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Kim, Chang, Kim, Kim, Chang, Ahn, Kim, Kwak, and Choi: Alteration of Coagulation and Fibrinolysis System According to Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(6): 625-630.

Published online: 30 June 2006

DOI: https://doi.org/10.4046/trd.2006.60.6.625

Alteration of Coagulation and Fibrinolysis System According to Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease

Young Kim, M.D.1, 2, Yoon Soo Chang, M.D.1, Hyung Jung Kim, M.D.1, Se Kyu Kim, M.D.1, Joon Chang, M.D.1, Chul Min Ahn, M.D.1, Sung Kyu Kim, M.D.1, Jin Young Kwak, M.D.2, Jin Hwa Choi, M.D.2

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.

Address for correspondence: Hyung Jung Kim, M.D. Address: 146-92, Dogok-dong, Kangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3316, Fax: 82-2-3463-3882, khj@yumc.yonsei.ac.kr

Received 11 May 2006       Accepted 12 June 2006

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Pulmonary hypertension in COPD patients is the result of a direct effect of tobacco smoke on the intrapulmonary vessels with the abnormal production of the mediators that control vasoconstriction, vasodilatation, and vascular cell proliferation, which ultimately lead to aberrant vascular remodeling and physiology. COPD patients are prone to the developmint of an acute and chronic thromboembolism with an elevation of the plasma procoagulant and fibrinolytic markers However, the roles of the coagulation and fibrinolysis system on the right ventricular dysfunction in COPD patients are not well defined. We examined the alteration of the coagulation and fibrinolysis system in COPD patients according to the right ventricular function measured using cardiac multidetector computed tomography (MDCT).

Methods

The right ventricular ejection fraction (RVEF) was measured using cardiac MDCT in 26 patients who were diagnosed with COPD according to the definition of the GOLD guideline. The plasma level of thrombin antithrombin (TAT) and plasminogen activator inhibitor (PAI)-1 were measured using an enzyme linked immunoassay.

Results

The plasma TAT was markedly elevated in COPD patients (10.5±19.8 µg/L) compared with those of the control (3.4±2.5 µg/L) (p<0.01). However, the plasma PAI-1 in COPD patients (29.6±20.7 ng/mL) was similar to that in the controls. The plasma TAT showed a significant inverse relationship with the RVEF measured by the cardiac MDCT in COPD patients (r=-0.645, p<0.01). However, the plasma PAI-1 did not show a relationship with the RVEF (r=0.022, p=0.92).

Conclusion

These results suggest that the coagulation system in COPD patients is markedly activated, and that the plasma level of TAT might be a marker of a right ventricular dysfunction in COPD patients.

Keywords: Chronic obstructive pulmonary disease, Pulmonary hypertension, Right ventricular failure, Thrombin antithrombin, Plasminogen activator inhibitor-1

Figures and Tables

Figure 1
Correlation between RVEF measured by MDCT and plasma TAT in 26 COPD patients.
trd-60-625-g001
Figure 2
Correlation between RVEF measured by MDCT and plasma PAI-1 in 26 COPD patients.
trd-60-625-g002
Table 1
Clinical characteristics of subjects
trd-60-625-i001

Values are mean±SD except for frequency data.

*PaO2 and PaCO2 values after nasal oxygen supply.

Table 2
Correlations between RVEF measured by MDCT and clinical characteristics of 26 COPD patients
trd-60-625-i002

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