title: Failure of platelet parameters and biomarkers to correlate platelet function to severity and etiology of heart failure in patients enrolled in the EPCOT trial. With special reference to the Hemodyne hemostatic analyzer. Whole Blood Impedance Aggregometry for the Assessment of Platelet Function in Patients with Congestive Heart Failure.
abstract: Data from small studies have suggested the presence of platelet abnormalities in patients with congestive heart failure (CHF). We sought to characterize the diagnostic utility of different platelet parameters and platelet-endothelial biomarkers in a random outpatient CHF population investigated in the EPCOT ('Whole Blood Impedance Aggregometry for the Assessment of Platelet Function in Patients with Congestive Heart Failure') Trial. Blood samples were obtained for measurement of platelet contractile force (PCF), whole blood aggregation, shear-induced closure time, expression of glycoprotein (GP) IIb/IIIa, and P-selectin in 100 consecutive patients with CHF. Substantial interindividual variability of platelet characteristics exists in patients with CHF. There were no statistically significant differences when patients were grouped according to incidence of vascular events, emergency revascularization needs, survival, or etiology of heart failure. Aspirin use did not affect instrument readings either. PCF correlates very poorly with whole blood aggregometry (r(2) = 0.023), closure time (r(2) = 0.028), platelet GP IIb/IIIa (r(2) = 0.0028), and P-selectin (r(2) = 0.002) expression. Furthermore, there was no correlation with brain natriuretic peptide concentrations, a marker of severity and prognosis in heart failure reflecting the neurohumoral status. Patients with heart failure enrolled in the EPCOT Trial exhibited a marginal, sometimes oppositely directed change in platelet function, challenging the diagnostic utility of these platelet parameters and biomarkers to serve as useful tools for the identification of platelet abnormalities, for predicting clinical outcomes, or for monitoring antiplatelet strategies in this population. The usefulness of these measurements for assessing platelets in the different clinical settings remains to be explored. Taken together, opposite to our expectations, major clinical characteristics of heart failure did not correlate well with the platelet characteristics investigated in this study.
authors.affiliation: Johns Hopkins University, Sinai Hospital, Baltimore, Md., USA. heartdrug@aol.com
authors.forename: Victor L
authors.initials: VL
authors.lastname: Serebruany
authors.forename: Marcus E
authors.initials: ME
authors.lastname: McKenzie
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Meister
authors.forename: Sergey Y
authors.initials: SY
authors.lastname: Fuzaylov
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gurbel
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Gattis
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000737:chemistry / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D019007:P-Selectin / Q000032:analysis; D015539:Platelet Activation; D010979:Platelet Function Tests / Q000295:instrumentation / Q000379:methods / Q000592:standards; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000032:analysis; D012044:Regression Analysis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D019007:P-Selectin; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020097:Natriuretic Peptide, Brain; D001241:Aspirin