Key result
Activated protein C resistance was present in 54% of dilated cardiomyopathy patients with left ventricular thrombus compared to 9.5% of those without (P<0.01), serving as an independent predictor.
Why the study?
Does activated protein C resistance predict left ventricular thrombus formation in patients with dilated cardiomyopathy?
Case-Control (n=60)
Does activated protein C resistance predict left ventricular thrombus formation in patients with dilated cardiomyopathy?
Absolute Event Rate: 54% vs 9.5%
p-value: p=< 0.01
Activated protein C resistance is an independent predictor of left ventricular thrombus formation in patients with severe dilated cardiomyopathy.
May not yet alter thrombus screening in dilated cardiomyopathy; leaves open prospective validation of activated protein C resistance as a predictor.
OBJECTIVES: The aim of this study was to investigate the association between left ventricular thrombus formation and natural anticoagulant systems including the protein C, protein S and antithrombin in patients with dilated cardiomyopathy. MATERIALS AND METHODS: Sixty patients with dilated cardiomyopathy who met the inclusion criteria were included in the study. Patients were divided into two groups: group I consisted of 22 patients with left ventricular thrombus and group II consisted of 38 patients without left ventricular thrombus. Our main inclusion criteria were ejection fraction </= 35% and left ventricular end-diastolic diameter >/= 6.0 cm. These two groups were compared for clinical and hematologic parameters (activated protein C resistance, protein S and antithrombin). RESULTS: There were no statistically significant differences between patients with or without left ventricular thrombi with respect to left ventricular end-diastolic and end-systolic dimensions, ejection fraction, fractional shortening and left atrial diameter. There were no statistically significant differences between patients with and without left ventricular thrombus with respect to platelet count (252 +/- 64/mm3 x 10(3) compared with 260 +/- 74/mm3 x 10(3) respectively, P=0.68), prothrombin time (12.94 +/- 1.9 s compared with 12.86 +/- 1.3 s respectively, P=0.82), activated partial thromboplastin time (32 +/- 5 compared with 30 +/- 4 s respectively, P=0.32) and fibrinogen levels (36 +/- 9 mg/dl compared with 34 +/- 8 mg/dl respectively, P=0.41). None of the patients had protein S and antithrombin deficiency. Activated protein C resistance was found in 12 patients (12 out of 22, 54%) in group I and four patients (four out of 38, 9.5%) in group II (P < 0.01). It was also shown to be an independent predictor of left ventricular thrombus (P < 0.05). CONCLUSION: Activated protein C resistance is found to be an independent predictor of left ventricular thrombus in patients with dilated cardiomyopathy who have ejection fractions less then 35% and left ventricular end-diastolic dimensions > 6.0 cm.
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Erbay et al. (2004) conducted a case-control in Dilated cardiomyopathy (n=60). Activated protein C resistance vs. No activated protein C resistance was evaluated on Left ventricular thrombus formation (p=< 0.01). Activated protein C resistance was present in 54% of dilated cardiomyopathy patients with left ventricular thrombus compared to 9.5% of those without (P<0.01), serving as an independent predictor.
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