Parametri agregacije trombocita i hemostaze tokom stres ehokardiografije sa dobutaminom u populaciji pacijenata koji su lečeni perkutanom koronarnom intervencijom

Abstract

Uvod: Agregabilnost trombocita i proces aktivacije hemostaze tokom ishemije miokarda u sklopu fizičkog ili mentalnog stresa, može biti jedan od brojnih faktora koji utiču na proces tromboze stenta nakon perkutane koronarne intervencije. Pacijenti i metode istraživanja: Studijsku populaciju čini 121 asimptomatskih pacijenata koji su imali uspešnu perkutanu koronarnu intervenciju četiri meseca pre visokodozne dobutamin stres ehokardiografije. Agregabilnost trombocita na epinefrin (EPI) i adenozin difosfat (ADP) je određena metodom light transmission aggregometry (LTA) zajedno sa aktivnošću proteina C i antitrombina u plazmi pre i u piku opterećenja tokom stres testa. Pacijenti su bili podeljeni u nekoliko grupa shodno tome da li su imali poremećaje kontraktilnosti određenih segmenata miokarda u miru ili u naporu. Svi pacijenti su u vreme dobutamin stres ehokardiografije bili na terapiji klopidogrelom i aspirinom. Rezultati: Nema statistički značajne razlike u agregabilnosti trombocita na ADP (47,50% prema 50,20%; p=0,970) kao ni na EPI (59,30% prema 60,30%; p=0,600) pre i u piku DSE. Statistički značajna razlika je utvrđena u aktivnosti antikoagulantnih proteina, antitrombina (84,85 IU/L prema 74,75 IU/L; p=0,001) i proteina C (77,75 IU/L prema 67,60 IU/L; p<0,001). Značajnost razlike u antitrombinu i proteinu C odnosi se na rezultat pre i u piku testa. Nije utvrđena značajna razlika u agregabilnosti trombocita i aktivnosti antikoagulantnih proteina u plazmi kod pacijenta sa ili bez indukovane ishemije u piku dobutamin stres ehokardiografije. Pacijenti koji su imali povišen wall motion score index (WMSI) u piku dobutamin stres ehokardiografije su imali veću agregabilnost trombocita na EPI (68,60% prema 54,70% p=0,017) nego pacijenti sa normalnom kontraktilnošću miokarda. Zaključak: Nema promena vrednosti u agregabilnosti trombocita pre i posle dobutamin stres ehokardiografije, međutim, dolazi do smanjenja aktivnosti antikoagulantnih proteina u plazmi u piku testa. Agregabilnost trombocita na EPI značajno raste u piku DSE kod pacijenata sa segmentnom hipokontraktilnošću miokarda.

Introduction: Platelets aggregability and the activation of hemostasis, during myocardial ischemia within physical or mental stress, can be one of many factors that influence the process of stent thrombosis after percutaneous coronary intervention. Patients and methods: The study population included 121 asymptomatic patients who had successful percutaneous coronary intervention four months before high-dose dobutamine stress echocardiography. Platelets aggregability on epinephrine (EPI) and adenosine diphosphate (ADP) were determined by Light Transmission Aggregometry (LTA), together with plasma activity of protein C and antithrombin before dobutamine stress echocardiography and at the peak stage of the stress test. Patients were divided into several groups whether they have baseline or induced disturbance of segmental myocardial kinetics or not. All patients were on clopidogrel and aspirin therapy at the time of dobutamine stress echocardiography. Results: There were no statistically significant difference in platelets aggregability on ADP (47.50% vs. 50.20%; p=0.970) as well as on EPI (59.30% vs. 60.30%, p=0.600) before and at the peak dobutamine stress echocardiography. A statistically significant difference was found in the anticoagulant activity of the antithrombin (84.85 IU/L vs. 74.75 IU/L, p=0.001) and protein C (77.75 IU/L vs. 67.60 IU/L, p<0.001). Significance of differences in antithrombin and the protein C, refers to the result before and at the peak levels of the test. There was no significant difference in Platelets aggregability and plasma activity of anticoagulant proteins in patients with or without induced myocardial ischemia at the peak of dobutamine stress echocardiography. Patients who had increased wall motion score index (WMSI) at the peak of dobutamine stress echocardiography had higher EPI induced platelets aggregability (68.60% vs. 54.70% p=0.017) than patients with normal myocardial contractility. Conclusion: There are no changes in the platelets aggregability before and after dobutamine stress echocardiography, however, plasma activity of anticoagulant proteins decreased at the peak level of the test. Platelet aggregability on EPI significantly increases at the peak of dobutamine stress echocardiography in patients with segmental myocardium hypocontractility.