Activation of coagulation system in dilated cardiomyopathy: comparison of patients with and without left ventricular thrombus.
OBJECTIVE
We aimed to investigate plasma levels of molecular markers for platelet activity, thrombin activation and fibrinolytic status in patients with dilated cardiomyopathy (DCM) with and without left ventricular (LV) thrombus and to compare these markers between patients with DCM and control participants.


METHODS
The study population comprised 60 patients with DCM who met the inclusion criteria. Patients were divided into two groups: 22 patients with LV thrombus and 38 patients without LV thrombus. The age-matched control group consisted of 23 healthy participants (18 men and five women with a mean age of 49). Patients with DCM and healthy participants were compared with respect to platelet activity, thrombin activation and fibrinolytic status. These comparisons were also performed in patients with DCM with and without LV thrombus.


RESULTS
Platelet factor 4 (28.2+/-4.4 ng/ml compared with 20+/-3.1 ng/ml, P<0.01) and beta-thromboglobulin (40+/-2 ng/ml compared with 17+/-3 ng/ml) levels, reflecting platelet activity, were significantly higher in patients with DCM than in control participants. Fibrinopeptide A (6.94+/-0.69 ng/ml compared with 1.96+/-0.1 ng/ml, P<0.001) and thrombin-antithrombin III complex (5.26+/-2.60 ng/ml compared with 3.17+/-1.23 ng/ml, P<0.001) levels, as markers of fibrin generation, were also higher in patients with DCM than in normal participants. Plasma levels of D-dimer (118+/-16 ng/ml compared with 85+/-3 ng/ml, P<0.001) and plasmin-alpha2-plasmin inhibitor complex (0.8+/-1.1 microg/ml compared with 0.6+/-1.7 microg/ml, P<0.001) in patients with DCM significantly exceeded those in the normal participants. There were no statistically significant differences between patients with and without LV thrombus in DCM with respect to platelet activity, thrombin activation and fibrinolytic status.


CONCLUSIONS
We have shown that platelet activation, thrombin activation and fibrinolytic activity are increased in patients with DCM compared to control participants. However, these markers reflecting coagulation activation in patients with LV thrombus are comparable to those in patients without LV thrombus.
Riza Erbay
Ali
A
Turkiye Yuksek Ihtisas Hospital Department of Cardiology, Ankara, Turkey.
Turhan
Hasan
H
Aksoy
Yuksel
Y
Senen
Kubilay
K
Yetkin
Ertan
E
D000328:Adult; D000990:Antithrombin III; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000503:physiopathology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005344:Fibrinopeptide A / Q000378:metabolism; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000097:blood; D015539:Platelet Activation; D010978:Platelet Factor 4 / Q000378:metabolism; D013318:Stroke Volume; D013917:Thrombin / Q000378:metabolism; D013927:Thrombosis / Q000097:blood* / Q000503:physiopathology; D014421:Turkey; D001620:beta-Thromboglobulin / Q000378:metabolism
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; D001620:beta-Thromboglobulin; C036309:fibrin fragment D; D005344:Fibrinopeptide A; D010978:Platelet Factor 4; D000990:Antithrombin III; D010447:Peptide Hydrolases; D013917:Thrombin