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Is diastolic dysfunction associated with thrombogenesis? A study of circulating markers of a prothrombotic state in
G Y Lip1, G D Lowe, M J Metcalfe
1Department of Cardiology, Stobhill General Hospital, Glasgow, UK.
Insights
Diastolic dysfunction in heart failure does not increase thromboembolic risk. Systolic dysfunction, particularly left ventricular aneurysms, is linked to higher prothrombotic factors in ischemic heart disease patients.
Area of Science:
- Cardiology
- Thrombosis
- Vascular Biology
Background:
- Clinical data often fails to distinguish between systolic and diastolic heart failure regarding thromboembolic risk.
- Ischemic heart disease commonly causes diastolic dysfunction, necessitating investigation into its specific role in thrombotic risk.
Purpose of the Study:
- To assess plasma fibrinogen, fibrin D-dimer, and von Willebrand factor levels in patients with ischemic heart disease.
- To determine if left ventricular diastolic dysfunction contributes independently to thromboembolic risk beyond systolic dysfunction.
Main Methods:
- A population-controlled cross-sectional study involving 106 patients with ischemic heart disease.
- Echocardiography was used to define left ventricular diastolic function.
- Patients were categorized into groups based on left ventricular function and aneurysm presence, with subgroups defined by diastolic dysfunction.
Main Results:
- No significant differences in plasma fibrinogen, fibrin D-dimer, or von Willebrand factor were found between patients with and without diastolic dysfunction.
- Systolic dysfunction, not diastolic dysfunction, correlated significantly with elevated prothrombotic markers.
- The most pronounced abnormalities in fibrinogen, endothelial dysfunction, and fibrin turnover were observed in patients with left ventricular aneurysms.
Conclusions:
- Left ventricular diastolic dysfunction does not appear to significantly increase thrombotic risk in patients with ischemic heart disease.
- Systolic dysfunction and left ventricular aneurysms are more strongly associated with prothrombotic factors.
- A potential link between cardiac hemodynamics and thrombogenesis is suggested by associations between prothrombotic factors and Doppler flow indices.
Abstract:
Clinical data on the contributory role of heart failure to thromboembolic risk does not differentiate between systolic and diastolic left ventricular dysfunction. We therefore conducted a population-controlled cross-sectional study to determine levels of plasma fibrinogen (associated with thromboembolism), fibrin D-dimer (a marker of fibrin turnover) and von Willebrand factor (a marker of endothelial dysfunction) in patients with ischaemic heart disease (a common cause of diastolic dysfunction) in whom left ventricular diastolic function was defined by echocardiography. We studied 106 patients: those with normal left ventricular function (n = 42, Group 1); those with left ventricular dysfunction but without aneurysms (n = 34, Group 2); and those with left ventricular aneurysm formation (n = 30, Group 3). Each of these groups was subdivided into those with (a) and without (b) diastolic dysfunction. Diastolic dysfunction was present in over 60% of patients, irrespective of left ventricular systolic impairment. There were no significant differences in median levels of plasma fibrinogen, fibrin D-dimer or von Willebrand factor in each group of patients with ischaemic heart disease, whether or not left ventricular diastolic dysfunction was present (Mann-Whitney test; P = N.S.). Systolic (rather than diastolic) dysfunction was the main correlate of these (analysis of variance, general linear model--ANOVA-GLM--P < 0.05) and the greatest abnormalities of fibrinogen, endothelial dysfunction and intravascular fibrin turnover were seen in patients with left ventricular aneurysms whether or not diastolic dysfunction was present. This study demonstrates that there is no evidence of a significant additional contribution to thrombotic risk (as assessed by plasma fibrinogen, von Willebrand factor and fibrin D-dimer) for patients with left ventricular diastolic dysfunction. A relationship is noted between some prothrombotic factors and Doppler indices of flow, which suggests a possible association between cardiac haemodynamics and thrombogenesis.