Insuficiencia Cardiaca Congestiva

642

CONTINUING MEDICAL EDUCATION
Medicina (Kaunas) 2010;46(9):642-7

The coagulation system changes in patients with chronic heart failure
Aušra Mongirdienė1, 2, Lolita Kuršvietienė2, Artūras Kašauskas2
2

Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Department of Biochemistry, Medical Academy, Lithuanian University of Health Sciences, Lithuania
1Key words: chronic heart failure; coagulation system; fibrinogen; platelets; endothelium. Summary. Though heart failure can mainly be caused by systolic or diastolic dysfunction, the impairments of the neurohormonal, immune, and hemostatic systems are observed too. Therefore, it is not easy to determine etiology of the syndrome. Parameters that can be helpful to predict chronic heart failure,to evaluate its course and the risk of complications are still being searched. The aim of this article is to review the recent studies in order to find the links between the coagulation system and the development of chronic heart failure. Stress is a key factor for the development of most diseases including chronic heart failure too. Signals of emotional and physical stress via particularstructures trigger an increase in concentrations of the following hormones: noradrenaline, renin, angiotensin II, aldosterone, vasopressin. It is proved that it causes the disorders of the coagulation system: an increase in the following factors of plasma coagulation (fibrinogen, VII, VIII, fibrinopeptide A, thrombinantithrombin complex), fibrinolysis (D-dimer), endothelium (interleukin 1, endothelin 1,vascular cell adhesion molecules, endothelial growth factor), platelet activity (von Willebrand factor, intercellular adhesion molecules, platelet factor 4, P-selectin, thromboxane A2, thromboglobulin, CD63P) and cytokines (tumor necrosis factor, interleukin 6) and decrease in E-selectin. The role of particular coagulation factors for the development of chronic heart failure has not been understoodyet. Thus, it is necessary to carry out further studies. Introduction In the general European population, the prevalence of symptomatic heart failure ranges from 0.4% to 2%. More frequently, it afflicts older subjects (1). Heart failure (HF) carries a poor prognosis if the cause of disease cannot be removed. Around half of patients with chronic HF (CHF) die within 4 years (2). A growing number ofrisk factors (non–insulin-dependent diabetes mellitus, overweight, aging population, and others) may contribute to new incidences of heart failure (3). Accurate diagnostics of CHF and its etiological factors is more complicated among older patients because of comorbidity. Diagnosis based only on clinical presentation may be not correct. An accurate diagnosis is required to apply an optimaltreatment aimed at removal the cause of the disease. A key factor for the development of CHF is heart dysfunction, accompanied by impairments of the
Correspondence to A. Mongirdienė, Department of Biochemistry, Medical Academy, Lithuanian University of Health Sciences, Eivenių 4, 50161 Kaunas, Lithuania E-mail: ausra.mongirdiene@mail.com

peripheral circulation, particularly, in kidney and skeletalmuscles. Activation of the neuroendocrine system is common in CHF. It is proved that activation of different inflammatory markers has an effect on cardiac dysfunction and the progression of CHF clinical syndrome (4–6). Although the importance of neuroendocrine mechanisms in the pathogenesis of CHF is recognized, still their role in diagnostics is unclear. Cohort studies have proved thatconcentrations of circulating hormones (noradrenalin, renin, angiotensin II, aldosterone, vasopressin) and hemostasis markers (endothelin 1, fibrinogen, and others) are linked to severity and prognosis of CHF; however, it is difficult to interpret these predictors in every case. Diuretics, vasodilatators, ACE inhibitors, and β-adrenoblockers alter the concentrations of blood neuroendocrine substances...