Journal of cardiology · 2017
Intravascular hemolysis in patients with mitral regurgitation: Evaluation by erythrocyte creatine.
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Sugiura Tetsuro, Okumiya Toshika, Kamioka Mikio, Kubo Toru, Hirakawa Yoko, Hisahara Taisuke, Matsumura Yoshihisa
Аннотация
BACKGROUND: Intravascular hemolysis has been reported in patients with cardiac valve prostheses, but intravascular hemolysis in patients with mitral regurgitation with native valve has not been evaluated in detail. We designed a study to elucidate the impact of regurgitation flow on intravascular hemolysis in patients with primary mitral regurgitation by measuring erythrocyte creatine.
METHODS: Erythrocyte creatine was enzymatically assayed in 29 patients with moderate to severe primary mitral regurgitation and 12 age-matched healthy volunteers. The size and characteristics of mitral regurgitation were determined by color Doppler echocardiography.
RESULTS: Erythrocyte creatine was significantly higher in patients with eccentric jet (n=17, 2.64±0.77μmol/g Hb) than that of central jet (n=12, 1.68±0.13μmol/g Hb) and control subjects (1.39±0.25μmol/g Hb). Patients with eccentric jet had a significantly lower erythrocyte count and hemoglobin (385±58 x104/μL and 116±19g/l) compared to those with central jet (450±47×104/μL and 137±14g/l) and control subjects (433±31×104/μL and 134±19g/l). There were no significant differences in age, estimated glomerular filtration rate, pulmonary artery systolic pressure, left atrial size and left ventricular end-diastolic dimension between patients with eccentric jet and central jet.
CONCLUSIONS: Intravascular hemolysis associated with subclincal anemia in patients with eccentric jet was due to the destruction of erythrocyte by collision of the eccentric jet to the atrial wall.
METHODS: Erythrocyte creatine was enzymatically assayed in 29 patients with moderate to severe primary mitral regurgitation and 12 age-matched healthy volunteers. The size and characteristics of mitral regurgitation were determined by color Doppler echocardiography.
RESULTS: Erythrocyte creatine was significantly higher in patients with eccentric jet (n=17, 2.64±0.77μmol/g Hb) than that of central jet (n=12, 1.68±0.13μmol/g Hb) and control subjects (1.39±0.25μmol/g Hb). Patients with eccentric jet had a significantly lower erythrocyte count and hemoglobin (385±58 x104/μL and 116±19g/l) compared to those with central jet (450±47×104/μL and 137±14g/l) and control subjects (433±31×104/μL and 134±19g/l). There were no significant differences in age, estimated glomerular filtration rate, pulmonary artery systolic pressure, left atrial size and left ventricular end-diastolic dimension between patients with eccentric jet and central jet.
CONCLUSIONS: Intravascular hemolysis associated with subclincal anemia in patients with eccentric jet was due to the destruction of erythrocyte by collision of the eccentric jet to the atrial wall.