Abnormalities of hemorheological, endothelial, and platelet function in patients with chronic heart failure in sinus rhythm - Effects of angiotensin-converting enzyme inhibitor and beta-blocker therapy

Article

关键词: VON-WILLEBRAND-FACTOR;    MYOCARDIAL-INFARCTION;    VENTRICULAR DYSFUNCTION;    DILATED CARDIOMYOPATHY;    HYPERCOAGULABLE STATE;    HEMOSTATIC FACTORS;    PLASMA-FIBRINOGEN;    P-SELECTIN;    DISEASE;    COUNT;   

DOI  :  10.1161/01.CIR.103.13.1746

来源: SCIE

【 摘 要 】

Background-To investigate the hypothesis that abnormalities of hemorheological (fibrinogen, plasma viscosity), endothelial (von Willebrand factor [vWF]), and platelet (soluble P-selectin) function would exist in patients with chronic heart failure (CHF) who are in sinus rhythm, we conducted a cross-sectional study of 120 patients with stable CHF (median ejection fraction 30%). We also hypothesized that ACE inhibitors and beta -blockers would beneficially affect the measured indices. Methods and Results-In the cross-sectional analysis, plasma viscosity (P=0.001), fibrinogen (P=0.02), VWF (P<0.0001), and soluble P-selectin (P<0.001) levels were elevated in patients with CHF compared with healthy controls. Women demonstrated greater abnormalities of hemorheological indices and vWF than males (all P<0.05). Plasma viscosity (P=0.009) and fibrinogen (P=0.0014) levels were higher in patients with more severe symptoms (New York Heart Association [NYHA] class III-IV), but there was no relationship with left ventricular ejection fraction. When ACE inhibitors were introduced, there was a reduction in fibrinogen (repeated-measures ANOVA, P=0.016) and vWF (P=0.006) levels compared with baseline. There were no significant changes in hemorheological, endothelial, or platelet markers after the introduction of -blocker therapy, apart from a rise in mean platelet count (P<0.001). Conclusions-Abnormal levels of soluble P-selectin, vWF, and hemorheological indices may contribute to a hypercoagulable state in CHF, especially in female patients and in those with more severe NYHA class. Treatment with ACE inhibitors improved the prothrombotic state in CHF, whereas the addition of -blockers did trot. These positive effects of ACE inhibitors may offer an explanation for the observed reduction in ischemic events in clinical trials.

【 授权许可】

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