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Soluble, platelet-bound, and total P-selectin as indices of platelet activation in congestive heart failure
Irene Chung1, Anirban Choudhury, Jeetesh Patel
1Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Insights
Platelet activation is present in congestive heart failure (CHF) patients but does not predict prognosis. These platelet abnormalities may stem from associated comorbidities rather than CHF itself.
Area of Science:
- Cardiology
- Hematology
- Thrombosis Research
Background:
- Congestive heart failure (CHF) complications often stem from thrombosis.
- The role of circulating platelets in CHF-related thrombosis is not fully understood.
Purpose of the Study:
- To assess platelet activation in CHF patients compared to controls.
- To investigate the prognostic value of platelet activation markers in CHF.
Main Methods:
- Measured soluble P-selectin (sP-sel), total platelet P-selectin (pP-sel), and platelet surface markers (CD62P%G, CD63%G) via ELISA and flow cytometry.
- Included 108 stable CHF patients (LVEF <50%), 70 disease controls, and 50 healthy controls.
- Followed patients for a median of 490 days to assess outcomes.
Main Results:
- CHF patients and disease controls showed elevated sP-sel, CD62P%G, and CD63%G compared to healthy controls.
- No significant correlations were found between platelet markers and ejection fraction or CHF etiology.
- Platelet markers did not predict composite endpoints, including death or hospitalization for heart failure.
Conclusions:
- Stable CHF patients exhibit abnormal platelet activation, even with antiplatelet therapy.
- These platelet abnormalities were similar to disease controls, suggesting comorbidity influence.
- Platelet activation markers in this study did not prove to be prognostic indicators for CHF patients.
Background:
Many complications associated with congestive heart failure (CHF) have a thrombosis-related aetiology. Platelets play an important role in thrombogenesis, but it is not clear whether circulating platelets actively participate in thrombosis-related complications associated with CHF.
Objective:
To determine whether soluble P-selectin, platelet surface P-selectin, and total platelet P-selectin as indices of platelet activation in CHF patients-compared to 'disease controls' and 'healthy controls'-and to assess their prognostic value in CHF.
Methods:
We measured soluble P-selectin (sP-sel, by enzyme-linked immunosorbent assay, ELISA), total platelet P-selectin (pP-sel, by a novel 'platelet lysate' assay), platelet surface P-selectin (CD62P%G) and platelet surface CD63 (CD63%G) expression by flow cytometry-in 108 patients with stable congestive heart failure (all with left ventricular ejection fraction (LVEF) <50%). Levels were compared with 50 healthy controls and 70 'disease controls' (patients with coronary artery disease with normal left ventricular systolic function).
Results:
CHF patients and disease controls had higher sP-sel, CD62P%G and CD63%G than healthy controls. There were no significant correlations between sP-sel, pP-sel, CD62P%G and CD63%G with ejection fraction (all P>0.05). There were no differences in these markers when ischaemic and non-ischaemic aetiologies of CHF were compared. After a median follow-up of 490 days (range 340-535), there were 7 deaths, 15 hospitalizations for worsening heart failure, 1 for cardiac resynchronization therapy, 4 for revascularizations, 4 for myocardial infarctions, and 1 stroke. None of the platelet markers were predictive of the composite end-point at follow-up.
Conclusions:
Patients with stable CHF exhibit evidence of abnormal platelet activation, despite usage of antiplatelet agents. These abnormalities did not determine prognosis and were broadly similar to those seen in 'disease controls' indicating that platelet abnormalities in CHF may simply be related to associated comorbidities.
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