythrocytes in hyperglycemic subjects. Clin Hemorheol Microcirc 2009; 41: 169-177
12 Shin S, Ku YH, Ho JX, Kim YK, Suh JS, Singh M. Progressive impairment of erythrocyte deformability as indicator of microangiopathy in type 2 diabetes mellitus. Clin Hemorheol Microcirc 2007; 36: 253-261
13 Tsukada K, Sekizuka E, Oshio C, Minamitani H. Direct measurement of erythrocyte deformability in diabetes mellitus with a transparent microchannel capillary model and high-speed video camera system. Microvasc Res 2001; 61: 231-239
14 Baskurt OK, Boynard M, Cokelet GC, Connes P, Cooke BM, Forconi S, Liao F, Hardeman MR, Jung F, Meiselman HJ, Nash G, Nemeth N, Neu B, Sandhagen B, Shin S, Thurston G, Wautier JL. New guidelines for hemorheological laboratory techniques. Clin Hemorheol Microcirc 2009; 42: 75-97
15 Hardeman MR, Goedhart PT, Dobbe JGG, Lettinga KP. Laser-assisted optical rotational cell analyser (L.O.R.C.A.); I. A new instrument for the measurement of structural hemorheological parameters. Clin Hemorheol 1994; 14: 605-618
16 Cicco G, Pirrelli A. Red blood cell (RBC) deformability, RBC aggregability and tissue oxygenation in hypertension. Clin Hemorheol Microcirc 1999; 21: 169-177
17 Ercan M, Konukoglu D, Erdem T, Onen S. The effects of cholesterol levels on hemorheological parameters in diabetic patients. Clin Hemorheol Microcirc 2002; 26: 257-263
18 Sola E, Vaya A, Santaolaria ML, Hernandez-Mijares A, Reganon E, Vila V, Martinez-Sales V, Corella D. Erythrocyte deformability in obesity measured by ektacytometric techniques. Clin Hemorheol Microcirc 2007; 37: 219-227
19 Juhan I, Vague P, Buonocore M, Moulin JP, Jouve R, Vialettes B. Abnormalities of erythrocyte deformability and platelet aggregation in insulin-dependent diabetics corrected by insulin in vivo and in vitro. Lancet 1982; 1: 535-537
20 Shin S, Ku YH, Suh JS, Singh M. Rheological characteristics of erythrocytes incubated in glucose media. Clin Hemorheol Microcirc 2008; 38: 153-161
21 Fujita J, Tsuda K, Takeda T, Yu L, Fujimoto S, Kajikawa M, Nishimura M, Mizuno N, Hamamoto Y, Mukai E, Adachi T, Seino Y. Nisoldipine improves the impaired erythrocyte deformability correlating with elevated intracellular free calcium-ion concentration and poor glycaemic control in NIDDM. Br J Clin Pharmacol 1999; 47: 499-506
22 Little RR, Sacks DB. HbA1c: how do we measure it and what does it mean?. Curr Opin Endocrinol Diabetes Obes 2009; 16: 113-118
23 Schwartz RS, Madsen JW, Rybicki AC, Nagel RL. Oxidation of spectrin and deformability defects in diabetic erythrocytes. Diabetes 1991; 40: 701-708
24 Pelikanova T, Kohout M, Valek J, Base J, Stefka Z. Fatty acid composition of serum lipids and erythrocyte membranes in type 2 (non-insulin-dependent) diabetic men. Metabolism 1991; 40: 175-180
25 Yang ZC, Xia K, Wang L, Jia SJ, Li D, Zhang Z, Deng S, Zhang XH, Deng HW, Li Y. Asymmetric dimethylarginine reduced erythrocyte deformability in streptozotocin-induced diabetic rats. Microvasc Res 2007; 73: 131-136
26 Kleinbongard P, Schulz R, Rassaf T, Lauer T, Dejam A, Jax TW, Kumara I, Gharini P, Kabanova S, Özüyaman B, Schnürch H-G, Gödecke A Weber AA, Robenek MJ, Robenek H, Bloch W, Rösen P, Kelm M. Red blood cells express a functional endothelial nitric oxide synthase. Blood 2006; 107: 2943-2951
27 Lauer T, Rassaf T, Planitz C, Preuss R, Krause R, Henle T, Deussen A. Evidence against Nitric Oxide-quenching Effects of Chemically Defined Maillard Reaction Products. Horm Metab Res 2008; 40: 233-238
28 Turchetti V, Leoncini F, De MC, Trabalzini L, Guerrini M, Forconi S. Evaluation of erythrocyte morphology as deformability index in patients suffering from vascular diseases, with or without diabetes mellitus: correlation with blood viscosity and intra-erythrocytic calcium. Clin Hemorheol Microcirc 1998; 18: 141-149
29 Kowluru R, Bitensky MW, Kowluru A, Dembo M, Keaton PA, Buican T. Reversible sodium pump defect and swelling in the diabetic rat erythrocyte: effects on filterability and implications for microangiopathy. Proc Natl Acad Sci USA 1989; 86: 3327-3331
30 Wasilewski J, Turczynski B, Slowinska L, Kowalik V, Osadnik T, Polonski L. Haemorheological factors and myocardial reperfusion in patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Kardiol Pol 2007; 65: 778-785
31 Jax TW, Peters AJ, Plehn G, Schoebel FC. Relevance of hemostatic risk factors on coronary morphology in patients with diabetes mellitus type 2. Cardiovasc Diabetol 2009; 8: 24-31