Korean Circ J.  2006 Jun;36(6):418-423. 10.4070/kcj.2006.36.6.418.

The Role of Endothelial Dysfunction for Thromboembolic Risk of Patients with Atrial Fibrillation

• Park HW
• Yun NS
• Lim SY
• Lee SR
• Hong S
• Kim KH
• Sohn IS
• Hong YJ
• Kim JH
• Kim W
• Shin MG
• Ahn YK
• Jeong MH
• Cho JG
• Park JC
• Kang JC

• KMID: 2227107
• DOI: http://doi.org/10.4070/kcj.2006.36.6.418

Abstract

BACKGROUND AND OBJECTIVES: Thromboembolism (TE) is a common complication of atrial fibrillation (AF). Although several serum markers for TE in AF patients have been reported, the mechanisms for TE have not been completely determined.
SUBJECTS AND METHODS
Seventy four patients with persistent or permanent AF (M:F=39:35, mean age: 53+/-18 years) were enrolled. The epidemiologic risk factors for TE, including old age (> or =65 years), diabetes, hypertension, heart failure (HF), valvular heart disease, left ventricular (LV) dysfunction, and a history of TE were investigated. Serum markers for the endothelial function [von-Willebrand factor (vWF) and thrombomodulin (TM)], inflammation [quantitative and high sensitive C-reactive protein (CRP) and interleukin (IL)-6], coagulation [fibrinogen, fibrinogen degradation product (FDP), d-dimer] and platelet activity (p-selectin), and the echocardiographic parameters were measured.
RESULTS
The vWF was increased in patients with old age, hypertension, HF and a history of TE, and the vWF was positively correlated with age and the left atrium dimension (LAD), respectively. TM was also increased in the patients with old age and a history of TE and the LV dysfunction, and it was positively correlated with age and the LAD. The quantitative CRP was increased with old age, hypertension and LV dysfunction, and it was positively correlated with age and the LAD. High sensitive CRP was increased with old age and LV dysfunction, and it was positively correlated with age and the LAD. IL-6 was increased in diabetic patients. Fibrinogen was increased with old age and hypertension, and it was positively correlated with age and the LAD. FDP and d-dimer were increased in the patients with a history of TE and LV dysfunction. P-selectin was neither increased nor correlated with any other parameters. All the analyzed serum markers, except the markers for coagulation and platelet activity, were correlated with age and the LAD.
CONCLUSIONS
It was shown that endothelial dysfunction plays an important role for the TE in AF patients. The serum markers for endothelial function may be used to screen the AF patients who are at a high risk for TE.

Keyword

Atrial fibrillation; Thromboembolism

MeSH Terms

Atrial Fibrillation*
Biomarkers
Blood Platelets
C-Reactive Protein
Echocardiography
Fibrinogen
Heart Atria
Heart Failure
Heart Valve Diseases
Humans
Hypertension
Inflammation
Interleukin-6
Interleukins
P-Selectin
Risk Factors
Thromboembolism
Thrombomodulin
C-Reactive Protein
Fibrinogen
Interleukin-6
Interleukins
P-Selectin
Thrombomodulin