P186	Endothelium-depent prothrombotic and fibrinolytic factors in patients with ischemic heart disease and chronic heart failure.
1E.V.Shlyakhto, 1K.A.Khmelnitskaya, 2M.U.Sitnikova
1Pavlov State Medical University, Saint Petersburg, RU; 2Almazov Research Institute of Cardiology, Saint Petersburg, RU.

AIM: To investigate the hypothesis that abnormalities of endothelial-dependent hemostasis [von Willebrand factor (vWf), tissue plasminogen activator (tPA)], and endothelial damage [circulating endothelial cells (CECs), an index of endothelial damage] would exist in patients with chronic heart failure (CHF). METHODS: In study we have investigated plasma levels of vWf, tPA-antigen, number of CECs in 108 patients with ischemic heart disease and stable CHF I-IV class (NYHA), who were compared with 30 age-matched patients with ischemic heart disease without CHF and 27 age-matched healthy control subjects. RESULTS: There was an increase in the number CECs in patients with CHF compared with group of without CHF (P=0.002) and with group of healthy controls (P=0.001). Patients with more severe symptoms CHF (class III–IV) had higher CECs (P=0.01), vWf (P=0.02) levels, lower tPA-antigen (P=0.1) levels, than those with milder symptoms (class I-II). A significant increase number of CECs (P=0.05), a level of vWf (P=0.05), a decrease of tPA-antigen (P=0.05) and prolongation euglobulin clot lysis time (P=0.05) were detected in patients CHF with left ventricular aneurism. There were significant correlations between amount of CECs (r=0.28, P=0.003), level of vWf (r= 0.22, P=0.008) and NYHA class; number of CECs (r=0.19, P=0.04), levels of vWf (r=0.25, P=0.04), tPA-antigen (r=-0.28, P=0.05) and presence of left ventricular aneurism; a quantity of CECs (r=0.26, P=0.006) and left ventricular ejection fraction. CONCLUSIONS: Abnormalities of endothelial thrombogenicity (increase of vWf and marker of endothelial damage-CECs) and thromboresistance (reduction of tPA) may contribute to a hypercoagulable state in CHF, especially in patients with more severe NYHA class. There were activation of hemostatic potential (elevation of vWf, number of CECs) and fibrinolisis reduction (decrease of tPA-antigen and prolongation of euglobulin clot lysis time) in patients CHF with left ventricular aneurism. KEYWORDS: ENDOTHELIUM, ENDOTHELIUM-DEPENT FACTORS, VON WILLEBRAND FACTOR, TISSUE PLASMINOGEN ACTIVATOR, CIRCULATING ENDOTHELIAL CELLS, THROMBOSIS, COAGULATION, HEART FAILURE.

Copyright © 2005 S. Karger AG, Basel. Any further use of this abstract requires written permission from the publisher.