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Peculiarities of the hemostasis system associated with cardiorenal syndrome in patients with chronic heart failure of ischemic origin

Mironchuk N. N., Mirsaeva G. Kh.

Keywords: hemostasis, cardiorenal syndrome, CHF

DOI: 10.18087/rhfj.2013.6.1880

Background. State of the hemostasis system in patients with CHF is quite well studied; however features of the hemostasis system associated with cardiorenal syndrome require clarification. Aim. Studying peculiarities of the hemostasis system in relation to severity of renal functional disorders in patients with CHF associated with postinfarction cardiosclerosis. Materials and methods. 82 patients with different CHF NYHA FCs who had a history of Q wave MI were evaluated. Mean age of patients was 54.0 (50.0–64.0) years. The control group consisted of 30 subjects without apparent disease who were sex- and age-matched with the patients. The patients were divided into three groups: group 1, patients with glomerular filtration rate (GFR) of 60–89 ml / min / 1.73m2 without signs of renal injury (n=41); group 2, patients with GFR of 60–89 ml / min / 1.73 m2 and signs of renal injury (n=26); and group 3, patients with GFR of 59–30 ml / min / 1.73 m2 (n=15). Plasma platelet count, mean platelet volume (MPV), spontanenous and ADP-induced platelet aggregation; thrombomodulin concentration, von Willebrand factor (vWF) activity; APTT, prothrombin and INR, fibrinogen, heparin cofactor activity of antithrombin, and D dimer were measured. Results. Patients with signs of chronic renal disease (CRD) associated with CHF were older and had more severe clinical symptoms of CHF. The increased severity of renal disorders was accompanied by lower platelet count and higher MPV and spontaneous aggregation. The vWF activity and thrombomodulin concentration were higher in CHF patients than in the control group but they did not depend on severity of renal dysfunction. Among plasma coagulation factors of hemostasis, D dimer was the most sensitive responder to aggravation of renal disorders. Correlations were found between GFR and spontaneous platelet aggregation (r= –0.26; p=0.02), albuminuria level and plasma concentration of D dimer (r=0.24; p=0.03), albuminuria level and heparin cofactor activity of antithrombin (r= –0.24; p<0.05). CHF NYHA FC correlated with MPV (r=0.23; p=0.04), prothrombin (r= –0.35; p=0.001), INR (r=0.34; p=0.002), and D dimer concentration (r=0.27; p=0.015). Conclusion. Impaired renal function in CHF patients affects all components of the hemostasis system. D dimer can be considered the most sensitive marker for hemostasis activation in patients with cardiorenal syndrome. The D dimer index may be an appropriate part of routine hemostasis evaluation in CHF patients with renal dysfunction.
  1. Ronco C, McCullough P, Anker SD et al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur. Heart J. 2010;31 (6):703–711.
  2. Hillege HL, Girbes AR, De Cam PJ et al. Renal function, neurohormonal activation and survival in patients with chronic heart failure. Circulation. 2000;102 (2):203–210.
  3. Терещенко С. Н., Жиров И. В. Место ингибиторов ангиотензинпревращающего фермента в лечении кардиоренального синдрома. Справочник поликлинического врача. 2008;2:43–47.
  4. Балуда В. П., Балуда М. В., Гольдберг А. П. Претромботические состояния. Тромбоз и его профилактика. – М., «Зеркало-М», 1999. –297 с.
  5. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр). Журнал Сердечная Недостаточность. 2010;11 (1):3–62.
  6. Смирнов А. В., Шилов Е. М., Швецов М. В. и др. Хроническая болезнь почек: основные положения, определение, диагностика, скрининг, подходы к профилактике и лечению (проект Национальных рекомендаций). Нефрология. Доступно на http://journal.nephrolog.ru / ckd / 
  7. Lip GY, Ponikowski P, Andreotti F et al. Thrombo-embolism and antithrombotic therapy for heart failure in sinus rhythm. A joint consensus document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis. Eur J Heart Fail. 2012;14 (7):681–695.
  8. Fisher D, Rossa S, Landmesser U et al. Endothelial dysfunction in patients with chronic heart failure is incidence of hospitalization, cardiac transplantation, or death. Eur Heart J. 2005;26 (1):65–69.
  9. Gibbs CR,Blann AD, Watson RD et al. 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. Circulation. 2001;103 (13):1746–1751.
  10. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009;63 (10):1509–1515.
  11. Chu SG, Becker RC, Berger PB et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analisis. J. Tromb and Hemost. 2010;8 (1):148–156.
  12. Thompson CB, Jakubowski JA. The pathophysiology and clinical relevance of platelet heterogeneity. Blood. 1988;72 (1):1–8.
  13. Chong AY, Freestone B, Patel J et al. Endothelial activation, dysfunction, and damage in congestive heart failure and the relation to brain natriuretic peptide and outcomes. Am J Cardiol. 2006;97 (5):671–675.
  14. Шмелева В. М., Семенова О. Н., Папаян Л. П. и др. Активация системы гемостаза у пациентов с хронической сердечной недостаточностью. Вестник Санкт-Петербургского университета. 2009;11 (1):37–43.
  15. Thijs A, Nanayakkara PW, Ter Wee PM et al. Mild-to-moderate renal impairment is associated with platelet activation: a cross-sectional study. Clin Nephrol. 2008;70 (4):325–331.
  16. Stam F, van Guldener C, Becker A et al. Endothelial dysfunction contributes to renal function-associated cardiovascular morta­lity in a population with mild renal insufficiency: the Hoorn study. J Am Soc Nephrol. 2006;17 (2):537–545.
  17. Dubin R, Cushman M, Folsom AR et al. Kidney function and multiple markers: cross sectional associations in the multi-ethnic study of atherosclerosis. BMC Nephrol. 2011;12:3.
  18. Wakabayashi I, Masuda H. Association of D-dimer with microalbuminuria in patients with type 2 diabetes mellitus. J Thromb Thrombolysis. 2009;27 (1):29–35.
Mironchuk N. N., Mirsaeva G. Kh. Peculiarities of the hemostasis system associated with cardiorenal syndrome in patients with chronic heart failure of ischemic origin. Russian Heart Failure Journal. 2013;14 (6):334-340

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