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Kelesoglu S, Elcık D, Zengin I, Ozan R, Inanc MT, Dogan A, Oguzhan A, Kalay N. Association of spontaneous echo contrast with Systemic Immune Inflammation Index in patients with mitral stenosis. Rev Port Cardiol 2022; 41:1001-1008. [PMID: 36137911 DOI: 10.1016/j.repc.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Spontaneous echo contrast (SEC) is the appearance of swirling, smoke-like echoes in the left atrium (LA) and is accepted as an independent predictor of thromboembolic risk. There is an established relationship between the inflammatory state and the prothrombotic state. Therefore, we investigated the relationship between the Systemic Immune Inflammation Index (SII), a new inflammation parameter introduced recently, and SEC in patients with mitral stenosis (MS). MATERIAL AND METHODS A total of 262 patients who underwent percutaneous mitral valvuloplasty (PMBV) for MS were included in this study. The patients were divided into two groups: patients with MS complicated by SEC and patients with MS without SEC, based on whether SEC occurred in the LA. RESULTS There were 79 patients (mean age 47.1 ± 6.6, 30.3% male gender) in the SEC (+) group, while there were 183 patients (mean age 46.4 ± 8.6, 29.5% male gender) in the SEC (-) group. In multivariate analysis, high levels of SII were an independent risk factor for SEC in patients with MS (OR: 1.001, 95% confidence interval (CI): 1.000-1.001, p<0.001) together with high levels of C-reactive protein (OR: 1.145, 95% CI: 1.027-1.277, p=0.014). The receiver operating characteristics (ROC) curve analysis showed that at a cutoff value of 547.6 for SII to predict SEC with 74.6% sensitivity and 77.6% specificity (area under ROC curve=0.736 (95% CI: 0.668-0.805), p<0.001). CONCLUSION Our study showed that the SII levels were independently associated with SEC in patients with MS.
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Affiliation(s)
- Saban Kelesoglu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - Deniz Elcık
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Iskan Zengin
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ramazan Ozan
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Tugrul Inanc
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ali Dogan
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Abdurrahman Oguzhan
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Yusuf J, Goyal M, Mukhopadhyay S, Mehta V, Dhaiya S, Saxena R, Trehan V. Effect of heart rate control on coagulation status in patients of rheumatic mitral stenosis with atrial fibrillation--A pilot study. Indian Heart J 2015; 67 Suppl 2:S40-5. [PMID: 26688152 PMCID: PMC4688446 DOI: 10.1016/j.ihj.2015.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND AIM OF STUDY Systemic thromboembolism is a major complication in patients of mitral stenosis (MS) with atrial fibrillation (AF) due to induction of hypercoagulable state. The aim was to assess the relationship, if any, between control of ventricular rate and systemic coagulation factors. METHOD 70 patients of moderate to severe MS in AF were studied. 35 patients with average heart rate > 100 beats/min over a 24 hour period assessed by Holter monitoring were considered as having a uncontrolled ventricular rate (Group A) and those with average heart rate ≤ 100 beats/min as controlled ventricular rate (Group B). 30 healthy volunteers acted as controls. RESULTS Plasma concentration of prothrombin fragment 1+2 (PF1+2) 6600 pmol/ml [interquartile range (IQR) 5400.0-9500], thrombin antithrombin III 22.0 ng/ml [IQR 18.6-28.0], and plasminogen activator inhibitor 46.8 ng/ml [IQR 44.0-54.0] were elevated in Group A as compared to Group B (5400 pmol/ml [IQR 3600-7700] p = 0.009, 16.0 ng/ml [IQR 11.0-18.5] p<0.001, and 25.8 ng/ml [IQR 20.9-34.4] p < 0.001), respectively. A significant correlation was found between heart rate and all three coagulation markers. Multivariate multiple regression analysis showed only heart rate to be an independent predictor of systemic coagulation activation and risk of thrombus formation. CONCLUSION Control of ventricular rate in subjects of MS with AF produces significant reduction in the activation of the coagulation system and may decrease risk of thrombosis.
