Diabetes Metab J.  2018 Apr;42(2):155-163. 10.4093/dmj.2018.42.2.155.

Hemorheologic Alterations in Patients with Type 2 Diabetes Mellitus Presented with an Acute Myocardial Infarction

• Park KH
• Kim U
• Choi KU
• Nam JH
• Lee JH
• Lee CH
• Son JW
• Park JS
• Shin DG
• Won KC
• Moon JS
• Kim YK
• Suh JS

• KMID: 2418708
• DOI: http://doi.org/10.4093/dmj.2018.42.2.155

Abstract

BACKGROUND
Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI.
METHODS
A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n = 77) and control group (AMI−, n = 118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups.
RESULTS
The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI−, P < 0.001) but the level of CSS was higher (316.13±108.20 mPa in AMI+ and 286.80±85.34 mPa in AMI−, P = 0.040) in the AMI+. The CSS was significantly related to the erythrocyte sedimentation rate (R² = 0.497, P < 0.001) and use of dipeptidyl peptidase-4 inhibitors (R² = 0.574, P = 0.048).
CONCLUSION
Diabetics with AMI resulted in adverse hemorheologic changes with lower EI and higher CSS compared to diabetic subjects without AMI. Evaluation of the hemorheologic parameters may provide valuable supplementary information for managing patients with AMI and T2DM.

Keyword

Diabetes mellitus, type 2; Erythrocyte deformability; Hemorheology; Myocardial infarction

MeSH Terms

Blood Sedimentation
Coronary Artery Disease
Diabetes Mellitus, Type 2*
Erythrocyte Deformability
Hemorheology
Humans
Myocardial Infarction*

Figure

• 

  Fig. 1 Study flow chart. AMI, acute myocardial infarction; PCI, percutaneous coronary intervention; T2DM, type 2 diabetes mellitus; T1DM, type 1 diabetes mellitus; MI, myocardial infarction.

• 

  Fig. 2 Schema of the measurement of the red blood cell. Elongation index (EI), which was measured at a pressure of 3 Pa, was defined as (L−W)/(L+W) and it was expressed as a percentage. L means the length of the major axis of the cell, and W means the width of the minor axis of the cell. The lower the value of the EI is, the more circular the cell becomes.

• 

  Fig. 3 Comparison of erythrocyte functions (A, elongation index, P<0.001; B, critical shear stress, P=0.040) between two groups. AMI, acute myocardial infarction. aAMI group showed lower elongation index (A, 30.44%±1.77% vs. 31.47%±1.48%) and higher critical shear stress (B, 316.13±108.20 mPa vs. 286.80±85.34 mPa) compared to control group.

• 

  Fig. 4 Correlation between the renal function and elongation index at 3 Pa (A, r=0.375, P<0.001; black square, acute myocardial infarction [AMI] group; empty square, non-AMI group) and critical shear stress (B, r=−0.317, P<0.001). GFR, glomerular filtration rate.

• 

  Fig. 5 Correlation between the elongation index at 3 Pa and critical shear stress (r=−0.124, P=0.090; black square, acute myocardial infarction [AMI] group; empty square, non-AMI group).

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  Fig. 6 Correlation between glycosylated hemoglobin and the elongation index at 3 Pa (r=−0.161, P=0.029; black square, acute myocardial infarction [AMI] group; empty square, non-AMI group).

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