J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 12, December 2018, pages 928-935

Clinical Impact of Hemorheology on Subclinical Myocardial Injury in Patients with Hypertension

Figure 1. System of microchannel array flow analyzer. The microchannel passage time of 100 µL of physiological saline was measured as a control, and then that of venous whole blood obtained from the subjects with 5% heparinization was determined. The WBPT of the subjects was expressed after correction for the passage time of physiological saline. Inter- and intra-assay coefficients of variation for WBPT were 8% and 5%, respectively. WBPT: whole blood passage time.

Figure 2. Relationship between hs-cTnT and WBPT. There is significantly positive correlation between log-hs-cTnT and WBPT (r = 0.33, P < 0.001). hs-cTnT: high-sensitivity troponin T; WBPT: whole blood passage time.

Figure 3. Cutoff value of WBPT for discriminating hs-cTnT levels as ≥ 0.014 ng/mL. Receiver-operating characteristic indicated that a WBPT cutoff of 55.6 s yielded the largest area under the curve, 0.744 (95% confidence interval: 0.699 - 0.784; P < 0.001), indicating a sensitivity of 85.7% and a specificity of 57.0% for discriminating hs-cTnT levels as ≥ 0.014 ng/mL. WBPT: whole blood passage time; hs-cTnT: high-sensitivity troponin T.

**Table 1.** Patient Characteristics
	Overall	hs-cTnT non-detection	hs-cTnT detection	P value
Data are expressed as mean ± SD. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; CCB: calcium channel blocker; RAS: renin-angiotensin system.
n (male/female)	447 (181/266)	47 (21/26)	400 (160/240)	0.535
Age (years)	65 ± 13	58 ± 12	66 ± 12	< 0.001
Body mass index (kg/m²)	23 ± 4	23 ± 3	23 ± 4	0.541
Exercise habits, n (%)	150 (34)	16 (34)	134 (34)	0.941
Current smoker, n (%)	118 (26)	11 (23)	107 (27)	0.624
Systolic BP (mm Hg)	161 ± 8	157 ± 10	162 ± 8	< 0.01
Diastolic BP (mm Hg)	96 ± 9	94 ± 10	96 ± 9	0.176
Dyslipidemia (%)	281 (63)	28 (60)	253 (63)	0.713
Total cholesterol (mg/dL)	212 ± 40	218 ± 38	211 ± 40	0.173
LDL cholesterol (mg/dL)	135 ± 36	137 ± 33	135 ± 36	0.553
Triglyceride (mg/dL)	128 ± 64	131 ± 66	128 ± 64	0.750
HDL cholesterol (mg/dL)	52 ± 15	55 ± 15	51 ± 14	0.063
Diabetes mellitus (%)	174 (39)	6 (13)	168 (42)	< 0.001
FBG (mg/dL)	116 ± 24	104 ± 20	118 ± 24	< 0.001
HOMA-IR	2.1 ± 1.4	1.5 ± 1.0	2.1 ± 1.4	< 0.01
SkinAF (AU)	2.6 ± 0.6	2.2 ± 0.6	2.6 ± 0.5	< 0.001
White blood cell (/µL)	5,610 ± 1,585	5,630 ± 1,364	5,608 ± 1,611	0.929
Hematocrit (%)	39.1 ± 5.5	39.2 ± 2.3	39.1 ± 5.8	0.943
Plate (10⁴/µL)	23.8 ± 5.9	24.2 ± 8.0	23.8 ± 5.6	0.636
eGFR (mL/min/1.73 m²)	66 ± 21	73 ± 17	65 ± 22	< 0.05
Cornell voltage (mm)	15 ± 6	12 ± 7	15 ± 5	< 0.001
Log-BNP (pg/mL)	1.8 ± 0.4	1.6 ± 0.4	1.8 ± 0.3	< 0.01
d-ROMs test (U. Carr)	335 ± 101	299 ± 103	339 ± 101	< 0.01
CAVI	9.0 ± 1.4	8.5 ± 1.2	9.0 ± 1.4	< 0.01
WBPT (s)	59.4 ± 16.8	50.2 ± 14.2	60.5 ± 16.8	< 0.001
log-hs-cTnT (ng/mL)	-1.9 ± 0.3	-	-1.9 ± 0.3	-
Medication
CCB, n (%)	349 (78)	40 (85)	309 (77)	0.219
RAS inhibitor, n (%)	186 (42)	22 (47)	164 (41)	0.446
β-blocker, n (%)	67 (15)	6 (13)	61 (15)	0.653
Statin, n (%)	147 (33)	14 (30)	133 (33)	0.634
Anti-diabetic drugs, n (%)	133 (30)	6 (13)	127 (32)	< 0.01

