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Whole blood impedance aggregometry for the assessment of platelet function in patients with congestive heart failure
V Serebruany1, M McKenzie, A Meister
1Sinai Hospital, Johns Hopkins University, Baltimore, MD 21215, USA. heartdrug@aol.com
Insights
Whole blood aggregometry (WBA) shows diagnostic utility in congestive heart failure (CHF) patients, despite variable platelet characteristics. WBA correlates with closure time and GP IIb/IIIa expression, proving valuable for screening in CHF populations.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Diagnostic Technologies
Background:
- Small studies indicate platelet abnormalities in congestive heart failure (CHF).
- Characterizing diagnostic tools for platelet function in CHF is crucial.
Purpose of the Study:
- To assess the diagnostic utility of whole blood aggregometry (WBA) in an outpatient CHF population.
- To investigate correlations between WBA and other platelet function markers.
Main Methods:
- Whole blood aggregation, shear-induced closure time, platelet contractile force, GP IIb/IIIa, and P-selectin were measured in 100 CHF patients.
- Statistical analysis was performed to determine correlations and group differences.
Main Results:
- Significant inter-individual variability in platelet characteristics was observed in CHF patients.
- WBA showed good correlation with closure time (r²=0.587) and GP IIb/IIIa expression (r²=0.435).
- Correlations with P-selectin expression were weaker, and no correlation was found with platelet contractile force.
Conclusions:
- Whole blood impedance aggregometry is a valuable diagnostic and screening tool for CHF patients.
- Further trials will evaluate WBA's ability to predict clinical outcomes and monitor anti-platelet therapy in CHF.
Objective:
Data from small studies have shown the presence of platelet abnormalities in patients with congestive heart failure (CHF). We sought to characterize the diagnostic utility of the whole blood aggregometry (WBA) in a random outpatient CHF population.
Methods:
Blood samples were obtained for measurement of whole blood aggregation, shear-induced closure time, platelet contractile force, expression of GP IIb/IIIa, and P-selectin in 100 consecutive patients with CHF.
Results:
Substantial inter-individual variability of platelet characteristics exists in patients with CHF. There were no statistically significant differences when patients were divided by the incidence of vascular events, emergency revascularization needs, survival, or etiology of heart failure. Surprisingly, aspirin use did not affect instrument readings as well. Whole blood aggregometry correlates well with the closure time (r(2)=0.587), and with GP IIb/IIIa expression (r(2)=0.435). Significant but less strong correlation has been observed for the WBA with platelet P-selectin expression (r(2)=0.295), and no correlation was present for the platelet contractile force measures (r(2)=0.030).
Conclusions:
Despite the fact that patients with heart failure enrolled in the EPCOT trial exhibited marginal, sometimes oppositely directed changes, in their platelet characteristics, whole blood impedance aggregometry is indeed capable to serve as a valuable diagnostic tool, and may be successfully used as an established screening device in this population. Ability of the whole blood aggregometry to predict clinical outcomes, or for the monitoring of anti-platelet agents in CHF patients, will be evaluated in the ongoing clinical trials.
