{"title":"评估窦性心律伴有左心房阑尾不活动的严重风湿性二尖瓣狭窄患者的凝血因子","authors":"Saibal Mukhopadhyay DM , Narendra Kumar Chauhan DM , Ghazi Muheeb DM , Jamal Yusuf DM , Vimal Mehta DM , Bhawna Mahajan MD , Sanjeev Kathuria DM , Rupesh Santosh Agrawal DM","doi":"10.1016/j.cjco.2024.07.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Patients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC) are prone to left atrium (LA) or LAA thrombus formation. But unlike for atrial fibrillation, oral anticoagulants are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR vs those in healthy control subjects.</div></div><div><h3>Methods</h3><div>The study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC who were eligible for balloon mitral valvuloplasty vs 35 healthy controls. All patients underwent transthoracic and transesophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, and had blood samples analyzed for procoagulant levels.</div></div><div><h3>Results</h3><div>Results showed comparable baseline characteristics between groups, with most patients in the New York Heart Association II or III functional classes, and with varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1 + 2 [patient vs control, 9017 pg/mL (6228.0-10,963.5) vs 1790 pg/mL (842.3-2712), <em>P</em> < 0.0001], thrombin-antithrombin III [patient vs control, 39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6.5), <em>P</em> < 0.0001], plasminogen activator inhibitor-1 (patients vs controls, 26.09 ± 8.18 ng/mL vs 8.05 ± 3.53 ng/mL, <em>P</em> < 0.0001), and fibrinogen (3.48 ± 0.89 g/L vs 3.01 ± 0.53 g/L, <em>P</em> = 0.029) in the LA of patients, compared to those in control subjects. Systemic procoagulant levels also were elevated in patients, but D-dimer levels were similar between the 2 groups.</div></div><div><h3>Conclusions</h3><div>The findings suggest a hypercoagulable state in patients, similar to that in patients with atrial fibrillation. The study advocates for consideration of use of oral anticoagulants in these patients until LA and LAA function improves, to mitigate thrombus formation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 10","pages":"Pages 1231-1239"},"PeriodicalIF":2.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessment of Coagulation Factors in Patients with Severe Rheumatic Mitral Stenosis in Sinus Rhythm with Left Atrial Appendage Inactivity\",\"authors\":\"Saibal Mukhopadhyay DM , Narendra Kumar Chauhan DM , Ghazi Muheeb DM , Jamal Yusuf DM , Vimal Mehta DM , Bhawna Mahajan MD , Sanjeev Kathuria DM , Rupesh Santosh Agrawal DM\",\"doi\":\"10.1016/j.cjco.2024.07.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Patients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC) are prone to left atrium (LA) or LAA thrombus formation. But unlike for atrial fibrillation, oral anticoagulants are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR vs those in healthy control subjects.</div></div><div><h3>Methods</h3><div>The study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC who were eligible for balloon mitral valvuloplasty vs 35 healthy controls. All patients underwent transthoracic and transesophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, and had blood samples analyzed for procoagulant levels.</div></div><div><h3>Results</h3><div>Results showed comparable baseline characteristics between groups, with most patients in the New York Heart Association II or III functional classes, and with varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1 + 2 [patient vs control, 9017 pg/mL (6228.0-10,963.5) vs 1790 pg/mL (842.3-2712), <em>P</em> < 0.0001], thrombin-antithrombin III [patient vs control, 39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6.5), <em>P</em> < 0.0001], plasminogen activator inhibitor-1 (patients vs controls, 26.09 ± 8.18 ng/mL vs 8.05 ± 3.53 ng/mL, <em>P</em> < 0.0001), and fibrinogen (3.48 ± 0.89 g/L vs 3.01 ± 0.53 g/L, <em>P</em> = 0.029) in the LA of patients, compared to those in control subjects. Systemic procoagulant levels also were elevated in patients, but D-dimer levels were similar between the 2 groups.