Document Detail


Pre-thrombotic state and impaired fibrinolytic potential in coronary heart disease patients with left ventricular dysfunction.
MedLine Citation:
PMID:  12544731     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Ferruchio De Lorenzo; Han Xiao; Mike Scully; Zbigniew Kadziola; Vijay V Kakkar
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  14     ISSN:  0957-5235     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-24     Completed Date:  2004-01-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  67-75     Citation Subset:  IM    
Copyright Information:
Copyright 2003 Lippincott Williams & Wilkins
Affiliation:
Thrombosis Research Institute, London, UK. dlorenzo@tri-london.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Case-Control Studies
Coronary Disease / blood,  etiology*,  pathology
Echocardiography, Stress
Female
Fibrinolysis / physiology*
Humans
Male
Middle Aged
Myocardial Ischemia / blood,  etiology,  ultrasonography
Myocardial Stunning / blood,  etiology,  ultrasonography
Necrosis
Plasminogen Activator Inhibitor 1 / blood,  metabolism
Recurrence
Thrombophilia / blood,  complications*,  diagnosis
Tissue Plasminogen Activator / blood,  metabolism
Ventricular Dysfunction, Left / blood,  etiology*,  ultrasonography
Chemical
Reg. No./Substance:
0/Plasminogen Activator Inhibitor 1; EC 3.4.21.68/Tissue Plasminogen Activator

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