Atak Ramazan, Yetkin Ertan, Yetkin Ozkan, Ayaz Selime, Ileri Mehmet, Senen Kubilay, Turhan Hasan, Erbay Ali Riza, Cehreli Sengül
Turkiye Yüksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
Angiology. 2003 Sep-Oct;54(5):593-7. doi: 10.1177/000331970305400509.
A hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF1+2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvuloplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p > 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p < 0.01). Statistically significant elevated systemic level of PF1+2 was observed only in LASEC-positive patients when compared to control subjects (p < 0.01, p > 0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.
二尖瓣狭窄（MS）和窦性心律（SR）患者中曾有高凝状态的报道。然而，有人提出MS患者仅左心房内的凝血活性可能增加，外周血水平正常。本研究的目的是通过测量严重二尖瓣狭窄且窦性心律、凝血时间正常且无左心房血栓患者的PF1+2来评估左心房局部和全身的凝血活性。本研究纳入了25例连续的中重度MS且窦性心律并接受经皮二尖瓣球囊成形术的患者。所有患者在瓣膜成形术前均行经食管超声心动图检查以排除左心房血栓和左心房自发显影（LASEC）的存在。LASEC阳性和LASEC阴性患者在年龄、性别、纤维蛋白原水平、凝血酶原时间、二尖瓣面积、平均二尖瓣压差、肺动脉压方面均无统计学显著差异（所有p>0.05）。与对照组相比，LASEC阳性和LASEC阴性患者的局部（左心房）PF1+2水平均显著升高（p<0.01）。与对照组相比，仅在LASEC阳性患者中观察到PF1+2的全身水平有统计学显著升高（分别为p<0.01，p>0.05）。总之，严重二尖瓣狭窄和SR患者在LASEC阴性和LASEC阳性组中均有局部凝血活性增加。尽管这种增加的局部凝血活性在LASEC阳性患者的外周血中有所体现，但在LASEC阴性患者的外周血中未体现。
