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Obstructive hypertrophic cardiomyopathy is associated with enhanced thrombin generation and platelet activation
  1. Pawel P Dimitrow (dimitrow{at}mp.pl)
  1. CM Jagiellonian University, Poland
    1. Anetta Undas
    1. CM Jagiellonian University, Poland
      1. Maria Bober
      1. CM Jagiellonian University, Poland
        1. Wieslawa Tracz
        1. CM Jagiellonian University, Poland
          1. Jacek S Dubiel
          1. CM Jagiellonian University, Poland

            Abstract

            Objectives and design The purpose of the study was to investigate the association of left ventricular outflow tract (LVOT) obstruction with blood coagulation, platelet activity and inflammatory response in patients with hypertrophic cardiomyopathy (HCM) and sinus rhythm.

            Patients and main outcome measures In 42 HCM patients with sinus rhythm, including 16 patients with resting LVOT obstruction (gradient >30 mmHg) and 29 age- and sex-matched controls, we determined markers of thrombin generation (thrombin-antithrombin complex [TAT], prothrombin fragment 1+2 [F1+2]), platelet activation (soluble CD40 ligand [sCD40L], b-thromboglobulin [b-TG], P-selectin), and inflammation (C-reactive protein [CRP], IL-6, tumor necrosis factor-a [TNF-a]).

            Results Thrombin, platelet, and inflammatory markers were higher in the entire HCM group than in controls (p<0.005 for all compared parameters). Compared with nonobstructive HCM, obstructive HCM was associated with increased thrombin formation [TAT, F1+2], platelet activation [sCD40L, b-TG, P-selectin] and both CRP and IL-6 levels. Only the level of TNF-a was similar in both forms of HCM. In contrast, the comparison of nonobstructive HCM with controls revealed that all these parameters (except for P-selectin) were similar. P-selectin was higher in nonobstuctive HCM. The LVOT gradient positively correlated with all the raised blood markers (r from 0.39 to 0.73; p<0.05), except for TNF-a. In multiple regression analysis models, the LVOT gradient was the only independent predictor of TAT (R2= 0.61; p=0.0003), sCD40L (R2=0.59; p=0.0008), F1+2 (R2=0.55; p=0.002), P-selectin (R2=0.49; p=0.004), and b-TG (R2=0.38; p=0.005) in HCM patients.

            Conclusions LVOT obstruction is independently associated with enhanced thrombin generation and platelet activity in HCM patients with sinus rhythm.

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