Table 1. Patient Characteristics

Overall

hs-cTnT non-detection

hs-cTnT detection

P value

Data are expressed as mean ± SD. hs-cTnT: high-sensitivity cardiac troponin T; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; CCB: calcium channel blocker; RAS: renin-angiotensin system.

n (male/female)

447 (181/266)

47 (21/26)

400 (160/240)

0.535

Age (years)

65 ± 13

58 ± 12

66 ± 12

< 0.001

Body mass index (kg/m²)

23 ± 4

23 ± 3

23 ± 4

0.541

Exercise habits, n (%)

150 (34)

16 (34)

134 (34)

0.941

Current smoker, n (%)

118 (26)

11 (23)

107 (27)

0.624

Systolic BP (mm Hg)

161 ± 8

157 ± 10

162 ± 8

< 0.01

Diastolic BP (mm Hg)

96 ± 9

94 ± 10

96 ± 9

0.176

Dyslipidemia (%)

281 (63)

28 (60)

253 (63)

0.713

Total cholesterol (mg/dL)

212 ± 40

218 ± 38

211 ± 40

0.173

LDL cholesterol (mg/dL)

135 ± 36

137 ± 33

135 ± 36

0.553

Triglyceride (mg/dL)

128 ± 64

131 ± 66

128 ± 64

0.750

HDL cholesterol (mg/dL)

52 ± 15

55 ± 15

51 ± 14

0.063

Diabetes mellitus (%)

174 (39)

6 (13)

168 (42)

< 0.001

FBG (mg/dL)

116 ± 24

104 ± 20

118 ± 24

< 0.001

HOMA-IR

2.1 ± 1.4

1.5 ± 1.0

2.1 ± 1.4

< 0.01

SkinAF (AU)

2.6 ± 0.6

2.2 ± 0.6

2.6 ± 0.5

< 0.001

White blood cell (/µL)

5,610 ± 1,585

5,630 ± 1,364

5,608 ± 1,611

0.929

Hematocrit (%)

39.1 ± 5.5

39.2 ± 2.3

39.1 ± 5.8

0.943

Plate (10⁴/µL)

23.8 ± 5.9

24.2 ± 8.0

23.8 ± 5.6

0.636

eGFR (mL/min/1.73 m²)

66 ± 21

73 ± 17

65 ± 22

< 0.05

Cornell voltage (mm)

15 ± 6

12 ± 7

15 ± 5

< 0.001

Log-BNP (pg/mL)

1.8 ± 0.4

1.6 ± 0.4

1.8 ± 0.3

< 0.01

d-ROMs test (U. Carr)

335 ± 101

299 ± 103

339 ± 101

< 0.01

CAVI

9.0 ± 1.4

8.5 ± 1.2

9.0 ± 1.4

< 0.01

WBPT (s)

59.4 ± 16.8

50.2 ± 14.2

60.5 ± 16.8

< 0.001

log-hs-cTnT (ng/mL)

-1.9 ± 0.3

Medication

CCB, n (%)

349 (78)

40 (85)

309 (77)

0.219

RAS inhibitor, n (%)

186 (42)

22 (47)

164 (41)

0.446

β-blocker, n (%)

67 (15)

6 (13)

61 (15)

0.653

Statin, n (%)

147 (33)

14 (30)

133 (33)

0.634

Anti-diabetic drugs, n (%)

133 (30)

6 (13)

127 (32)

< 0.01

**Table 2.** Correlation Between hs-cTnT, WBPT and Clinical Parameters in hs-cTnT Detectable Patients
	log-hs-cTnT/r	WBPT/r
r: expressed correlation coefficient. P < 0.05, P < 0.01, **P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; WBPT: whole blood passage time; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; CCB: calcium channel blocker; RAS: renin-angiotensin system.
Sex (female = 0, male = 1)	-0.11*	0.05
Age	0.27***	0.08
Body mass index	0.02	0.11*
Exercise habits (No = 0, Yes = 1)	0.08	-0.16**
Current smoker (No = 0, Yes = 1)	0.10	0.17**
Systolic BP	0.09	0.06
Diastolic BP	0.07	0.03
Dyslipidemia (No = 0, Yes = 1)	0.02	0.01
Total cholesterol	0.09	0.03
LDL cholesterol	0.06	0.04
Triglyceride	0.09	0.07
HDL cholesterol	-0.03	-0.02
Diabetes mellitus (No = 0, Yes = 1)	0.16**	0.11*
FBG	0.11*	0.10
HOMA-IR	0.09	0.09
Skin AF	0.41***	0.21***
White blood cell	0.08	0.11*
Hematocrit	0.09	0.18***
Plate	0.08	0.07
eGFR	-0.19***	-0.14**
Cornell voltage	0.15**	0.09
log-BNP	0.26***	0.08
d-ROMs test	0.29***	0.29***
CAVI	0.39***	0.37***
CCB (No = 0, Yes = 1)	-0.05	-0.04
RAS inhibitor (No = 0, Yes = 1)	-0.09	-0.08
β-blocker (No = 0, Yes = 1)	-0.04	0.03
Statin (No = 0, Yes = 1)	-0.07	-0.09
Anti-diabetic drugs (No = 0, Yes = 1)	-0.09	-0.06

