title: Plasma homocysteine level and left ventricular thrombus formation in acute anterior myocardial infarction patients following thrombolytic therapy with t-PA.
abstract: 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.
authors.affiliation: Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Cardiology Department, Istanbul, Turkey. lutfu.orhan@yahoo.com
authors.forename: Ahmet L
authors.initials: AL
authors.lastname: Orhan
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Okuyan
authors.forename: Baris
authors.initials: B
authors.lastname: Okcun
authors.forename: Zekeriya
authors.initials: Z
authors.lastname: Nurkalem
authors.forename: Nurten
authors.initials: N
authors.lastname: Sayar
authors.forename: Ozer
authors.initials: O
authors.lastname: Soylu
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yildiz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
authors.forename: Hasim
authors.initials: H
authors.lastname: Mutlu
authors.forename: Serdar
authors.initials: S
authors.lastname: Kucukoglu
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D006710:Homocysteine; D010959:Tissue Plasminogen Activator