title: Predictors of left ventricular thrombus formation in patients with dilated cardiomyopathy: role of activated protein C resistance.
abstract: 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.
authors.affiliation: Turkie Yuksek Ihtisas Hospital Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Erbay
authors.forename: Hasan
authors.initials: H
authors.lastname: Turhan
authors.forename: Kubilay
authors.initials: K
authors.lastname: Senen
authors.forename: Funda
authors.initials: F
authors.lastname: Yetkin
authors.forename: Selime
authors.initials: S
authors.lastname: Ayaz
authors.forename: Fusun
authors.initials: F
authors.lastname: Kara
authors.forename: Naciye S
authors.initials: NS
authors.lastname: Buyukasik
authors.forename: Ertan
authors.initials: E
authors.lastname: Yetkin
mesh_terms: 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
chemical_list: D017293:Protein S; D000990:Antithrombin III