Elevated circulating levels of von Willebrand factor and D-dimer in patients with heart failure and mechanical prosthesis.
To test the hypothesis of association between heart failure and altered haemostatic balance in patients with a mechanical valve prosthesis, comparisons were made between 20 patients with mitral valve replacement and stable chronic heart failure (group A), 20 with the same prosthesis but satisfactory haemodynamics (group B) and 20 age-matched controls (group C). The left ventricular ejection fraction was significantly highest (p < 0.001) in group A. The pulmonary artery systolic pressure was also highest in group A (p < 0.001), without significant difference between groups B and C. Two group A patients had a transient ischaemic attack. The D-dimer plasma concentrations and the antigenic and biologic von Willebrand factor activities were significantly greatest in group A. Significant correlation was found between the plasma concentrations of these activities and pulmonary artery systolic pressure and between D-dimer and ejection fraction. Platelet-activating factor was detected only in six group A patients. The observed relationship between haemostatic factors and heart failure in patients with mechanical heart-valve prosthesis advocates careful evaluation of von Willebrand factor and D-dimer in order to prevent embolic events in such cases.
Mastroroberto
P
P
Cardiovascular Surgery Unit, Medical School of Catanzaro, Italy.
Chello
M
M
Perticone
F
F
D016275:Atrial Function; D001794:Blood Pressure; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D004617:Embolism / Q000517:prevention & control; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006331:Heart Diseases / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000097:blood*; D006350:Heart Valve Prosthesis; D006487:Hemostasis; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D016014:Linear Models; D008875:Middle Aged; D008943:Mitral Valve; D010972:Platelet Activating Factor / Q000032:analysis; D011651:Pulmonary Artery; D013318:Stroke Volume; D013599:Systole; D013927:Thrombosis / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D014841:von Willebrand Factor / Q000032:analysis*
D005338:Fibrin Fibrinogen Degradation Products; D010972:Platelet Activating Factor; C036309:fibrin fragment D; D014841:von Willebrand Factor