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Affiliation(s)
- Jamal Yusuf
- Professor, Department of Cardiology, G.B. Pant Hospital, New Delhi, India
| | - Mayank Goyal
- Senior Resident, Department of Cardiology, G.B. Pant Hospital, New Delhi, India
| | | | - Vimal Mehta
- Professor, Department of Cardiology, G.B. Pant Hospital, New Delhi, India
| | - Sunil Dhaiya
- Senior Research Fellow, Department of Hematology, AIIMS, New Delhi, India
| | - Renu Saxena
- Professor, Department of Hematology, AIIMS, New Delhi, India
| | - Vijay Trehan
- Professor, Department of Cardiology, G.B. Pant Hospital, New Delhi, India
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Kurakula N, Durgaprasad R, Velam V, Akula VS, Kasala L, Muvva KV. Predictive Value of D-Dimer Levels and Tissue Doppler Mitral Annular Systolic Velocity for Detection of Left Atrial Appendage Thrombus in Patients with Mitral Stenosis in Sinus Rhythm. Echocardiography 2015; 33:264-75. [PMID: 26239565 DOI: 10.1111/echo.13026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transesophageal echocardiogram (TEE) is a gold standard test for diagnosis of left atrial (LA) thrombus, but it has limited sensitivity for identification of small thrombi within side lobes. Thus, the absence of visualizing a left atrial appendage (LAA) thrombus does not equate with the absence of a LAA thrombus. AIM To assess the predictive value of mitral annular systolic velocity (Sa) and D-dimer for the detection of LA thrombus and spontaneous echocardiographic contrast (SEC) in mitral stenosis (MS) patients with sinus rhythm (SR). METHODS Transthoracic echocardiogram, TEE, and D-dimer analysis were performed in 104 severe MS patients and divided them into three groups: Group I:no LA thrombus or SEC; Group II:LA SEC only; and Group III:LA thrombus. RESULTS Group III had more severe New York Heart Association (NYHA) class (III-IV) dyspnea and lower Sa (6.9 ± 0.7 vs.10.0 ± 1.2 cm/sec), lower LAA late emptying velocity (17.7 ± 2.1 vs. 24.4 ± 4.2 cm/sec), larger LA transverse dimension, and LAA area (LAAA) than group I+II. Mean D-dimer levels were higher in groups III and II than in group I. In multivariate analysis Sa, D-dimer levels, LAAA, and NYHA class were independent predictors of LA thrombus. ROC curve analysis revealed that higher Sa >8 cm/sec and lower D-dimer levels <370 μg/L predict the absence of LA thrombus and lower Sa <8 cm/sec and higher D-dimer levels >510 μg/L predict the presence of LA thrombus. CONCLUSION Measurement of Sa and D-dimer levels is necessary for better assessment of LA thrombus and SEC, for identification of patients who are at high risk for LA thrombus formation and for initiation of prophylactic anticoagulation.
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Affiliation(s)
- Naresh Kurakula
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Rajasekhar Durgaprasad
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Vanajakshamma Velam
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Vidya Sagar Akula
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Latheef Kasala
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Akpek M, Kaya MG, Yarlioglues M, Dogdu O, Ardic I, Sahin O, Elcik D, Ozdogru I, Topsakal R, Oguzhan A, Ergin A, Kalay N. Relationship between platelet indices and spontaneous echo contrast in patients with mitral stenosis. Eur J Echocardiogr 2011; 12:865-70. [PMID: 21893553 DOI: 10.1093/ejechocard/jer159] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To determine the association of platelet indices with spontaneous echo contrast (SEC) in patients with mitral stenosis. METHODS AND RESULTS A total of 232 consecutive patients with mitral stenosis who undergoing mitral balloon valvuloplasty were enrolled to the study. Patients were divided into two groups according to the formation of SEC in the left atrium. Group 1: mitral stenosis complicated with SEC; Group 2: mitral stenosis without SEC. Transthoracic echocardiography and transoesophageal echocardiography were performed for each patient. Complete blood counting parameters were measured and all routine biochemical tests were performed. There were 133 patients (mean age 42 ± 11 and 74% female) in the SEC(-) group and 99 patients (mean age 45 ± 10 and 64% female) in the SEC(+) group. Plateletcrit (0.25 ± 0.06 vs. 0.27 ± 0.07, P = 0.043) and mean platelet volume (MPV) levels (9.4 ± 1.1 vs. 10.4 ± 1.2, P < 0.001) were significantly higher in the SEC(+) group. When we divided the SEC(+) patients into four subgroups according to previously reported criteria, MPV levels increased to correlate with the degree of SEC (P < 0.001). At multivariate analysis, MPV levels [odds ratio (OR) 2.365, 95% confidence interval (CI) 1.720-3.251; P < 0.001] and PCT levels (OR 2.699, 95% CI 1.584-4.598; P= 0.033) are independent risk factors of SEC in patients with mitral stenosis. CONCLUSION In patients with mitral stenosis, cheaply and easily measurable platelet indices including MPV and PCT levels are associated with the presence of SEC and are independent risk factors of SEC.
