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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 October;163(5):145-8
Dilatative myocardiopathy and hemorheologic assessment
Mazzone M. 1, Forte P. 1, Portale G. 1, Buccelletti F. 1, Ursella S. 1, La Sala M. 1, Testa A. 1, Covino M. 1, Pignataro G. 1, Ierardi C. 2, Bellocci F. 2, Biasucci L. 2, Rebuzzi A. 2, Gentiloni Silveri N. 1
1 Department of Emergency and Admission, Catholic University of The Sacred Heart, Rome, Italy;
2 Unit of Cardiology, Catholic University of The Sacred Heart, Rome, Italy
Aim. Patients with heart failure present high d-dimer levels and major hemorheologic balance alterations compared to patients suffering from ischemic cardiopathy without decompensation. In order to test the hypothesis that a prothrombotic state is related to this pathology and to its severity, we tested fibrinolysis activation markers, in particular plasmatic levels of d-dimers.
Methods. We recruited 15 patients (8 males and 7 females), mean age 73.1±12.8 years, with acute heart failure, who came to the Emergency Department from March to May 2003. Analyses of venous blood samples (e.g. lactic dehydrogenase [LDH], creatine kinase [CK], MB creatin-kinase [CKMB], cardiac troponine T [TnT]), chest X-rays, electrocardiograms (ECGs) and echocardiograms were performed.
Results. Echocardiograms showed a mean ejection fraction (EF) of 25.2±9%. Cardiac cytonecrosis markers were high in patients with diagnosis of ischemic cardiopathy with angor or dyspnea symptoms; chest X-rays suggested a cardiomediastinic shape enlargement. Hemocoagulative tests did not show prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) lengthening. However, an increase in fibrinolytic activity was found in all patients: in fact elevated levels of plasmatic d-dimers were observed. The resulting mean d-dimer values were 1 617.5±1 428.5 ng/ml.
Conclusion. In many studies the conclusion is drawn that cardiac cavity dilatation is the cause of venous stasis and of the build up of thrombi in the venous system too; this process is mostly true in patients with low cardiac output: in fact, stasis could play an important role in modifying the hemorheologic balance. Plasma levels of d-dimer were related to the NYHA cardiac decompensation classification, and to EF reduction as shown by the echocardiogram.