Fibrin Clot Properties and Thrombin Generation in Hypertrophic CardiomyopathyFunding This work was supported by the Department of Scientific Research and Structural Funds of Medical College, Jagiellonian University (grant K/ZDS/007912).
08 August 2019
21 August 2019
28 October 2019 (online)
Although most patients with hypertrophic cardiomyopathy (HCM) are oligosymptomatic with normal life expectancy, approximately one-fifth experience increased morbidity and mortality. There are a wide range of clinical manifestations of HCM including diastolic dysfunction, end-stage heart failure (HF), ischemia, left ventricular outflow tract (LVOT) obstruction, atrial fibrillation (AF), syncope, and sudden cardiac death (SCD). Thromboembolic (TE) events such as stroke are observed predominantly in patients with AF.  In a landmark study, TE complications were reported in 51 (6%) out of 900 ambulatory HCM patients over a period of 7 ± 7 years with an overall incidence of 0.8%/year and 1.9% for those > 60 years old. The independent predictors of TE complications were found to be AF, age, and HF. Of note, in 6 (12%) patients with TE complications, the etiology was not established.
Hypercoagulation has been demonstrated previously in HCM. However, blood coagulopathies in HCM patients have been poorly explored. An unfavorable fibrin clot phenotype, including the formation of dense and poorly lysable clots, has been reported in patients with TE events. Prothrombotic features have been demonstrated in AF patients with an increased risk of stroke. It is unknown whether HCM per se predisposes to a prothrombotic state. We investigated fibrin clotting properties and thrombin generation parameters in HCM patients without concomitant AF.
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