title: Effect of selected prothrombotic and proinflammatory factors on the incidence of venous thrombosis after pacemaker implantation.
abstract: BACKGROUND
  Venous thrombosis (VT), a major cause of venous obstruction, is a rather rare but dangerous complication of pacemaker (PM) implantation.
  
  
  OBJECTIVE
  To assess the prognostic value of selected proinflammatory and prothrombotic markers in predicting symptomatic venous obstruction after PM implantation.
  
  
  METHODS
  The study involved 81 patients (31 females; mean age 71 ± 8 years) divided into 2 groups depending on the occurrence of venous obstruction. Group I included 71 patients (29 females; mean age 71 ± 2 years) without this complication and group II included 10 patients (2 females, mean age 71.6 ± 2) with venous obstruction. All patients were followed up for 19 months. Transthoracic echocardiography and venous ultrasonography were performed before PM implantation and at the time of incident venous obstruction. Interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), D-dimer, fibrinogen, tissue factor (TF), factor VII and plasminogen activator inhibitor-1 (PAI-1) levels were measured at baseline and within 7 days after PM implantation.
  
  
  RESULTS
  Patients in group II had a significantly lower left ventricular ejection fraction (LVEF), higher left ventricular end--diastolic diameter (LVEDD) and impaired left ventricular filling (Vp) compared to group I. Patients in group II developed VT on average at 13.06 (range 7-18) months following PM implantation. At baseline, IL-6, hsCRP, D-dimer, fibrinogen, TF, factor VII, and PAI-1 levels were significantly higher in group II compared to group I. In all patients, levels of prothrombotic factors were higher following PM implantation compared to baseline values, with the exception of fibrinogen level in group I. Cut-off values indicating increased thrombosis risk were determined for the examined parameters (LVEF, LVEDD, Vp, IL-6, hsCRP, D-dimer, fibrinogen, factor VII, TF, PAI-1) based on the ROC curves. Major predictors of thrombotic risk included LVEF, LVEDD, and D-dimer, fibrinogen and TF levels. Highest predictive values were noted for LVEDD > 58 mm (OR = 52.8) and D-dimer level > 498 mg/L (OR = 3003).
  
  
  CONCLUSIONS
  1. Patients who developed VT after PM implantation had elevated baseline levels of IL-6, hsCRP, fibrinogen, D-dimer, TF, factor VII, and PAI-1. 2. Levels of pro-inflammatory markers increased after the implantation procedure in all patients. 3. Parameters with the highest diagnostic value for predicting incident VT included decreased LVEF, increased LVEDD and elevated D-dimer, fibrinogen and TF levels.
authors.affiliation: Department of Electrocardiology, Institute of Cardiology, The John Paul II Hospital in Krakow, Jagiellonian University, School of Medicine, Krakow, Poland. jlelakow@szpitaljp2.krakow.pl
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.forename: Teresa Barbara
authors.initials: TB
authors.lastname: Domagała
authors.forename: Anna
authors.initials: A
authors.lastname: Rydlewska
authors.forename: Rafał
authors.initials: R
authors.lastname: Januszek
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kotula Horowitz
authors.forename: Jacek
authors.initials: J
authors.lastname: Majewski
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ząbek
authors.forename: Barbara
authors.initials: B
authors.lastname: Małecka
authors.forename: Jacek
authors.initials: J
authors.lastname: Musiał
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D015994:Incidence; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D012372:ROC Curve; D012307:Risk Factors; D013925:Thromboplastin / Q000378:metabolism; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D005340:Fibrinogen; D002097:C-Reactive Protein; D013925:Thromboplastin