Exercise stress testing enhances blood coagulation and impairs fibrinolysis in asymptomatic aortic valve stenosis

Kolasa-Trela, Renata; Fil, Korneliusz; Wypasek, Ewa; Undas, Anetta

doi:10.1016/j.jjcc.2014.07.019

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…Asymptomatic patients with moderateto-severe aortic valve stenosis demonstrated prothrombotic alterations in coagulation and fibrinolysis markers during exercise stress testing, reacting to exercise with more prominent and extended thrombin production and impaired fibrinolysis. The authors of this study concluded that exercise-induced prothrombotic states may contribute to progression of the disease [90].…”

Section: Coagulation and Fibrinolysismentioning

confidence: 84%

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review

Skouras

Antonakis-Karamintzas

Tsantes

et al. 2023

Sports

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Hemostatic balance refers to the dynamic balance between blood clot formation (coagulation), blood clot dissolution (fibrinolysis), anticoagulation, and innate immunity. Although regular habitual exercise may lower the incidence of cardiovascular diseases (CVD) by improving an individual’s hemostatic profile at rest and during exertion, vigorous exercise may increase the risk of sudden cardiac death and venous thromboembolism (VTE). This literature review aims to investigate the hemostatic system’s acute and chronic adaptive responses to different types of exercise in healthy and patient populations. Compared to athletes, sedentary healthy individuals demonstrate similar post-exercise responses in platelet function and coagulatory and fibrinolytic potential. However, hemostatic adaptations of patients with chronic diseases in regular training is a promising field. Despite the increased risk of thrombotic events during an acute bout of vigorous exercise, regular exposure to high-intensity exercise might desensitize exercise-induced platelet aggregation, moderate coagulatory parameters, and up-regulate fibrinolytic potential via increasing tissue plasminogen activator (tPA) and decreasing plasminogen activator inhibitor (PAI-1) response. Future research might focus on combining different types of exercise, manipulating each training characteristic (frequency, intensity, time, and volume), or investigating the minimal exercise dosage required to maintain hemostatic balance, especially in patients with various health conditions.

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Section: Coagulation and Fibrinolysismentioning

confidence: 84%

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review

Skouras

Antonakis-Karamintzas

Tsantes

et al. 2023

Sports

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“…The same cohort was also investigated how stress echocardiography alters blood coagulation and fibrinolysis, as described in detail previously [22]. At rest AS patients had higher HGF and TGF-β but not IL-6, IL-10 and VEGF levels.…”

Section: Discussionmentioning

confidence: 99%

“…Sex- and age-matched individuals recruited from the hospital staff and relatives served as controls. The two groups have been described in detail previously [22]. Briefly, the exclusion criteria were: history of angina, myocardial infarction, stroke, dizziness, or syncope, another cardiac valve disease of more than a moderate degree, left ventricular (LV) ejection fraction (EF) <50%, prior or current atrial fibrillation, hyper- or hypothyroidism, diabetes treated with insulin, renal or liver dysfunction, chronic pulmonary disease, treatment with oral anticoagulants, thienopyridine or nonsteroidal anti-inflammatory drugs other than aspirin, known cancer, autoimmune disorders, inability to perform exercise testing.…”

Section: Methodsmentioning

confidence: 99%

Specific changes in circulating cytokines and growth factors induced by exercise stress testing in asymptomatic aortic valve stenosis

et al. 2017

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BackgroundWe evaluated exercise-induced changes in the profile of circulating cytokines and growth factors in patients with AS.MethodsWe studied 32 consecutive asymptomatic moderate-to-severe AS patients and 32 age and sex-matched controls. Plasma levels of interleukin (IL)-6, IL-10, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF)-β were measured at 4 time points, i.e. at rest, at peak bicycle exercise, one hour and 24 hours after a symptom-limited exercise.ResultsExercise increased all the 5 markers in both groups (all p<0.0001). The maximum levels of all tested cytokines were higher in the AS group (all p<0.05) compared with controls. In AS patients the highest levels of VEGF, IL-6, and IL-10 were observed one hour after exercise, while in the control group at peak exercise. In both groups maximum TGF- β levels were observed one hour after exercise. HGF levels were higher at peak and one hour after test in the AS group (p = 0.0001), however the maximum value in AS was observed at peak while in controls after test. In both groups TGF-β was the only marker that remained increased 24 hours after exercise compared with the value at rest (p = 0.0001). The cytokines and growth factors showed no association with heart rate and the workload.ConclusionIn asymptomatic patients with moderate-to-severe AS, exercise produces a different pattern of changes in circulating cytokines and growth factors, and maximum levels of all tested cytokines were significantly higher in AS patients compared with the control group.

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Impaired fibrinolysis in degenerative mitral and aortic valve stenosis

Mazur

Myć

Natorska

et al. 2018

J Thromb Thrombolysis

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Valvular heart disease is associated with an increased thromboembolic risk. Impaired fibrinolysis was reported in severe aortic stenosis (AS). Little is known about fibrinolysis in mitral stenosis (MS). We sought to compare fibrinolysis impairment in AS and MS. We studied 121 individuals scheduled for elective aortic valve (AV) or mitral valve (MV) surgery for AS (n = 76) or MS (n = 45), in order to compare fibrinolysis impairment. Fibrinolytic capacity was assessed by determination of clot lysis time (t) and fibrinolysis inhibitors, including plasma plasminogen activator inhibitor-1 (PAI-1) antigen (PAI-1:Ag) and activity, thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and activity. Prolonged t (+ 29%), elevated TAFI activity (+ 12%), TAFI:Ag (+ 21%), and PAI-1:Ag (+ 84%) were observed in patients with MS, compared with those with AS. t Correlated with mean and maximal MV gradients (r = 0.43, p < 0.0001 and r = 0.39, p < 0.0001, respectively), but not with AV gradients. Mean and maximal MV gradients correlated with TAFI activity and PAI:Ag. Patients with permanent atrial fibrillation (AF; 35 with MS and 5 with AS) had longer t (by 22%, p = 0.0002) and higher PAI-1:Ag (by 74%, p < 0.0001) than the remainder. In the whole group, postoperative drainage volumes correlated inversely with PAI-1:Ag (r = - 0.22, p = 0.02). MS is associated with more pronounced impairment of global fibrinolytic capacity than AS at the stage of surgical intervention, which is in part driven by AF. Our findings suggest that hypofibrinolysis might be implicated in the progression of MS and its thromboembolic complications.

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Exercise stress testing enhances blood coagulation and impairs fibrinolysis in asymptomatic aortic valve stenosis

Cited by 5 publications

References 32 publications

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review

The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review

Specific changes in circulating cytokines and growth factors induced by exercise stress testing in asymptomatic aortic valve stenosis

Impaired fibrinolysis in degenerative mitral and aortic valve stenosis

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