1. Pre-thrombotic state and impaired fibrinolytic potential in coronary heart disease patients with left ventricular dysfunction.
- Author
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De Lorenzo F, Xiao H, Scully M, Kadziola Z, and Kakkar VV
- Subjects
- Aged, Case-Control Studies, Coronary Disease blood, Coronary Disease pathology, Echocardiography, Stress, Female, Humans, Male, Middle Aged, Myocardial Ischemia blood, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia etiology, Myocardial Stunning blood, Myocardial Stunning diagnostic imaging, Myocardial Stunning etiology, Necrosis, Plasminogen Activator Inhibitor 1 blood, Plasminogen Activator Inhibitor 1 metabolism, Recurrence, Thrombophilia blood, Thrombophilia diagnosis, Tissue Plasminogen Activator blood, Tissue Plasminogen Activator metabolism, Ventricular Dysfunction, Left blood, Ventricular Dysfunction, Left diagnostic imaging, Coronary Disease etiology, Fibrinolysis physiology, Thrombophilia complications, Ventricular Dysfunction, Left etiology
- Abstract
Patients with coronary heart disease (CHD) are at considerable risk for recurrent ischaemic events. A pre-thrombotic state and/or impaired fibrinolysis might play an important role in causing recurrent ischaemic events. Two hundred and fifty-seven CHD patients underwent the dobutamine stress echocardiography test (DSE) to investigate the possible presence of inducible ischaemia; 89 patients showed evidence of stunned and/or necrotic myocardium (resting wall motion abnormalities). Factor VIII activity and fibrinogen levels were significantly higher in patients with stunned/necrotic myocardium than in CHD patients with normal resting wall motions (factor VIII activity, P = 0.004; fibrinogen, P = 0.04). Of interest, after stimulating the fibrinolytic system with the DSE test, plasminogen activator inhibitor-1 activity was significantly higher in patients with necrotic/stunned myocardium than in patients with resting normal wall motion (P = 0.03), whereas tissue-type plasminogen activator activity after the DSE test was significantly lower in patients with stunned/necrotic myocardium than in patients with normal wall motion (P = 0.001). Overall, 30 CHD patients developed induced ischaemia (new wall motion abnormalities) during the DSE test. CHD patients with stunned and/or necrotic myocardium presented decreased fibrinolytic potential and the presence of a hypercoagulable state due to increased factor VIII activity, and fibrinogen levels. Therefore, these CHD patients must be considered at high risk of re-developing coronary thrombosis and might benefit from a more aggressive anticoagulant therapy., (Copyright 2003 Lippincott Williams & Wilkins)
- Published
- 2003
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