Patients with acute coronary syndromes have low tissue factor activity and microparticle count,but normal concentration of tissue factor antigen in platelet free plasma – a pilot study

Objectives: Tissue factor (TF) is a main initiator of coagulation cascade. Its determination in conditions of acute coronary syndrome is logistically difficult. Hence, in our study, the activity and the concentration of TF and the count of microparticles in the platelet free plasma (PFP) were determined. Methods: Blood was drawn from both coronary sinus and femoral vein circulation in a cohort of 40 patients. TF activity was measured by activation of factor X in the presence of factor VIIa, whereas microparticles were detected using flow cytometry. TF antigen concentrations were determined using the ELISA test. Results: TF activity in the stable angina subgroup was not significantly different from the control group (18.12 ± 3.35 mOD/min vs. 17.72 ± 4.05 mOD/min, respectively), but it was significantly lower in the unstable angina (7.62 ± 4.19 mOD/min) and myocardial infarction (MI) (3.56 ± 3.85 mOD/min) subgroups (P < 0.05). Results from the coronary sinus and femoral vein circulations were not significantly different. The count of microparticles decreased according to the severity of the acute coronary syndrome: control group, 520 ± 172; stable angina subgroup, 532 ± 167; unstable angina subgroup, 392 ± 142; and MI subgroup, 165 ± 30 (P < 0.05). There were no significant differences in concentrations of TF antigen in four subgroups. Conclusions: These results suggest that the procoagulant TF‐bearing microparticles could be recruited from PFP by interaction with platelets and blood cells in the conditions of acute coronary syndrome.     

Age-related hemodynamic and morphologic differences in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

BACKGROUND: Alcohol septal ablation (ASA) decreases the left ventricular (LV) outflow gradient and relieves symptoms in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to evaluate the early course of hemodynamic, morphologic and clinical changes in younger and elderly patients. METHODS AND RESULTS: Forty-four consecutive patients (age, 24-81 years) underwent the ASA procedure for HOCM. Clinical and echocardiographic data were obtained at baseline and periodically up to 12 months after ASA. There was a significant correlation between septum thickness and age at baseline and in the early post procedural period (p = 0.004 at baseline, p = 0.0033 days postoperative, p = 0.0193 weeks pos operative). The dependence of septal thickness on the duration of follow-up (p < 0.001) was significantly influenced by age (p = 0.026), which retained statistical significance after multivariate adjustment (p = 0.031). A decrease in the gradient of the LV outflow was identified in all age-related groups of patients (p < 0.001). After multivariate adjustment, there was a significant influence of age (p = 0.003) and creatine kinase-MB peak (p = 0.016) on the course of outflow gradient reduction. CONCLUSIONS: ASA is an effective treatment option for patients with HOCM, irrespective of their age. Younger patients are characterized by a thicker basal septum at baseline and a slower hemodynamic improvement within the early post procedural period.     

Increased risk of traffic accidents in subjects with latent toxoplasmosis: a retrospective case-control study

Background

The parasite Toxoplasma gondii infects 30–60% of humans worldwide. Latent toxoplasmosis, i.e., the life-long presence of Toxoplasma cysts in neural and muscular tissues, leads to prolongation of reaction times in infected subjects. It is not known, however, whether the changes observed in the laboratory influence the performance of subjects in real-life situations.

Methods

The seroprevalence of latent toxoplasmosis in subjects involved in traffic accidents (N = 146) and in the general population living in the same area (N = 446) was compared by a Mantel-Haenszel test for age-stratified data. Correlation between relative risk of traffic accidents and level of anti-Toxoplasma antibody titre was evaluated with the Cochran-Armitage test for trends.

Results

A higher seroprevalence was found in the traffic accident set than in the general population (Chi²_MH = 21.45, p < 0.0001). The value of the odds ratio (OR) suggests that subjects with latent toxoplasmosis had a 2.65 (C.I.₉₅= 1.76–4.01) times higher risk of an accident than the toxoplasmosis-negative subjects. The OR significantly increased with level of anti-Toxoplasma antibody titre (p < 0.0001), being low (OR = 1.86, C.I.₉₅ = 1.14–3.03) for the 99 subjects with low antibody titres (8 and 16), higher (OR = 4.78, C.I.₉₅ = 2.39–9.59) for the 37 subjects with moderate titres (32 and 64), and very high (OR = 16.03, C.I.₉₅ = 1.89–135.66) for the 6 subjects with titres higher than 64.

Conclusion

The subjects with latent toxoplasmosis have significantly increased risk of traffic accidents than the noninfected subjects. Relative risk of traffic accidents decreases with the duration of infection. These results suggest that 'asymptomatic' acquired toxoplasmosis might in fact represent a serious and highly underestimated public health problem, as well as an economic problem.

     

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