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Determinants of increased regional left atrial coagulation activity in patients with mitral stenosis
R E Peverill1, R W Harper, J Gelman
1Cardiology Unit, Monash Medical Centre, Melbourne, Australia.
Insights
In mitral stenosis, increased left atrial coagulation activity is linked to left atrial spontaneous echo contrast (LASEC). This heightened activity occurs regardless of heart rhythm and is independent of systemic coagulation levels.
Area of Science:
- Cardiology
- Hematology
- Thrombosis Research
Background:
- Mitral stenosis may involve increased left atrial coagulation.
- The relationship between left atrial coagulation and thrombus formation factors is unclear.
- The link between left atrial and systemic coagulation remains unresolved.
Purpose of the Study:
- To investigate regional left atrial coagulation activity in mitral stenosis.
- To determine the relationship between left atrial coagulation and left atrial spontaneous echo contrast (LASEC).
- To compare left atrial and systemic coagulation markers.
Main Methods:
- Measured prothrombin fragment 1 + 2 (F1 + 2) levels in left atrial and peripheral venous blood.
- Included 32 patients with mitral stenosis undergoing percutaneous balloon mitral valvuloplasty.
- Compared F1 + 2 levels between patients with and without LASEC, and with control subjects.
Main Results:
- Left atrial F1 + 2 levels were significantly higher in patients with LASEC compared to those without.
- LASEC was the sole significant predictor of increased regional left atrial coagulation activity.
- Systemic coagulation markers did not differ between patients and controls.
Conclusions:
- Increased left atrial coagulation activity in mitral stenosis is associated with LASEC.
- This heightened activity is observed in both sinus rhythm and atrial fibrillation.
- Regional left atrial coagulation is elevated despite normal systemic coagulation activity.
Background:
Recent evidence suggests that regional left atrial coagulation activity may be increased in mitral stenosis and perhaps contribute to the pathophysiology of left atrial thrombus. However, the relation of left atrial coagulation activity to factors that predispose to left atrial thrombus formation is unknown, and the relation between left atrial and systemic coagulation activities is unresolved.
Methods And Results:
Left atrial and peripheral venous levels of the coagulation marker prothrombin fragment 1 + 2 (F1 + 2) were measured in 32 patients with mitral stenosis with normal clotting times and no left atrial thrombus who were undergoing percutaneous balloon mitral valvuloplasty. Baseline peripheral venous F1 + 2 levels, measured at the beginning of the valvuloplasty procedure, did not differ from those of 30 age-matched control patients. Prevalvuloplasty left atrial F1 + 2 levels, obtained immediately after transseptal puncture, were similar to femoral venous levels in patients without left atrial spontaneous echo contrast (LASEC) (0.81 +/- 0.32 versus 0.81 +/- 0.27 nmol/L, n = 7) but greater than femoral venous levels in patients with LASEC and either sinus rhythm (1.57 +/- 0.86 versus 0.99 +/- 0.38 nmol/L, n = 16, P < .001) or atrial fibrillation (1.52 +/- 0.69 versus 0.85 +/- 0.33 nmol/L, n = 9, P < .003). Furthermore, LASEC emerged as the only significant predictor of increased regional left atrial coagulation activity (P = .005) on stepwise multivariate logistic regression analysis.
Conclusions:
Increased regional left atrial coagulation activity in mitral stenosis occurs in the presence of LASEC, is evident in either sinus rhythm or atrial fibrillation, and is associated with normal systemic coagulation activity.