Tetsuro Sugiura1, Toshika Okumiya2, Mikio Kamioka3, Toru Kubo4, Yoko Hirakawa4, Taisuke Hisahara1, Yoshihisa Matsumura1. 1. Department of Laboratory Medicine, Kochi Medical School, Kochi, Japan. 2. Department of Analytical Biochemistry, Kumamoto University School of Health Sciences, Kumamoto, Japan. 3. Department of Laboratory Medicine, Kochi Medical School, Kochi, Japan. Electronic address: mkamioka@kochi-u.ac.jp. 4. Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Kochi, Japan.
Abstract
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.
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.