Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and permanent atrial fibrillation - Effects of cardioversion and return of left atrial function
Plasma von Willebrand factor, fibrinogen and soluble P-selectin levels in paroxysmal, persistent and permanent atrial fibrillation - Effects of cardioversion and return of left atrial function
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DOI：
10.1053/euhj.2000.2531
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发表时间：
2001-09-01
影响因子：
39.3
通讯作者：
Lip, GYH
中科院分区：
文献类型：
--
作者：
Li-Saw-Hee, FL;Blann, AD;Lip, GYH
背景：心房颤动与卒中和血栓栓塞症的风险增加有关，可能是通过导致血栓前状态或高凝状态。然而，目前尚不清楚在慢性房颤患者的临床亚组中，即在阵发性、持续性或永久性房颤患者中，这种情况是否有所不同。因此，我们假设：(I)这些患者的血栓前状态存在差异；(Ii)随着持续性房颤的选择性电复律和左房功能的恢复，高凝状态指数将会降低。患者和方法我们研究了69例慢性房颤患者：阵发性房颤23例(男性16例，平均年龄65岁+/-SD 13岁)；持续性房颤23例(男性16例；65岁13岁)，房颤持续时间2~6个月，平均3个月；永久性房颤23例(男性16例，+/-10年67岁)。血液结果与20名年龄和性别匹配的健康对照组进行了比较。持续性房颤患者在复律前、复律后3周和12周分别进行选择性直流电复律，复律前、复律后3周和12周分别进行多普勒超声心动图检查和血常规检查。通过检测血浆纤维蛋白原、可溶性P-选择素(反映血小板活化程度的指标)和血管性假血友病因子(血管内皮细胞功能障碍的标志物)水平来量化血栓前状态。
Background Atrial fibrillation is associated with increased risk of stroke and thromboembolism, possibly by conferring a prothrombotic or hypercoagulable state. However, it is unclear whether or not this differs in the clinical subgroups of chronic atrial fibrillation patients, that is, in those with paroxysmal, persistent or permanent atrial fibrillation. We therefore hypothesized that: (i) there are differences in the prothrombotic state between these patients; and (ii) reduction in indices of hypercoagulability would follow elective electrical cardioversion of persistent atrial fibrillation and the return of left atrial function.Patients and Methods We studied 69 patients with chronic atrial fibrillation: 23 with paroxysmal atrial fibrillation (16 males; mean age 65 years +/- SD 13); 23 with persistent atrial fibrillation (16 males; 65 years 13), with a mean duration of atrial fibrillation of 3 months (range 2 to 6 months); and 23 with permanent atrial fibrillation (16 males; 67 years +/- 10). Blood results were compared to 20 age- and sex-matched healthy controls. The patients with persistent atrial fibrillation then underwent elective DC cardioversion, with Doppler echocardiographic examinations and bloods tests performed prior to cardioversion, and at 3 and 12 weeks afterwards. The prothrombotic state was quantified by measurement of plasma levels of fibrinogen, soluble P-selectin (an index of platelet activation) and von Willebrand factor (a marker of endothelial dysfunction).Results Permanent atrial fibrillation was associated with significantly raised levels of von Willebrand factor, soluble P-selectin and fibrinogen (all P