Document Detail

Clinical cardiac involvement in thrombotic thrombocytopenic purpura: a systematic review.
MedLine Citation:
PMID:  18028268     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Autopsy studies consistently demonstrate cardiac involvement in thrombotic thrombocytopenic purpura (TTP), but clinical evidence for cardiac abnormalities is rarely reported. STUDY DESIGN AND METHODS: This systematic review addresses the apparent discrepancy between autopsy and clinical data. English language articles were identified by keywords for both TTP and for cardiac symptoms, testing, or events. Patients were analyzed if they were more than 10 years old with idiopathic TTP. RESULTS: Thirty articles were identified that described 111 eligible patients: 20 case reports described 27 patients, 9 retrospective cohort studies described 74 patients, and 1 prospective cohort study described 10 patients. Cardiac events included infarction (26 patients), congestive failure (17), arrhythmias (10), cardiogenic shock (6), and sudden cardiac death (8). Mortality was assessed in 101 patients: 55 died, and 48 autopsies were described. All demonstrated cardiac microvascular thrombi, hemorrhage, and/or necrosis. Follow-up information was reported in only 6 of the 16 patients who survived a cardiac event (follow-up duration, 10 days-2 years; median, 7 weeks). CONCLUSIONS: The frequency and sequelae of clinical cardiac abnormalities in TTP cannot be accurately assessed because most patients were described in reports of few selected patients; many patients were reported before the availability of effective treatment for TTP and sensitive tests for cardiac involvement. Continuing case reports and cohort studies, however, suggest that cardiac abnormalities may be important and often unrecognized causes of mortality and morbidity in patients with TTP. Prospective studies are needed to determine if cardiac therapy can improve survival and long-term outcomes of patients with TTP.
Beau M Hawkins; Mazen Abu-Fadel; Sara K Vesely; James N George
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-11-19
Journal Detail:
Title:  Transfusion     Volume:  48     ISSN:  0041-1132     ISO Abbreviation:  Transfusion     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-30     Completed Date:  2008-03-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  United States    
Other Details:
Languages:  eng     Pagination:  382-92     Citation Subset:  IM    
Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA.
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MeSH Terms
Follow-Up Studies
Heart Diseases / enzymology,  pathology*
Purpura, Thrombotic Thrombocytopenic / pathology*

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