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Todua et al. Homocysteine in pulmonary artery thromboembolism

INTRODUCTION diseases, such as venous and arterial thromboses,
pulmonary embolism, stroke and myocardial infarction.
Pulmonary artery thromboembolism (PATE) is an acute Hyperhomocysteinemia can suppress a whole range
occlusion of the pulmonary trunk, or its branches, with of anti-coagulating mechanisms, which involve the
thrombi, formed in the veins of the greater circulation, mediation of the vascular endothelium in pathological
or in the cavities of the right section of the heart. Modern processes, and as a result, even a moderate increase
medical literature uses the term pulmonary embolism. in homocysteine levels in the blood can cause not only
More than 500,000 cases of pulmonary embolism are arterial thrombosis and atherosclerosis, but also vein
diagnosed annually. [1-3] thrombosis. [6-8]

Modern diagnostics of PATE have faced substantial Evaluation of D-dimer levels has an active application
difficulties, associated with polymorphism of developing in current clinical practice, and provides additional
clinical syndromes; suddenness and catastrophic information for thrombosis diagnostics (D-dimers
speed of disease development, and the lack of are molecules that circulate in the blood during the
highly informative methods of investigation (perfusive development of thrombi, which can be resolved under
scintigraphy of the lungs, pulmoangiography) in some the action of a fibrinolytic system). [9,10]
hospitals. [3-5]
METHODS
The diagnostic problems that need to be solved when
patients have suspected PATE are: The aim of our investigation was to assess the
(1) to confirm the presence of an embolism; importance of measuring D-dimer and homocysteine
(2) to determine the exact location of the levels, along with the use of multilayer computer
thromboembolism in pulmonary vessels; tomography (CT), in the diagnosis of patients with
(3) to determine the rate of embolic damage of suspected PATE.
pulmonary vessel beds;
(4) to assess the haemodynamic state in the greater We examined 54 patients (31 males and 23 females)
circulation and the lesser circulation; from 18 to 76 years of age, who were suffering
(5) to ascertain the source of the embolism and to from conditions and complaints that are typical of
assess the probability of relapse. PATE, such as chest pain, haemoptysis, dyspnoea,
tachycardia, arterial hypotension and signs of vein
Venous thromboembolism (VTE) is associated with thrombosis in the inferior limbs. In 51 patients (94.4%),
a 5% to 27% annual risk of recurrence after the PATE was evident in different localizations at varying
discontinuation of anticoagulant (AC) therapy, and rates of severity.
indefinite AC treatment is recommended if the bleeding
risk is low-to-moderate. However, in one-third of A total of 27 healthy persons, with an average age
patients with unprovoked VTE, the risk of recurrence of 52.3 ± 1.3 years old, formed a control group. The
is so low (< 3% per year) that AC therapy > 3 months investigation was randomized, as we did not include
may not be necessary. [4,5] patients with normal values of D-dimer, and there
were no patients with the above mentioned complains
Pulmoangiography is the method of choice in pulmonary (chest pain, haemoptysis, dyspnoea, tachycardia,
embolism diagnostics. However, this examination is arterial hypotension and signs of vein thrombosis in
associated with discomfort, elevated cost, and the risk the inferior limbs). All investigations were conducted at
of serious complications, typical of invasive procedures. the Research Institute of Clinical Medicine.
Ventilation-perfusion scintigraphy is widely used at
the initial stage of revealing pulmonary embolism, but D-dimer levels were measured in patients with
the validity of the method is limited due to numerous suspected PATE using enzyme-linked immunosorbent
uncertain conclusions. Precise presentation of assays. Patients with D-dimer levels > 500 ng/L were
pulmonary architectonics has become possible since subjected to ultrasonic scanning of proximal veins of
the invention of spiral, and then multilayer scanners, inferior limbs with compression, and to multilayer CT.
which can provide a higher accuracy of diagnostics. [3,5] Homocysteine levels were measured by an enzymatic
method using the biochemical analyser COBAS
It should also be noted that numerous retrospective INTEGRA 400 PLUS (Roche Diagnostics).
and prospective investigations have shown a close
interdependence between homocysteine (a sulphur- Multilayer CT (МLCТ) was carried out using the
containing amino acid that is an intermediate product of Siemens SOMATOM Sensation 16 Cardiac. During
methionine and cysteine exchange) and cardiovascular MLCT-pulmoangiography after native examination of
Vessel Plus ¦ Volume 1 ¦ March 31, 2017 39