Table 2. Correlation Between hs-cTnT, WBPT and Clinical Parameters in hs-cTnT Detectable Patients

log-hs-cTnT/r

WBPT/r

r: expressed correlation coefficient. *P < 0.05, **P < 0.01, ***P < 0.001. hs-cTnT: high-sensitivity cardiac troponin T; WBPT: whole blood passage time; BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; HOMA-IR: homeostatic model assessment of insulin resistance; AF: autofluorescence; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; d-ROMs: derivatives of reactive oxygen metabolites; CAVI: cardio-ankle vascular index; CCB: calcium channel blocker; RAS: renin-angiotensin system.

Sex (female = 0, male = 1)

-0.11*

0.05

Age

0.27***

0.08

Body mass index

0.02

0.11*

Exercise habits (No = 0, Yes = 1)

0.08

-0.16**

Current smoker (No = 0, Yes = 1)

0.10

0.17**

Systolic BP

0.09

0.06

Diastolic BP

0.07

0.03

Dyslipidemia (No = 0, Yes = 1)

0.02

0.01

Total cholesterol

0.09

0.03

LDL cholesterol

0.06

0.04

Triglyceride

0.09

0.07

HDL cholesterol

-0.03

-0.02

Diabetes mellitus (No = 0, Yes = 1)

0.16**

0.11*

FBG

0.11*

0.10

HOMA-IR

0.09

Skin AF

0.41***

0.21***

White blood cell

0.08

0.11*

Hematocrit

0.09

0.18***

Plate

0.08

0.07

eGFR

-0.19***

-0.14**

Cornell voltage

0.15**

0.09

log-BNP

0.26***

0.08

d-ROMs test

0.29***

CAVI

0.39***

0.37***

CCB (No = 0, Yes = 1)

-0.05

-0.04

RAS inhibitor (No = 0, Yes = 1)

-0.09

-0.08

β-blocker (No = 0, Yes = 1)

-0.04

0.03

Statin (No = 0, Yes = 1)

-0.07

-0.09

Anti-diabetic drugs (No = 0, Yes = 1)

-0.09

-0.06

**Table 3.** Multiple Regression Analysis
Explanatory factor	β	P value
(A) Subordinate factor is log-hs-cTnT, R² = 0.35; (B) subordinate factor is WBPT, R² = 0.30. AF: autofluorescence; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T.
^(A)Skin AF	0.27	< 0.001
CAVI	0.16	< 0.01
WBPT	0.15	< 0.01
Age	0.13	< 0.01
d-ROMs test	0.12	< 0.01
eGFR	-0.11	< 0.01
log-BNP	0.10	< 0.05
Cornell voltage	0.09	0.068
(B)^CAVI	0.26	< 0.001
log-hs-cTnT	0.18	< 0.01
d-ROMs test	0.17	< 0.01
Skin AF	0.15	< 0.01
Hematocrit	0.13	< 0.01
Exercise habits	-0.12	< 0.01
Current smoker	0.11	< 0.05
eGFR	-0.09	0.057

Table 3. Multiple Regression Analysis

Explanatory factor

P value

(A) Subordinate factor is log-hs-cTnT, R² = 0.35; (B) subordinate factor is WBPT, R² = 0.30. AF: autofluorescence; CAVI: cardio-ankle vascular index; WBPT: whole blood passage time; d-ROMs: derivatives of reactive oxygen metabolites; eGFR: estimated glomerular filtration rate; BNP: brain natriuretic peptide; hs-cTnT: high-sensitivity cardiac troponin T.

^(A)Skin AF

0.27

< 0.001

CAVI

0.16

< 0.01

WBPT

0.15

< 0.01

Age

0.13

< 0.01

d-ROMs test

0.12

< 0.01

eGFR

-0.11

< 0.01

log-BNP

0.10

< 0.05

Cornell voltage

0.09

0.068

(B)^CAVI

0.26

< 0.001

log-hs-cTnT

0.18

< 0.01

d-ROMs test

0.17

< 0.01

Skin AF

0.15

< 0.01

Hematocrit

0.13

< 0.01

Exercise habits

-0.12

< 0.01

Current smoker

0.11

< 0.05

eGFR

-0.09

0.057