Predictors of left ventricular thrombus formation in patients with dilated cardiomyopathy: role of activated protein C resistance.
OBJECTIVE
The aim of this study was to investigate the association between left ventricular thrombus formation and natural anticoagulant systems including the protein C, protein S and antithrombin in patients with dilated cardiomyopathy.


METHODS
Sixty patients with dilated cardiomyopathy who met the inclusion criteria were included in the study. Patients were divided into two groups: group I consisted of 22 patients with left ventricular thrombus and group II consisted of 38 patients without left ventricular thrombus. Our main inclusion criteria were ejection fraction </= 35% and left ventricular end-diastolic diameter >/= 6.0 cm. These two groups were compared for clinical and hematologic parameters (activated protein C resistance, protein S and antithrombin).


RESULTS
There were no statistically significant differences between patients with or without left ventricular thrombi with respect to left ventricular end-diastolic and end-systolic dimensions, ejection fraction, fractional shortening and left atrial diameter. There were no statistically significant differences between patients with and without left ventricular thrombus with respect to platelet count (252 +/- 64/mm3 x 10(3) compared with 260 +/- 74/mm3 x 10(3) respectively, P=0.68), prothrombin time (12.94 +/- 1.9 s compared with 12.86 +/- 1.3 s respectively, P=0.82), activated partial thromboplastin time (32 +/- 5 compared with 30 +/- 4 s respectively, P=0.32) and fibrinogen levels (36 +/- 9 mg/dl compared with 34 +/- 8 mg/dl respectively, P=0.41). None of the patients had protein S and antithrombin deficiency. Activated protein C resistance was found in 12 patients (12 out of 22, 54%) in group I and four patients (four out of 38, 9.5%) in group II (P < 0.01). It was also shown to be an independent predictor of left ventricular thrombus (P < 0.05).


CONCLUSIONS
Activated protein C resistance is found to be an independent predictor of left ventricular thrombus in patients with dilated cardiomyopathy who have ejection fractions less then 35% and left ventricular end-diastolic dimensions > 6.0 cm.
Erbay
Ali Riza
AR
Turkie Yuksek Ihtisas Hospital Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey.
Turhan
Hasan
H
Senen
Kubilay
K
Yetkin
Funda
F
Ayaz
Selime
S
Kara
Fusun
F
Buyukasik
Naciye S
NS
Yetkin
Ertan
E
D020016:Activated Protein C Resistance / Q000150:complications*; D000990:Antithrombin III / Q000378:metabolism; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000150:complications*; D016009:Chi-Square Distribution; D003328:Coronary Thrombosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017293:Protein S / Q000378:metabolism; D012044:Regression Analysis; D012307:Risk Factors
D017293:Protein S; D000990:Antithrombin III