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Affiliation(s)
- Mahmut Akpek
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey.
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Varol E, Ozaydin M, Türker Y, Alaca S. Mean platelet volume, an indicator of platelet activation, is increased in patients with mitral stenosis and sinus rhythm. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:708-12. [DOI: 10.3109/00365510903007000] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dimitrow PP, Hlawaty M, Undas A, Śnieżek-Maciejewska M, Sobień B, Stępień E, Tracz W. Effect of aortic valve stenosis on haemostasis is independent from vascular atherosclerotic burden. Atherosclerosis 2009; 204:e103-8. [DOI: 10.1016/j.atherosclerosis.2008.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/21/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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Yavuz B, Ertugrul DT, Yalcin AA, Kucukazman M, Ata N, Dal K. Increased mean platelet volume in rheumatic mitral stenosis: a possible factor for thromboembolic events. J Cardiol 2008; 53:204-7. [PMID: 19304123 DOI: 10.1016/j.jjcc.2008.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2008] [Revised: 10/24/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUNDS Systemic embolism is an important complication in patients with rheumatic mitral stenosis (RMS). The mean platelet volume (MPV) is considered a marker and determinant of platelet function since larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis. The aim of this study was to investigate MPV in patients with RMS and healthy control subjects. METHODS We selected 30 consecutive patients with RMS and 31 consecutive healthy age- and sex-matched control subjects. All subjects were in sinus rhythm. We measured MPV in a blood sample collected in EDTA. RESULTS Demographic data of the RMS (mean age: 39.5+/-9.9 years, 22 [71%] female) and control groups (mean age: 39.2+/-9.3 years, 20 [67%] female) were similar. The MPV was significantly higher in patients with RMS 8.8 (8.2-11.3) fl than control subjects 8.1 (7.1-9.3) (P<0.001). CONCLUSION Elevated MPV might be considered as a marker of increased thromboembolic risk in patients with RMS. We suggest that patients with high MPV values might benefit from antiplatelet therapy.
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Affiliation(s)
- Bunyamin Yavuz
- Kecioren Teaching and Research Hospital, Department of Cardiology, Ankara, Turkey.
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Ozdemir O, Alyan O, Soylu M, Topaloglu S, Aras D, Metin F, Geyik B, Ozbakir C, Demir AD. Relation between Sympathetic Overactivity and Left Atrial Spontaneous Echo Contrast in Patients with Mitral Stenosis and Sinus Rhythm. Heart Lung Circ 2006; 15:242-7. [PMID: 16860607 DOI: 10.1016/j.hlc.2006.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spontaneous echo contrast (SEC) is common in patients with mitral stenosis (MS) and presence of SEC in left atrium (LA) is associated with a higher risk of thromboembolism. Recently, an increase in activation of platelets was demonstrated in patients with SEC raising the hypothesis that platelets are involved in the pathogenesis of SEC. In this study, we evaluated effects of autonomic nervous system activity on SEC formation in patients with rheumatic MS and sinus rhythm by heart rate variability analysis. METHODS AND RESULTS Twenty-six patients with LASEC were compared with 28 patients without LASEC. Mean heart rate, low frequency (LF) and low frequency/high frequency (LF/HF) ratio were significantly higher, standard deviation of all NN (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50) and high frequency (HF) values were lower in the patients with LASEC. A standard deviation of all NN intervals <90ms separated the patients with LASEC from control subjects with a sensitivity of 77% and specificity of 90%; a low frequency >79.5 with a sensitivity of 92% and specificity of 90; a low frequency/high frequency ratio >3.7 with a sensitivity of 96% and specificity of 90%. A left atrial diameter >4.3 cm increased the LASEC formation by 3.0 folds, HR >78 beats/min by 6.4 folds, standard deviation of all NN intervals <90 ms by 9.2 folds, a low frequency/high frequency ratio >3.7 by 6.4 folds, sP-selectin>142 by 5.8 folds. Variables affecting sP-selectin levels were LA diameter, mitral valve area, transmitral mean gradient, left ventricular ejection fraction, the presence of mitral regurgitation, HR, standard deviation of all NN intervals, low frequency, high frequency and low frequency/high frequency ratio. CONCLUSION Sympathetic overactivity and reduced heart rate variability are important determinants for LASEC formation and increased s-P selectin levels. Therefore, platelet activation via increased sympathetic activity may play an important role in pathogenesis of LASEC.