</div></div><div><h3>Conclusions</h3><div>The findings suggest a hypercoagulable state in patients, similar to that in patients with atrial fibrillation. The study advocates for consideration of use of oral anticoagulants in these patients until LA and LAA function improves, to mitigate thrombus formation.</div></div>\",\"PeriodicalId\":36924,\"journal\":{\"name\":\"CJC Open\",\"volume\":\"6 10\",\"pages\":\"Pages 1231-1239\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CJC Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589790X2400283X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X2400283X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景在正常窦性心律(NSR)下患有严重二尖瓣狭窄(MS)、左心房附壁(LAA)不活动并伴有左心房自发回声对比(LASEC)的患者很容易形成左心房(LA)或 LAA 血栓。但与心房颤动不同的是,口服抗凝药并不常用于这类患者。本研究旨在比较 NSR 重度 MS 患者与健康对照组患者在局部(LA)和全身范围内的促凝血剂和纤维蛋白原水平。所有患者均接受了经胸和经食道超声心动图检查,以评估 MS 的严重程度、LAA 活动性和 LASEC 分级,并对血液样本进行了促凝血剂水平分析。结果结果显示,各组患者的基线特征相当,大多数患者属于纽约心脏协会 II 或 III 功能分级,LASEC 分级各不相同。患者的凝血酶原片段 1 + 2 [患者 vs 对照组,9017 pg/mL (6228.0-10,963.5) vs 1790 pg/mL (842.3-2712),P < 0.0001]、凝血酶原-抗凝血酶 III [患者 vs 对照组,39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6. 5),P < 0.0001]、凝血酶原-抗凝血酶 III 水平明显更高。与对照组相比,患者 LA 中的凝血酶原-抗凝血酶 III [患者 vs 对照组,39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6.5), P < 0.0001]、纤溶酶原激活物抑制剂-1(患者 vs 对照组,26.09 ± 8.18 ng/mL vs 8.05 ± 3.53 ng/mL,P < 0.0001)和纤维蛋白原(3.48 ± 0.89 g/L vs 3.01 ± 0.53 g/L,P = 0.029)。患者的全身促凝血剂水平也有所升高,但两组患者的 D-二聚体水平相似。该研究主张考虑对这些患者使用口服抗凝剂,直到 LA 和 LAA 功能改善,以减少血栓形成。
Assessment of Coagulation Factors in Patients with Severe Rheumatic Mitral Stenosis in Sinus Rhythm with Left Atrial Appendage Inactivity
Background
Patients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC) are prone to left atrium (LA) or LAA thrombus formation. But unlike for atrial fibrillation, oral anticoagulants are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR vs those in healthy control subjects.
Methods
The study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC who were eligible for balloon mitral valvuloplasty vs 35 healthy controls. All patients underwent transthoracic and transesophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, and had blood samples analyzed for procoagulant levels.
Results
Results showed comparable baseline characteristics between groups, with most patients in the New York Heart Association II or III functional classes, and with varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1 + 2 [patient vs control, 9017 pg/mL (6228.0-10,963.5) vs 1790 pg/mL (842.3-2712), P < 0.0001], thrombin-antithrombin III [patient vs control, 39 ng/mL (5.45-74.85) vs 2.80 ng/mL (1.6-6.5), P < 0.0001], plasminogen activator inhibitor-1 (patients vs controls, 26.09 ± 8.18 ng/mL vs 8.05 ± 3.53 ng/mL, P < 0.0001), and fibrinogen (3.48 ± 0.89 g/L vs 3.01 ± 0.53 g/L, P = 0.029) in the LA of patients, compared to those in control subjects. Systemic procoagulant levels also were elevated in patients, but D-dimer levels were similar between the 2 groups.
Conclusions
The findings suggest a hypercoagulable state in patients, similar to that in patients with atrial fibrillation. The study advocates for consideration of use of oral anticoagulants in these patients until LA and LAA function improves, to mitigate thrombus formation.