RESUMEN
OBJECTIVES: In contrast to its membrane-bound form, soluble endothelial protein C receptor (sEPCR) expresses procoagulant activity through binding to protein C. We aimed to investigate the relationship between sEPCR levels and protein C activity in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: The study population included 60 STEMI patients who had undergone a primary percutaneous coronary intervention and 29 patients with stable angina pectoris (SAP) with significant coronary stenosis on angiography. Preprocedural sEPCR levels and protein C activity were determined in all study patients. RESULTS: In the STEMI group, the baseline sEPCR level was significantly higher (172.0±89.3 vs. 107.1±39.2 ng/ml, P<0.001) and protein C activity was significantly lower (91.9±26.4 vs. 124.5±16.2%, P<0.001) compared with patients with SAP. There was a significant negative correlation between protein C activity and sEPCR in the STEMI group (r=-0.38, P=0.002); however, no significant correlation was observed in the SAP group (r=0.02, P=0.91). Angiographic thrombus load and the incidence of no-reflow phenomenon were significantly higher in STEMI patients with protein C activity under the median level. CONCLUSION: The ratio of sEPCR levels to protein C activity is high, with a significant negative correlation in patients with STEMI. Lower protein C activity is associated with the development of no-reflow in STEMI patients. However, the sEPCR level has no relation to the development of no-reflow. The clinical significance of elevated sEPCR level in STEMI should be evaluated in larger studies.
Asunto(s)
Antígenos CD/sangre , Infarto del Miocardio/sangre , Proteína C/análisis , Receptores de Superficie Celular/sangre , Adulto , Anciano , Angina Estable/sangre , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Angiografía Coronaria , Receptor de Proteína C Endotelial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/terapia , Fenómeno de no Reflujo/etiología , Intervención Coronaria Percutánea/efectos adversos , Valor Predictivo de las Pruebas , Factores de Riesgo , Resultado del TratamientoRESUMEN
This paper reports a 43-year-old patient who had a large, mobile, worm-like thrombus in the left main coronary artery after receiving a chemotherapy regimen containing cisplatin, bleomycin and etoposide for a nonseminomatous testes tumor. The patient was successfully treated with thrombolytic therapy. Physicians should be aware that thrombotic events may be observed after the administration of certain chemotherapeutic agents, particularly cisplatin.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Trombosis Coronaria/diagnóstico , Citostáticos/efectos adversos , Neoplasias Testiculares/tratamiento farmacológico , Disfunción Ventricular Izquierda/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Trombosis Coronaria/tratamiento farmacológico , Citostáticos/uso terapéutico , Humanos , Masculino , Neoplasias Testiculares/diagnóstico , Terapia Trombolítica , Disfunción Ventricular Izquierda/tratamiento farmacológicoRESUMEN
AIM: The left atrial appendage (LAA) function was evaluated in patients with severe rheumatic mitral regurgitation, having sinus rhythm or atrial fibrillation, by standard and tissue Doppler echocardiographic examinations. METHODS AND RESULTS: Sixty patients with rheumatic severe mitral regurgitation were enrolled. The patients (14 females and 6 males) having sinus rhythm were selected as group I and 20 patients (15 females and 5 males) with atrial fibrillation formed group II. 20 healthy subjects (15 female and 5 males) served as the control group (group III). In order to determine the LAA functions, LAA peak filling flow velocity (LAAPFV), LAA peak emptying flow velocity (LAAPEV) and percentage of LAA area change (LAAAC %) were measured. In the TDI records of the subjects with sinus rhythm, the first positive wave identical to the LAA late emptying wave (LEW) following the P-wave was accepted as LAA late systolic wave (LSW), and the second negative wave identical to the LAA late filling flow was accepted as late diastolic wave (LDW). In patients with atrial fibrillation, the positive wave was accepted as LAA late systolic wave (LSW), and the second negative wave identical to the LAA late filling flow was accepted as late diastolic wave (LDW). LAA outflow and inflow velocities were lower in the group having atrial fibrillation (P < 0.002, and P < 0.007, respectively). LAAAC% was also reduced in group II (P < 0.0001). The pulsed Doppler LSW and LDW velocities, measured with TDI method were found to be quite reduced in patients with AF (P: 0.002 and P: 0.001, respectively). The study parameters were statistically similar in patients with normal sinus rhythm and controls. CONCLUSION: In this study, we found that the LAA functions are impaired in patients with severe mitral regurgitation, having AF, whereas preserved in patients with normal sinus rhythm, compared to controls.