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Affiliation(s)
- Ozcan Ozdemir
- Türkiye Yüksek Ihtisas Hospital, Cardiology Clinics, Ankara, Turkey.
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Gur C, Lalazar G, Raphaeli G, Gilon D, Ben-Chetrit E. Mitral stenosis presenting with acute hearing loss. PLoS Med 2006; 3:e233. [PMID: 16768545 PMCID: PMC1479417 DOI: 10.1371/journal.pmed.0030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 03/29/2006] [Indexed: 11/25/2022] Open
Abstract
A 47-year old woman presented with acute hearing loss, followed by dyspnea and then reduced consciousness and a hemiparesis. Investigations led to a diagnosis of cardiac emboli related to rheumatic mitral stenosis.
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Abstract
The current understanding of thrombogenesis is modeled on Virchow's triad: stasis, hypercoagulability, and vessel wall injury. There is a dynamic (always changing) nonlinear interaction between the vascular wall, blood components, and flow, which at times defined "pathologic" leads to thrombosis or hemorrhage, at other times called "healthy" to normal hemostasis. The triad named after Virchow was not designated as such in Virchow's work. Instead, Virchow showed that thrombosis itself leads to endothelial damage, hypercoagulability, and stasis. Thus, cause and effect regarding the elements of Virchow's triad and thrombosis become indistinguishable if linearity is considered mandatory. Considering a nonlinear relation solves this problem. In the real patient, each element is present to a degree. At every moment in time, the direction of coagulation (toward hemostasis, thrombosis, or hemorrhage) and the dynamic of interaction of the elements of the triad change. The complexity and nonlinearity of the thrombotic context is evident. These facts suggest a new venue for diagnostic classification of stroke (ischemic and hemorrhagic) by causation and have implications for its prevention and treatment. Clinical and laboratory evidence can be gathered for the elements of Virchow's triad as well as for fibrinolysis and thrombosis. Mathematical methods other than probability-based statistics can represent the measured presence of these elements to a degree and their nonlinear relationship. These include, but may not be limited to, Riemannian geometry, fuzzy logic, cellular automata, and infinitesimals, all proscribed by evidence-based medicine. However, by using these methods, diagnosis and treatment measures for stroke can be built on a causal rather than risk methodology, individualizing medical decisions to the patient. All current clinical guidelines are based on linear methods of probability-based statistics and group-based data. The therapeutic choice of antithrombotic therapy in the individual patient for whom measured elements of thrombogenesis are available rests on the knowledge and expertise of the treating physician.
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Affiliation(s)
- Cathy M Helgason
- Department of Neurology, University of Illinois College of Medicine at Chicago, 912 South Wood Street, Room 855N, Chicago, IL 60612, USA.
