Laura Sabatini

Correlation between left atrial size, prothrombotic state and markers of endothelial dysfunction in patients with lone chronic nonrheumatic atrial fibrillation

Atrial fibrillation is associated with a prothrombotic state and endothelial dysfunction. To understand whether the prothrombotic state was correlated with endothelial dysfunction and whether the latter was related to atrial dimension (endocardial damage), we studied systemic hemocoagulative activity and markers of endothelial dysfunction in 45 patients with chronic nonrheumatic atrial fibrillation and in 35 controls. We assessed fibrinogen, antithrombin III, protein C, markers of platelet activation (platelet factor 4 and beta-thromboglobulin) as markers of fibrinolysis, and D-dimer, tissue plasminogen activator, plasminogen activator inhibitor, von Willebrands factor and soluble thrombomodulin as endothelial dysfunction. Plasma fibrinogen (P<0. 005), platelet factor 4 (P<0.001), thromboglobulin (P<0.001), D-dimer (P<0.03), tissue plasminogen activator (P<0.006), plasminogen activator inhibitor (P<0.04) and both von Willebrands factor (P<0.0001) and soluble thrombomodulin (P<0.03) were significantly higher in the patients than in the controls. Positive significant linear correlations were found between fibrinogen and markers of endothelial dysfunction and left atrial volume and fibrinogen or markers of endothelial dysfunction. These findings confirm that chronic nonrheumatic atrial fibrillation is associated with a prothrombotic state but also suggest that there is a correlation between endothelial dysfunction, coagulation factors and left atrial dimension.

Levels of antibodies against protein C and protein S in pregnancy and in preeclampsia

Objectives. The clinical relevance of antibodies anti-protein C and anti-protein S in pregnancy remains controversial. We evaluate whether, in the absence of thrombophilic diseases, maternal plasma levels of antibodies (IgM and IgG) change during pregnancy and in preeclampsia (PE), with and without superimposed fetal growth restriction (FGR). Methods. A retrospective cohort of 50 women with PE (n = 30) and PE + FGR (n = 20) and 70 controls [first trimester (n = 20); second trimester (n = 20); third trimester (n = 30)] were enrolled in the study. Results. In healthy pregnant women, plasma levels of anti-protein C antibodies decreased from first to third trimester and were below the range of positivity. IgM anti-protein-C and anti-protein-S were significantly higher (P < 0.001) in both PE (23.88 ± 10.65 MoM and 43.90 ± 20.45 MoM, respectively) and PE + FGR group (15.95 ± 12.62 MoM and 36.02 ± 27.43 MoM, respectively) than in control group (2.23 ± 3.23 MoM and 1.68 ± 4.075 MoM, respectively), in the presence of unchanged levels of IgG isotype. Conclusions. In this study, we first found that the production of anti-protein C and anti-protein S antibodies decreases throughout healthy pregnancies, while they circulate in high levels in women with PE and PE/FGR.

Myocardial infarction and arterial thrombosis in identical newborn twins with homozygosity for the PAI-1 4 G/5 G polymorphism

Myocardial infarction in the perinatal period, in the absence of congenital heart disease or coronary artery lesions, is rare. The most common etiology described are the thromboembolism and perinatal asphyxia. We report a case of monozygotic twins who developed, after birth, acute vascular events and both had PAI-1 4G/4G homozygosity.

Maternal serum protein S forms in pregnancies complicated by intrauterine growth restriction

OBJECTIVES The clinical relevance of protein S deficiency in pregnant women remains controversial. Major debate exists regarding which parameter (total protein S antigen, free protein S antigen or functional protein S) should be evaluated in order to define protein S deficiency. The present study aimed to identify which of these parameters correlate with intrauterine growth restriction (IUGR). STUDY DESIGN A retrospective case-control study of women with IUGR (n=27) and healthy controls (n=123) in the third trimester of pregnancy. RESULTS The maternal serum of women in the IUGR group had significantly lower levels of functional and free protein S compared with the control group: 54.07 ± 24.72% vs 65.20 ± 17.95% (p<0.005) and 42.88 ± 11.01% vs 56.64 ± 13.30% (p<0.0001), respectively. No significant correlation was found between total protein S and IUGR. CONCLUSIONS Levels of functional and free protein S are correlated with IUGR.

Factor II: C activity and uterine artery Doppler evaluation to improve the early prediction of pre-eclampsia on women with gestational hypertension.

Objective To evaluate whether the determination of maternal plasma Factor II:C (FII:C) and mean uterine artery resistance index may be useful to early predict pre-eclampsia in patients with gestational hypertension. Design Prospective study. Setting Consecutive enrollment in a public tertiary clinical care centre. Patients A total of 65 women with gestational hypertension at 24–26 weeks. Intervention Measurements of maternal plasma FII:C activity levels, ultrasonographic biometrical parameters and Doppler velocimetry of maternal uterine arteries. Main outcome measure(s) The probability of developing pre-eclampsia was the main outcome of the study and it was computed by combining the FII:C and the mean uterine artery resistance index cut-off points, chosen by receiver operating characteristic (ROC) curve analysis. Results F-II:C activity levels and mean uterine artery resistance index were significantly (both P < 0.01) higher in women who developed pre-eclampsia. A weak, but significant correlation (r = 0.3, P < 0.05) was found between these two parameters. FII:C activity levels at the cut-off value of 136.5% achieved a sensitivity of 61.1% and a specificity of 71.3%, while mean uterine artery resistance index (RI) at the cut-off value of 0.57 showed a sensitivity of 85.7% and a specificity of 90.2% in predicting the onset of pre-eclampsia. When both FII:C and mean uterine RI were over the cut-off points the positive predictive value was of 89%, with a 100% negative predictive value when both were below the cut-off points. Conclusion F-II:C activity levels and mean uterine artery resistance index determination at mid trimester may improve the prediction of superimposed pre-eclampsia on women with early onset gestational hypertension.