Archives of the Turkish Society of Cardiology
Improvement of endothelial function early after thrombolytic therapy in patients with prosthetic heart valve thrombosis [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2020; 48(6): 566-575 | DOI: 10.5543/tkda.2020.23621

Improvement of endothelial function early after thrombolytic therapy in patients with prosthetic heart valve thrombosis

Beytullah Çakal1, Macit Kalçık2, Ahmet Güner3, Mahmut Yesin4, Mustafa Ozan Gürsoy5, Sabahattin Gündüz6, Süleyman Karakoyun4, Emrah Bayam7, Semih Kalkan6, Mehmet Özkan8
1Department of Cardiology, İstanbul Medipol University Hospital, İstanbul, Turkey
2Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
3Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
4Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
5Department of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
6Department of Cardiology, Kartal Koşuyolu High Specialization Training and Research Hospital, İstanbul, Turkey
7Department of Cardiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
8Division of Health Sciences, Ardahan University, Ardahan, Turkey


OBJECTIVE
Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients.

METHODS
The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7±13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia.

RESULTS
The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31±0.76% vs. 5.87±0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65±0.86% vs. 7.13±1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07±0.61% vs. 5.38±0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31±0.76% vs. 8.22±1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87±0.84% vs. 6.11±0.95%; p=0.276).

CONCLUSION
This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.

Keywords: Echocardiography, endothelial functions; flow-mediated dilatation; prosthetic valve thrombosis; transesophageal echocardiography.

How to cite this article
Beytullah Çakal, Macit Kalçık, Ahmet Güner, Mahmut Yesin, Mustafa Ozan Gürsoy, Sabahattin Gündüz, Süleyman Karakoyun, Emrah Bayam, Semih Kalkan, Mehmet Özkan. Improvement of endothelial function early after thrombolytic therapy in patients with prosthetic heart valve thrombosis. Turk Kardiyol Dern Ars. 2020; 48(6): 566-575

Corresponding Author: Macit Kalçık, Türkiye
© Copyright 2020 Archives of the Turkish Society of Cardiology
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