Archives of the Turkish Society of Cardiology
Improvement of endothelial functions early after thrombolytic therapy in patients with prosthetic heart valve thrombosis [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. Ahead of Print: TKDA-23621 | DOI: 10.5543/tkda.2020.23621

Improvement of endothelial functions 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, Istanbul Medipol University Hospital, Bagcilar, Istanbul, 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, Istanbul, Turkey
4Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
5Department of Cardiology, Izmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey
6Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
7Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
8Division of Health Sciences, Ardahan University, Ardahan, Turkey


OBJECTIVE
Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Recently, thrombolytic therapy (TT) has been widely used as a first-line treatment for PVT. Previously, endothelial dysfunction has been reported in patients with PVT. In this study, we aimed to investigate the alterations in endothelial functions early after TT in PVT patients.

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

RESULTS
The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. Obstructive PVT patients had lower baseline FMD values than 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 successfully thrombolysed patients after TT (5.65±0.86 vs. 7.13±1.26 %; p<0.001). There was no significant difference in 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 significant for patients with non-obstructive PVT (5.87±0.84 vs. 6.11±0.95 %; p=0.276).

CONCLUSION
This study demostrated that successful TT may contribute to improvement of imparied endothelial functions in patients with obstructive PVT.

Keywords: Echocardiography, endothelial functions, flow mediated dilation, prosthetic valve thrombosis, transesophageal echocardiography

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