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    Improvement of endothelial function early after thrombolytic therapy in patients with prosthetic heart valve thrombosis
    (Turkish Society of Cardiology, 2020) Çakal, Beytullah; Kalçık, Macit; Güner, Ahmet; Yesin, Mahmut; Gürsoy, Mustafa Ozan; Gündüz, Sabahattin; Karakoyun, Süleyman; Bayam, Emrah; Kalkan, Semih; Özkan, Mehmet
    Objective: Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients.Methods: The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7 +/- 13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia.Results: The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31 +/- 0.76% vs. 5.87 +/- 0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65 +/- 0.86% vs. 7.13 +/- 1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07 +/- 0.61% vs. 5.38 +/- 0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31 +/- 0.76% vs. 8.22 +/- 1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87 +/- 0.84% vs. 6.11 +/- 0.95%; p=0.276).Conclusion: This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.
  • Küçük Resim Yok
    Öğe
    The role of protein Z and protein Z-dependent protease inhibitor polymorphisms in the development of prosthetic heart valve thrombosis
    (2017) Karakoyun, Süleyman; Gürsoy, Mustafa Ozan; Kalçık, Macit; Yesin, Mahmut; Gündüz, Sabahattin; Astarcıoğlu, Mehmet Ali; Bayram, Zübeyde; Çakal, Beytullah; Bayam, Emrah; Özkan, Mehmet
    BACKGROUND AND AIM OF THE STUDY: Protein Z (PZ) is a vitamin K-dependent factor that is synthesized mainly by the liver. It acts as an activator of serpin, the protein Z-dependent inhibitor (ZPI), which inhibits factor Xa. The potential role of alterations in protein Z and/or ZPI levels in the pathogenesis of thrombotic and/or hemorrhagic diseases has been previously investigated, but results have been conflicting. The study aim was to evaluate the role of PZ/ZPI polymorphisms in the development of prosthetic valve thrombosis (PVT).METHODS: This prospective, observational cross-sectional study included 50 consecutive patients with PVT [non-obstructive thrombosis (NOT) in 35 patients; obstructive thrombosis (OT) in 15] and 50 consecutive healthy subjects with normally functioning prostheses. gDNA was extracted from ca. 5 × 106 leukocytes, using the QIAamp DNA Mini Kit (Qiagen), according to the manufacturer's recommendations. For mutational analysis, a minisequencing method was employed. Results of the analyses were compared between the PVT and control groups, and also between the OT and NOT subgroups.RESULTS: The frequency of A allele (mutant type) of PZG79A was equal in all PVT patients and in controls. With regards to PZ-A13G polymorphisms, frequency of the mutant G allele was 22% in PVT patients and 19% in controls. Serpina-R67X polymorphism was observed in 8% of PVT patients and 6% of controls. Normal variant CC was present in 47 controls (94%), whereas a heterozygotic mutation (CT) was detected in four PVT patients (8%). Frequency of the ZPI-R67X mutation was significantly higher in patients with OT than in those with NOT (p = 0.041).CONCLUSIONS: The present study was the first to evaluate the potential impact of PZ (PZ-A13G, PZG79A) and ZPI (R-67X, W303X) polymorphisms in the development of PVT. Based on the results of this small observational case-control study, PZ/ZPI polymorphisms do not appear to play an active role in the development of PVT. Hence, further extensive studies are necessary.