fibrinopeptide-a and Mitral-Valve-Stenosis

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and may cause systemic embolization resulting in serious and fatal complications. Several clinical techniques are used to detect the presence of LA thrombi, but even echocardiography, the most widely used, has some drawbacks depending on the sizes and locations of the thrombi. This study evaluated D-dimer, fibrinopeptide A(FPA), and thrombin-antithrombin III complex (TAT) as molecular markers for diagnosing the presence of LA thrombi in 26 patients with MS who underwent cardiac surgery. Atrial fibrillation was detected in all patients. Patients with episodes of obvious thromboembolic diseases were excluded. Blood was obtained from the brachial vein before the surgery (3 +/- 1 days; mean +/- SD). The presence or absence of thrombi was confirmed at surgery in all patients. Levels of both D-dimer and TAT were significantly higher in patients with thrombi than in those without thrombi or in normal subjects. FPA levels did not differ significantly between the three groups. The levels of D-dimer and TAT correlated significantly with the weights of the LA thrombi. LA thrombi (ca > or = 2 g) were always confirmed at surgery in patients with levels of D-dimer higher than 200 ng/ml and/or levels of TAT higher than 4 ng/ml. These results indicate that D-dimer and TAT are simple and useful diagnostic markers for determining LA thrombi in patients with MS.

Topics: Antithrombin III; Biomarkers; Echocardiography; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Heart Diseases; Humans; Male; Middle Aged; Mitral Valve Stenosis; Peptide Hydrolases; Thrombosis

Topics: Antithrombin III; Blood Coagulation; Fibrinopeptide A; Humans; Hypertension, Pulmonary; Mitral Valve Stenosis; Peptide Hydrolases

Left atrial (LA) thrombi sometimes occur in patients with mitral stenosis (MS) and the systemic embolization due to thrombi causes a serious, occasionally fatal complication. Several clinical techniques have been used to estimate the presence of LA thrombi. However, the hitherto available methods, even an echocardiography which has been most widely used, still have some drawbacks, depending on the size and location of thrombi. The author measured D-dimer, fibrinopeptide A (FPA) and thrombin-antithrombin III complex (TAT) in the patients with MS and evaluated the diagnostic value of these molecular markers to estimate the presence of LA thrombi. Twenty six patients with MS who had undergone cardiac operation were studied. Atrial fibrillation was found in all the patients. Episode of obvious thromboembolic diseases is a criteria of exclusion. Blood was drawn from the brachial vein several days (3 +/- 1 days: mean +/- SD) before the operation. The presence or absence of thrombus was confirmed at the surgery in all the cases. 1) Both levels of D-dimer and TAT were significantly higher in the patients with thrombi than those in the patients without thrombus or those in normal controls (mean: 378, 93 and 64 ng/ml, respectively; p less than 0.01 for both and 9.1, 2.0 and 1.7 ng/ml, respectively; p less than 0.01 for both). However, levels of FPA were not significantly different among the three groups (mean: 7.9, 4.9 and 3.7 ng/ml, respectively; NS for both). 2) both levels of D-dimer and TAT were significantly correlated with the weights of LA thrombus (r = 0.87, p less than 0.01: r = 0.79, p less than 0.01, respectively). 3) LA thrombi (ca. greater than or equal to 2 g) were always confirmed at the surgery in the patients who had levels of D-dimer higher than 200 ng/ml and/or TAT higher than 4 ng/ml. The plasma levels of D-dimer and TAT were further followed after the surgery in the same 18 patients (8 patients who had thrombus, the rest who didn't). 1) In the patients who had thrombi, levels of D-dimer were significantly decreased after the surgery (mean: from 267 ng/ml to 73 ng/ml, p less than 0.05). Levels of TAT were slightly but not significantly decreased (mean: from 82 ng/ml to 76 ng/ml, NS).(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Aged; Antithrombin III; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Heart Atria; Heart Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve Stenosis; Peptide Hydrolases; Thrombosis; Warfarin

Topics: Adult; Aged; Blood Coagulation Tests; Echocardiography, Doppler; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Fibrinopeptide B; Humans; Intracranial Embolism and Thrombosis; Middle Aged; Mitral Valve Stenosis; Peptide Fragments; Prognosis

It has been reported that a patient with atrial fibrillation (AF) is in the hypercoagulable state and that this state results in a high incidence of systemic thromboembolisms. In this paper, we have investigated plasma fibrinopeptide A (FPA) levels and the effects of subcutaneous administration of heparin on these levels in patients with AF. Forty-five patients with hypertension (HT) or mitral stenosis (MS) were classified into four groups according to whether they had AF complications; i.e. HT with normal sinus rhythm (NSR), HT with AF, MS with NSR and MS with AF. Patients with AF demonstrated significantly higher plasma FPA levels and lower plasma antithrombin III (AT III) activities than those with NSR. When low dose heparin was administered to patients with AF, plasma FPA levels were decreased to the near normal range, accompanied by an increase in heparin-AT III complex activity and heparin concentration 0.5-1.0 h after injection. These levels were maintained for 5 h. From these results it was concluded that patients with AF were in the hypercoagulable state and that the measurement of plasma FPA levels provided a possibility to detect the underlying activation of blood coagulation.

Topics: Atrial Fibrillation; Fibrinogen; Fibrinopeptide A; Heparin; Humans; Hypertension; Mitral Valve Stenosis