Cevik Cihan, Otahbachi Mohammad, Nugent Kenneth, Ozkan Mehmet
Texas Tech University Health Sciences Center, Department of Internal Medicine, 3601 4th Street, Lubbock, TX, USA
J Heart Valve Dis. 2009 May;18(3):278-83.
Severe mitral regurgitation (MR) reduces left atrial thrombus formation in patients with mitral stenosis (MS) and atrial fibrillation (AF). Plasma D-dimer levels represent a biochemical marker for fibrinolytic activity in prothrombotic states. The prothrombotic burden in patients with mitral valve disease and/or AF was assessed using plasma D-dimer levels.
The study population included 89 patients with mitral valve disease, 21 with AF but normal valves, and 15 healthy controls. The mitral valve group was subdivided into patients with MS (n = 27), severe MR (n = 26), and MS with concomitant with severe MR (MS/MR; n = 36). These subgroups were further subdivided according to the atrial rhythm (sinus rhythm (SR)+AF).
The mean left atrial size was increased in all groups with cardiac disease. D-dimer levels were highest in the MS+AF subgroup (527 +/- 134 microg/l). Patients with MS+AF, MS+SR, and nonvalvular AF had significantly higher D-dimer levels than controls (p < 0.01, by ANOVA). Patients with MR had normal levels of D-dimer. The atrial rhythm did not influence D-dimer levels in the MS/MR subgroup, or in the pure MR subgroup (p = NS).
Plasma D-dimer levels correlated with the embolic risk in mitral valve disease and non-valvular AF. The highest levels were found in patients with MS+AF and non-valvular AF. Severe MR decreased the D-dimer levels in MS and/or AF to control levels.
重度二尖瓣反流（MR）可减少二尖瓣狭窄（MS）合并心房颤动（AF）患者的左心房血栓形成。血浆D - 二聚体水平是血栓前状态下纤溶活性的生化标志物。采用血浆D - 二聚体水平评估二尖瓣疾病和/或AF患者的血栓前负荷。
研究人群包括89例二尖瓣疾病患者、21例瓣膜正常的AF患者和15名健康对照者。二尖瓣疾病组再细分为MS患者（n = 27）、重度MR患者（n = 26）以及MS合并重度MR患者（MS/MR；n = 36）。这些亚组再根据心房节律（窦性心律（SR）+AF）进一步细分。
所有心脏病组的平均左心房大小均增加。D - 二聚体水平在MS + AF亚组中最高（527±134μg/l）。MS + AF、MS + SR和非瓣膜性AF患者的D - 二聚体水平显著高于对照组（方差分析，p < 0.01）。MR患者的D - 二聚体水平正常。心房节律对MS/MR亚组或单纯MR亚组的D - 二聚体水平无影响（p = 无显著性差异）。
血浆D - 二聚体水平与二尖瓣疾病和非瓣膜性AF的栓塞风险相关。MS + AF和非瓣膜性AF患者的D - 二聚体水平最高。重度MR将MS和/或AF患者的D - 二聚体水平降至对照水平。
