Jamal Yusuf1, Mayank Goyal2, Saibal Mukhopadhyay3, Vimal Mehta1, Sunil Dhaiya4, Renu Saxena5, Vijay Trehan1. 1. Professor, Department of Cardiology, G.B. Pant Hospital, New Delhi, India. 2. Senior Resident, Department of Cardiology, G.B. Pant Hospital, New Delhi, India. 3. Professor, Department of Cardiology, G.B. Pant Hospital, New Delhi, India. Electronic address: saibalmukhopadhyay@yahoo.com. 4. Senior Research Fellow, Department of Hematology, AIIMS, New Delhi, India. 5. Professor, Department of Hematology, AIIMS, New Delhi, India.
Abstract
BACKGROUND AND AIM OF STUDY: Systemic thromboembolism is a major complication in patients of mitral stenosis (MS) with atrial fibrillation (AF) due to induction of hypercoagulable state. The aim was to assess the relationship, if any, between control of ventricular rate and systemic coagulation factors. METHOD: 70 patients of moderate to severe MS in AF were studied. 35 patients with average heart rate > 100 beats/min over a 24 hour period assessed by Holter monitoring were considered as having a uncontrolled ventricular rate (Group A) and those with average heart rate ≤ 100 beats/min as controlled ventricular rate (Group B). 30 healthy volunteers acted as controls. RESULTS: Plasma concentration of prothrombin fragment 1+2 (PF1+2) 6600 pmol/ml [interquartile range (IQR) 5400.0-9500], thrombin antithrombin III 22.0 ng/ml [IQR 18.6-28.0], and plasminogen activator inhibitor 46.8 ng/ml [IQR 44.0-54.0] were elevated in Group A as compared to Group B (5400 pmol/ml [IQR 3600-7700] p = 0.009, 16.0 ng/ml [IQR 11.0-18.5] p<0.001, and 25.8 ng/ml [IQR 20.9-34.4] p < 0.001), respectively. A significant correlation was found between heart rate and all three coagulation markers. Multivariate multiple regression analysis showed only heart rate to be an independent predictor of systemic coagulation activation and risk of thrombus formation. CONCLUSION: Control of ventricular rate in subjects of MS with AF produces significant reduction in the activation of the coagulation system and may decrease risk of thrombosis.
BACKGROUND AND AIM OF STUDY: Systemic thromboembolism is a major complication in patients of mitral stenosis (MS) with atrial fibrillation (AF) due to induction of hypercoagulable state. The aim was to assess the relationship, if any, between control of ventricular rate and systemic coagulation factors. METHOD: 70 patients of moderate to severe MS in AF were studied. 35 patients with average heart rate > 100 beats/min over a 24 hour period assessed by Holter monitoring were considered as having a uncontrolled ventricular rate (Group A) and those with average heart rate ≤ 100 beats/min as controlled ventricular rate (Group B). 30 healthy volunteers acted as controls. RESULTS: Plasma concentration of prothrombin fragment 1+2 (PF1+2) 6600 pmol/ml [interquartile range (IQR) 5400.0-9500], thrombin antithrombin III 22.0 ng/ml [IQR 18.6-28.0], and plasminogen activator inhibitor 46.8 ng/ml [IQR 44.0-54.0] were elevated in Group A as compared to Group B (5400 pmol/ml [IQR 3600-7700] p = 0.009, 16.0 ng/ml [IQR 11.0-18.5] p<0.001, and 25.8 ng/ml [IQR 20.9-34.4] p < 0.001), respectively. A significant correlation was found between heart rate and all three coagulation markers. Multivariate multiple regression analysis showed only heart rate to be an independent predictor of systemic coagulation activation and risk of thrombus formation. CONCLUSION: Control of ventricular rate in subjects of MS with AF produces significant reduction in the activation of the coagulation system and may decrease risk of thrombosis.
Authors: Miguel A Quiñones; Catherine M Otto; Marcus Stoddard; Alan Waggoner; William A Zoghbi Journal: J Am Soc Echocardiogr Date: 2002-02 Impact factor: 5.251
Authors: Alexander Weymann; Anton Sabashnikov; Sadeq Ali-Hasan-Al-Saegh; Aron-Frederik Popov; Seyed Jalil Mirhosseini; William L Baker; Mohammadreza Lotfaliani; Tong Liu; Hamidreza Dehghan; Senol Yavuz; Michel Pompeu Barros de Oliveira Sá; Jae-Sik Jang; Mohamed Zeriouh; Lei Meng; Fabrizio D'Ascenzo; Abhishek J Deshmukh; Guiseppe Biondi-Zoccai; Pascal M Dohmen; Hugh Calkins; Integrated Meta-Analysis Of Cardiac Cardiac Surgery And Cardiology-Group Imcsc-Group Journal: Med Sci Monit Basic Res Date: 2017-03-31