engleski

Platelet reactivity in advanced chronic left heart failure with secondary pulmonary artery hypertension - A hidden potential tool in patient management?

Background: Pulmonary artery hypertension (PAH) caused by chronic heart failure (HF) has a large impact on patient outcomes. Both systolic and diastolic HFcause an increased left atrial filling pressure and a postcapillary PAH which, if left untreated, eventually induces irreversible structural changes in pulmonary arteries. Pathogenetic pathway leading towards elevated pulmonary vascular resistance(PVR) in idiopathic PAH is based on vasoconstriction, inflammation, thrombosis and vascular proliferation. Platelets are known mediators in each of these processes and have been shown to have an important role in the development of idiopathic PAH.However, the extent to which platelets are involved in the pathogenesis of secondary PAH, especially due to HF, remains unclear and insufficiently explored.Purpose: We investigated whether platelet reactivity (PR) correlates to the level ofPAH and/or the reversibility of pulmonary artery haemodynamics in patients with advanced HF.Methods:Platelet reactivity was tested using Multiplate function analyzer (ASPI, ADP, COL, TRAP tests) in patients with advanced chronic HF undergoing diagnostic evaluation at our department. Blood samples were taken directly from Swan- Ganzcatheter during the right heart catheterization before and immediately after PVRreversibility tests was performed using intravenous prostaglandins. Results:Herein, we report analyzed data collected on 75 patients (84% male, meanage 57.1±11.5 y), most of which suffer from either dilated or ischemic cardiomyopathy. Arachidonic acid mediated PR (ASPI test) showed statistically significant correlation with changes in transpulmonary pressure gradient during reversibility test (R=-0.348, P=0.037), while changes in ASPI, ADP and COL tests correlated significantly to changes in PAPm (R=0.589, P=0.000 ; R=0.406, P=0.021 ; R=0.607, P=0.004, respectively).Conclusion:Although the present sample size is insufficient to confirm our hypotheses, current results suggest that PR has a significant role in pulmonary vasculature changes in patients with PAH (WHO II). Results warrant further research to determine whether platelet function testing might have a potential role in routine managementof these patients.

Platelet reactivity, heart failure, pulmonary artery hypertension

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