Erythrocyte aggregability, and fibrinogen during atrial fibrillation
Authors: Gotsadze M , Kandashvili T , Momtselidze N , Mantskava M 
Published: May 2024

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Academician N. Kipshidze University Clinic - Republican Hospital; IVANE BERITASHVILI CENTER OF EXPERIMENTAL BIOMEDICINE, Department of rheology and diagnostic analytical services.

Introduction
Despite all biomedical efforts, the prevalence of atrial fibrillation and its associated morbidity and mortality are increasing globally year after year. The disease's unfavorable epidemiological picture determined the reality of the project. There are many hypotheses to explain the pathogenesis of atrial fibrillation. All the hypotheses are based on mechanisms at local points and microwaves (in whole or in part). None of them consider the role of hemodynamics and hemorheology in the formation and progression of atrial fibrillation. It is also unknown how atrial fibrillation affects intracardiac macro- and microcirculation.

Purpose
The goals of this project were to determine how hemodynamics and hemorheology change in patients with atrial fibrillation. In order to gain a better understanding of the pathological processes underlying AF, we sought to access the relationships between hemodynamics, rheological properties,and the coagulation system of blood.

Methods
The Erythrocyte (RBC) Aggregation Index (EAI) was monitored in the development and validation cohorts (90 patients and 20 healthy individuals) using the textural analysis system (Tas-Plus, Leitz, Germany) and an innovative "Georgian technique" with the unique function of a quantitative assessment of the EAI. The method was developed by Georgian scientists and is well-known around the world for being direct, numerical, and precise. In all patients Coagulogram and 12-lead standard ECG were performed.

Results
According to the data obtained, the patients' rheological and coagulation system conditions are the same, and they are distinct from the control group. During the statistical processing of the total amount of fibrinogen (Fib), the patients were divided into three categories. The average Fib in Category I patients was 336.40 ±27,77 mg/dl, and the average EAI-RBC value was 32.8± 9.4. Category II: FIB: 373.00±22.65mg/dl; EAI-RBC: 39.8±13.8 and Category III: FIB:471.27±21.58 mg/dl; EAI-RBC: 42.6±10.4. The control group: FIB: 301±18,1 mg/dl, EAI-RBC: 25.6±1.29. Fibrinogen and the Index of Erythrocyte Aggregation were found to have a linear relationship. The higher the concentration of fibrinogen, the more severe the hemorheological disorders. It should be noted that the categories were chosen without taking into account the forms of atrial fibrillation.

Conclusions
The findings clearly show the existence of two parallel mechanisms in the body. These are the coagulation systems, characterized by dynamic equilibrium, and the rheology systems, which lack a physiologically balanced opposing system. Coagulation control does not accurately describe hemorheological parameters, which are one of the most powerful mechanisms for atrial fibrillation formation In order to better understand the diseases' occurrence and progression, the simultaneous studies of fibrinogen concentration and rheological parameters are especially important for both fundamental and practical medicine.