Pre-thrombotic state and impaired fibrinolytic potential in coronary heart disease patients with left ventricular dysfunction.
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.
De Lorenzo
Ferruchio
F
Thrombosis Research Institute, London, UK. dlorenzo@tri-london.ac.uk
Xiao
Han
H
Scully
Mike
M
Kadziola
Zbigniew
Z
Kakkar
Vijay V
VV
D000368:Aged; D016022:Case-Control Studies; D003327:Coronary Disease / Q000097:blood / Q000209:etiology* / Q000473:pathology; D025401:Echocardiography, Stress; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D017682:Myocardial Stunning / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D009336:Necrosis; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000378:metabolism; D012008:Recurrence; D019851:Thrombophilia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D010959:Tissue Plasminogen Activator / Q000097:blood / Q000378:metabolism; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*
D017395:Plasminogen Activator Inhibitor 1; D010959:Tissue Plasminogen Activator