Plasma homocysteine level and left ventricular thrombus formation in acute anterior myocardial infarction patients following thrombolytic therapy with t-PA.
OBJECTIVE
The aim of this study was to evaluate the relationship between homocysteine levels and the development of left ventricular thrombus in acute anterior myocardial infarction patients directed to thrombolytic therapy.


RESULTS
Seventy-nine patients presenting with ST elevated acute anterior myocardial infarction and treated with thrombolytic agent, t-PA, were included in the study. Two-dimensional echocardiography was used to divide patients into 2 groups according to the presence (n = 14) or absence (n = 65) of thrombus in the left ventricle following myocardial infarction. The levels of fasting plasma total homocysteine, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, vitamin B12 and folic acid were assessed. There were no significant differences between two groups in terms of age, gender, hyperlipidemia and smoking. History of diabetes mellitus (28.57% versus 6.15%, p = 0.04), peak creatine phosphokinase levels (4153.54 +/- 1228.41 U/L versus 2456.92 +/- 1421.36 U/L, p < 0.001), mean left ventricular wall motion score index (2.21 +/- 0.18 versus 1.83 +/- 0.23, p < 0.001) and total fasting homocysteine levels (18.24 +/- 5.67 mmol/L versus 12.31 +/- 3.52 mmol/L, p < 0.001) were significantly higher in patients with left ventricular thrombus. In multivariate analysis; only diabetes mellitus (p = 0.03), higher wall motion score index (p = 0.001) and higher homocysteine levels (p = 0.04) were independent predictors of left ventricular thrombus formation.


CONCLUSIONS
Our results suggest that; diabetes mellitus, higher wall motion score index and hyperhomocysteinemia independently increases the risk for the development of left ventricular thrombus formation in patients with acute anterior myocardial infarction following thrombolytic therapy.
Orhan
Ahmet L
AL
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Cardiology Department, Istanbul, Turkey. lutfu.orhan@yahoo.com
Okuyan
Ertugrul
E
Okcun
Baris
B
Nurkalem
Zekeriya
Z
Sayar
Nurten
N
Soylu
Ozer
O
Uslu
Nevzat
N
Yildiz
Ahmet
A
Eren
Mehmet
M
Mutlu
Hasim
H
Kucukoglu
Serdar
S
D000328:Adult; D004452:Echocardiography / Q000009:adverse effects / Q000379:methods; D005215:Fasting; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging
D005343:Fibrinolytic Agents; D006710:Homocysteine; D010959:Tissue Plasminogen Activator