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Open AccessArticle

Impaired Fibrinolysis in Patients with Isolated Aortic Stenosis is Associated with Enhanced Oxidative Stress

1
Institute of Cardiology, Jagiellonian University Medical College, 31-202 Krakow, Poland
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Krakow Center for Medical Research and Technologies, John Paul II Hospital, 31-202 Krakow, Poland
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Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
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Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland
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Department of Cardiac and Vascular Diseases, John Paul II Hospital, 31-202 Krakow, Poland
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KCRI, 30-055 Krakow, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 2002; https://doi.org/10.3390/jcm9062002
Received: 18 May 2020 / Revised: 18 June 2020 / Accepted: 23 June 2020 / Published: 25 June 2020
(This article belongs to the Section Vascular Medicine)
Aortic stenosis (AS) has been associated with impaired fibrinolysis and increased oxidative stress. This study aimed to investigate whether oxidative stress could alter fibrin clot properties in AS. We studied 173 non-diabetic patients, aged 51–79 years, with isolated AS. We measured plasma protein carbonylation (PC) and thiobarbituric acid reactive substances (TBARS), along with plasma clot permeability (Ks), thrombin generation, and fibrinolytic efficiency, which were evaluated by two assays: clot lysis time (CLT) and lysis time (Lys50). Coagulation factors and fibrinolytic proteins were also determined. Plasma PC showed an association with AS severity, reflected by the aortic valve area and the mean and maximum aortic gradients. Plasma PC was positively correlated with CLT, Lys50, plasminogen activator inhibitor-1 (PAI-1), and tissue factor (TF) antigens. TBARS were positively correlated with maximum aortic gradient, Lys50, and TF antigen. Regression analysis showed that PC predicted prolonged CLT (>104 min; odds ratio (OR) 6.41, 95% confidence interval (CI) 2.58–17.83, p < 0.001) and Lys50 (>565 s; OR 5.83, 95% CI 2.23–15.21, p < 0.001). Multivariate regression analysis showed that mean aortic gradient, PC, α2-antiplasmin, PAI-1, and triglycerides were predictors of prolonged CLT, while PC, α2-antiplasmin, and fibrinogen were predictors of Lys50. Our findings suggest that elevated oxidative stress contributes to impaired fibrinolysis in AS and is associated with AS severity. View Full-Text
Keywords: aortic stenosis; oxidative stress; fibrinolysis; α2-antiplasmin; PAI-1 aortic stenosis; oxidative stress; fibrinolysis; α2-antiplasmin; PAI-1
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Siudut, J.; Natorska, J.; Wypasek, E.; Wiewiórka, Ł.; Ostrowska-Kaim, E.; Wiśniowska-Śmiałek, S.; Plens, K.; Legutko, J.; Undas, A. Impaired Fibrinolysis in Patients with Isolated Aortic Stenosis is Associated with Enhanced Oxidative Stress. J. Clin. Med. 2020, 9, 2002.

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