title: Cardiovascular manifestations in patients with thrombotic thrombocytopenic purpura: a single-center experience.
abstract: BACKGROUND
  Cardiovascular manifestation in patients with thrombotic thrombocytopenic purpura.
  
  
  OBJECTIVE
  The aim of this study was to investigate the incidence of acute myocardial infarction (AMI), arrhythmias, congestive heart failure, and mortality in patients hospitalized for thrombotic thrombocytopenic purpura (TTP).
  
  
  METHODS
  Thirty-eight patients (27 women and 11 men), mean age 44 years, were hospitalized with the diagnosis of TTP confirmed by a hematologist. We investigated the incidence of AMI which developed during hospitalization for TTP. AMI was diagnosed by new electrocardiographic changes, increased serum cardiac troponin I levels, and clinical symptomatology. The patients with AMI were also monitored for development of arrhythmias during hospitalization.
  
  
  RESULTS
  Of the 38 patients, 8 (21%) developed new Q-wave AMI. There was no significant difference in baseline characteristics between patients who developed AMI and those who did not develop AMI. Of the 8 patients with AMI, 2 (25%) developed atrial fibrillation, 1 (13%) developed atrial flutter, 1 (13%) developed supraventricular tachycardia, and 2 (25%) developed congestive heart failure. Death occurred in 3 of 8 patients (38%) with AMI and in 1 of 30 patients (3%) without AMI (P < 0.01).
  
  
  CONCLUSIONS
  New Q-wave AMI developed in 21% of 38 patients hospitalized with TTP. Supraventricular tachyarrhythmias developed in 50% of 8 patients with TTP who developed AMI. Patients hospitalized for TTP should be monitored for adverse cardiac events due to the high incidence of new AMI, supraventricular tachyarrhythmias, and mortality.
authors.affiliation: Department of Medicine, Cardiology and Hematology Divisions, New York Medical College, Valhalla, New York, USA. kaushanggandhi@yahoo.com
authors.forename: Kaushang
authors.initials: K
authors.lastname: Gandhi
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Harit
authors.initials: H
authors.lastname: Desai
authors.forename: Harshad
authors.initials: H
authors.lastname: Amin
authors.forename: Mala
authors.initials: M
authors.lastname: Sharma
authors.forename: Hoang M
authors.initials: HM
authors.lastname: Lai
authors.forename: Parminder
authors.initials: P
authors.lastname: Singh
mesh_terms: D051722:ADAM Proteins / Q000172:deficiency; D000071120:ADAMTS13 Protein; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications*; D012307:Risk Factors; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human
references.citation: Transfusion. 2008 Feb;48(2):382-92
references.pmid: 18028268
references.citation: Ann Intern Med. 1979 Sep;91(3):357-63
references.pmid: 573083
references.citation: Int J Cardiol. 2004 Jun;95(2-3):339-41
references.pmid: 15193843
references.citation: Ther Apher. 2002 Feb;6(1):2-4
references.pmid: 11886570
references.citation: Arch Pathol Lab Med. 1999 Oct;123(10):937-40
references.pmid: 10506449
references.citation: N Engl J Med. 2002 Aug 22;347(8):589-600
references.pmid: 12192020
references.citation: Arch Intern Med. 1990 Jul;150(7):1535-7
references.pmid: 2369253
references.citation: Medicine (Baltimore). 1981 Nov;60(6):413-28
references.pmid: 7031412
references.citation: Ann Intern Med. 1966 Jul;65(1):37-43
references.pmid: 5949189
references.citation: Int J Cardiol. 2008 Aug 18;128(2):257-60
references.pmid: 17692959
references.citation: Blood. 2002 Jul 15;100(2):710-3
references.pmid: 12091372
references.citation: Nephrol Dial Transplant. 2006 Jun;21(6):1549-54
references.pmid: 16574680
references.citation: Eur J Haematol. 2009 Feb;82(2):83-92
references.pmid: 19067741
references.citation: Am J Med. 2005 May;118(5):544-7
references.pmid: 15866258
references.citation: Eur J Haematol. 2008 Oct;81(4):311-6
references.pmid: 18616514
references.citation: Arch Pathol Lab Med. 2003 Jul;127(7):834-9
references.pmid: 12823037