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Experimental and Imaging Techniques for Examining Fibrin Clot Structures in Normal and Diseased States
Published on: April 1, 2015
Correlation of cross-linked fibrin degradation products (D-dimer) with coronary angiographic lesion morphology
A Alzarka1, J I Haft, H Bassil
1Department of Cardiology, St. Michael's Medical Center, Newark, New Jersey 07102.
Insights
Complex coronary lesions may not indicate active fibrinolysis. Elevated D-dimer levels, a marker of clot breakdown, were not significantly higher in patients with complex lesions, suggesting fibrinolysis often stops with persistent clots.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Biochemistry
Background:
- Complex coronary lesions are often presumed to be "active" and associated with ongoing fibrinolysis.
- Fibrinolysis, the breakdown of blood clots, plays a crucial role in cardiovascular health.
- D-dimer levels serve as a biomarker for fibrinolysis, indicating the degradation of cross-linked fibrin.
Purpose of the Study:
- To investigate the association between complex irregular coronary lesions and ongoing fibrinolysis.
- To determine if complex coronary morphologies correlate with elevated D-dimer levels.
- To assess the relationship between clinical diagnosis and D-dimer levels in patients with coronary lesions.
Main Methods:
- Enzyme-linked immunosorbent assay (ELISA) was used to measure D-dimer levels in 136 patients.
- Blood samples were collected prior to coronary arteriography.
- Patients were categorized into groups based on coronary lesion morphology (complex, smooth, normal).
Main Results:
- A majority of patients (64%) with complex coronary morphologies had normal D-dimer levels.
- No significant difference in abnormal D-dimer levels was observed between complex lesion groups and control groups (normal or smooth lesions).
- Clinical diagnosis, rather than lesion morphology, was predictive of elevated D-dimer levels.
Conclusions:
- Complex coronary lesions are not consistently associated with ongoing fibrinolysis.
- Endogenous fibrinolysis frequently appears to cease even in the presence of persistent coronary clots.
- Clinical assessment may be a more reliable indicator of fibrinolytic activity than complex lesion morphology alone.
Abstract:
We tested the hypothesis that complex irregular coronary lesions are "active" lesions and thus associated with ongoing fibrinolysis by measuring the degradation products of cross-linked fibrin (D-dimer) in 136 patients undergoing coronary arteriography. Blood samples obtained before catheterization were assayed by an enzyme linked immunosorbent assay (ELISA) using specific monoclonal antibodies for D-dimer particles. In the four groups with complex coronary morphologies (filling defects, extrinsic lesions with irregular borders and total occlusions with or without staining) the majority of patients (64%) had normal D-dimer levels. The incidence of abnormal D-dimer levels was not significantly higher in any of these four groups than in the two groups with normal coronaries or with smooth lesions. In the same patients, however, the clinical diagnosis was predictive of the presence of elevated D-dimer levels. These findings suggest that complex coronary lesions are often not associated with ongoing fibrinolysis and that endogenous fibrinolysis frequently ceases in the presence of persistent clot.
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