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Platelet hyperaggregability in patients with atrial fibrillation

Evidence of a background proinflammatory milieu

Thrombozytenhyperaggregabilität bei Patienten mit Vorhofflimmern

Hinweise auf ein proinflammatorisches Milieu

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Abstract

Objective

Atrial fibrillation (AF) is a condition where platelet hyperaggregability is commonly present. We examined potential physiological bases for platelet hyperaggregability in a cohort of patients with acute and chronic AF. In particular, we sought to identify the impact of inflammation [myeloperoxidase (MPO) and C-reactive protein (CRP)] and impaired nitric oxide (NO) signaling.

Methods

Clinical and biochemical determinants of adenosine diphosphate (ADP)-induced platelet aggregation were sought in patients (n = 106) hospitalized with AF via univariate and multivariate analysis.

Results

Hyper-responsiveness of platelets to ADP was directly (r = 0.254, p < 0.01) correlated with plasma concentrations of thrombospondin-1 (TSP-1), a matricellular protein that impairs NO responses and contributes to development of oxidative stress. In turn, plasma TSP-1 concentrations were directly correlated with MPO concentrations (r = 0.221, p < 0.05), while MPO concentrations correlated with those of asymmetric dimethylarginine (ADMA, r = 0.220, p < 0.05), and its structural isomer symmetric dimethylarginine (SDMA, r = 0.192, p = 0.05). Multivariate analysis identified TSP-1 (β = 0.276, p < 0.05) concentrations, as well as female sex (β = 0.199, p < 0.05), as direct correlates of platelet aggregability, and SDMA concentrations (β = − 0.292, p < 0.05) as an inverse correlate.

Conclusion

We conclude that platelet hyperaggregability, where present in the context of AF, may be engendered by impaired availability of NO, as well as via MPO-related inflammatory activation.

Zusammenfassung

Ziel

Bei Vorhofflimmern ist oft eine Hyperaggregabilität der Thrombozyten vorhanden. Mögliche physiologische Gründe dafür wurden in einer Kohorte von Patienten mit akutem oder chronischem Vorhofflimmern untersucht. Insbesondere wurde die Rolle von Entzündungsparametern evaluiert, namentlich Myeloperoxidase, C-reaktives Protein und eventuelle Störungen im Stickstoffmonoxid(NO)-Signalweg.

Methoden

Bei 106 wegen Vorhofflimmerns stationär aufgenommenen Patienten wurden klinische und biochemische Ursachen der adenosindiphosphatinduzierten Thrombozytenaggregation mittels univariater und multivariater statistischer Analysen untersucht.

Ergebnisse

Die Hyperreaktivität von Thrombozyten auf ADP war direkt (r = 0,254; p < 0,01) mit der Plasmakonzentration von Thrombospondin-1 (TSP-1) korreliert, einem Matrixprotein, das die Funktion von NO inhibiert und damit zum oxidativen Stress beiträgt. Plasmathrombospondin-1 korrelierte dagegen mit der Plasma-MPO-Konzentration (r = 0,221; p < 0,05). MPO wiederum korrelierte signifikant mit asymmetrischem Dimethylarginin (ADMA, r = 0,220; p < 0,05) und auch dessen strukturellem Isomer, dem symmetrischen Dimethylarginin (SDMA, r = 0,192; p = 0,05). Die multivariate Analyse ergab, dass eine direkte Korrelation der Thrombozytenhyperreaktivität mit dem Plasma-TSP-1 (β = 0,276; p < 0,05) und weiblichem Geschlecht bestand, während die Plasma-SDMA-Konzentration eine negative Korrelation aufwies (β = − 0,292, p < 0,05).

Schlussfolgerung

Die Hypothese der Autoren lautet, dass die bei Vorhofflimmern auftretende Thromozytenhyperaggregabilität durch eine geringere Verfügbarkeit von NO und auch durch einen MPO-induzierten Entzündungszustand bedingt sein könnte.

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Acknowledgments

This investigation was supported by an NHMRC Program Grant and the NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease. Nathan Procter is supported by The University of Adelaide and the Basil Hetzel Institute for Translational Research. Jocasta Ball and Simon Stewart are supported by the National Health and Medical Research Council. Jeffrey Isenberg is supported by NIH grants P01 HL103455, R01 HL-108945, R01 HL112914-01A1, and also by the Institute for Transfusion Medicine, the Hemophilia Center of Western Pennsylvania, as well as the Vascular Medicine Institute.

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Authors and Affiliations

  1. Basil Hetzel Institute, Department of Cardiology, The Queen Elizabeth Hospital, University of Adelaide, Cardiology Unit, 28 Woodville Rd, Woodville South, 5011, SA, Australia

    Nathan E.K. Procter, Doan T.M. Ngo, Yuliy Y. Chirkov &  John D. Horowitz

  2. National Health and Medical Research Council (NHMRC) Centre of Research Excellence to Reduce Inequality in Heart Disease, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    Jocasta Ball & Simon Stewart

  3. Heart, Lung, Blood and Vascular Medicine Institute, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Jeffrey S. Isenberg

  4. School of Medicine, Boston University, Boston, MA, USA

    Elaine M. Hylek

  5. Baker IDI Heart and Diabetes Institute, Melbourne, Australia

    Simon Stewart

Authors
  1. Nathan E.K. Procter
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  2. Jocasta Ball
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  3. Doan T.M. Ngo
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Corresponding author

Correspondence to John D. Horowitz.

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Conflict of interest

J.S. Isenberg is Chair of the Scientific Advisory Boards of Vasculox, Inc. (St. Louis, MO) and Radiation Control Technologies, Inc. (RCT1; New York, NY) and holds equity in the same.

N.E.K. Procter, J. Ball, D.T.M. Ngo, Y.Y. Chirkov, E.M. Hylek, S. Stewart, and J.D. Horowitz state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Procter, N., Ball, J., Ngo, D. et al. Platelet hyperaggregability in patients with atrial fibrillation. Herz 41, 57–62 (2016). https://doi.org/10.1007/s00059-015-4335-y

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  • DOI: https://doi.org/10.1007/s00059-015-4335-y

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