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Okamoto M, Fujii Y, Makita Y, Kajihara K, Yamasaki S, Iwamoto A, Hashimoto M, Sueda T, Yoshida N. Left Atrial Appendage Function in Patients with Systemic Embolism in Spite of in Sinus Rhythm. J Am Soc Echocardiogr 2006; 19:211-4. [PMID: 16455427 DOI: 10.1016/j.echo.2005.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We sought to investigate whether left atrial (LA) appendage (LAA) function was impaired in patients with systemic embolism in sinus rhythm. METHODS Transesophageal echocardiography was performed in 7 patients within 5 days after embolism (early group) and in 32 patients, more than 5 days after embolism (late group). We searched intracardiac thrombus and determined LAA area and LAA flow velocity, and the grade of spontaneous echocontrast. RESULTS LA thrombus could be detected in 2 of the 39 patients only in early group (P = .028). The patients of early group, as compared with late group, had lower LAA flow velocity (28 +/- 16 vs 60 +/- 26 cm/s, P = .007) and higher grade of spontaneous echocontrast score (1.14 +/- 1.46 vs 0.25 +/- 0.62, P = .013). LA dimension and LAA area were not statistically different. CONCLUSION LAA function may be impaired early after embolism even in sinus rhythm.
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Affiliation(s)
- Mitsunori Okamoto
- Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
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Tengiz I, Ercan E, Sahin F, Alioglu E, Duman C, Saydam G, Buyukkececi F. Presence of factors that activate platelet aggregation in mitral stenotic patients' plasma. Curr Control Trials Cardiovasc Med 2005; 6:2. [PMID: 15733325 PMCID: PMC553988 DOI: 10.1186/1468-6708-6-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 02/27/2005] [Indexed: 11/24/2022]
Abstract
Background Although the association between mitral stenosis (MS) and increased coagulation activity is well recognized, it is unclear whether enhanced coagulation remains localized in the left atrium or whether this represents a systemic problem. To assess systemic coagulation parameters and changes in platelet aggregation, we measured fibrinogen levels and performed in vitro platelet function tests in plasma obtained from mitral stenotic patients' and from healthy control subjects' peripheral venous blood. Methods Sixteen newly diagnosed patients with rheumatic MS (Group P) and 16 healthy subjects (Group N) were enrolled in the study. Platelet-equalized plasma samples were evaluated to determine in vitro platelet function, using adenosine diphosphate (ADP), collagen and epinephrine in an automated aggregometer. In vitro platelet function tests in group N were performed twice, with and without plasma obtained from group P. Results There were no significant differences between the groups with respect to demographic variables. Peripheral venous fibrinogen levels in Group P were not significantly different from those in Group N. Adenosine diphosphate, epinephrine and collagen-induced platelet aggregation ratios were significantly higher in Group P than in Group N. When plasma obtained from Group P was added to Group N subjects' platelets, ADP and collagen-induced, but not epinephrine-induced, aggregation ratios were significantly increased compared to baseline levels in Group N. Conclusion Platelet aggregation is increased in patients with MS, while fibrinogen levels remain similar to controls. We conclude that mitral stenotic patients exhibit increased systemic coagulation activity and that plasma extracted from these patients may contain some transferable factors that activate platelet aggregation.
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Affiliation(s)
- Istemihan Tengiz
- Department of Cardiology, Central Hospital, 1644 sk. No:2/2, 35010 Bayrakli, Izmir, Turkey
| | - Ertugrul Ercan
- Department of Cardiology, Central Hospital, 1644 sk. No:2/2, 35010 Bayrakli, Izmir, Turkey
| | - Fahri Sahin
- Department of Hematology, Ege University Medical School, 35100 Bornova, Izmir, Turkey
| | - Emin Alioglu
- Department of Cardiology, Central Hospital, 1644 sk. No:2/2, 35010 Bayrakli, Izmir, Turkey
| | - Can Duman
- Department of Biochemistry, Kocaeli University Medical School, 41900 Derince, Kocaeli, Turkey
| | - Guray Saydam
- Department of Hematology, Ege University Medical School, 35100 Bornova, Izmir, Turkey
| | - Filiz Buyukkececi
- Department of Hematology, Ege University Medical School, 35100 Bornova, Izmir, Turkey
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Lake RM, Davutoglu V. Paroxysmal postural dyspena related to multiple large organized thrombi in the left atrium. Clin Cardiol 2004; 27:A14; author reply A14,A23. [PMID: 15119689 PMCID: PMC6654138 DOI: 10.1002/clc.4960270418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Vedat Davutoglu
- Department of Cardiology, Sahinbey Medical Center, Gaziantep University, Gaziantep, Turkey
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