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Todua et al. Homocysteine in pulmonary artery thromboembolism

[Table 1]. MLCT and pulmoangiography revealed revealing an anatomic picture of the disease. [7,9]
pulmonary infarction of various sizes and localization
in 13 (24%) patients, while in 41 (76%) patients, these On the basis of numerous results, obtained during
signs were absent. According to the statistics, PATE the investigation of haemostasis and homocysteine,
causes complications in the form of infarction in 10- according to which homocysteine can cause a
30% of cases. damaging effect on thrombocytes, the interdependence
between the rate of D-dimer changes and observed
DISCUSSION hyperhomocysteinemia becomes evident. Moderate
hyperhomocysteinemia, up to 19.0 μmol/L not
Pulmonary angiography is a gold standard of PATE complicated with thromboembolism was observed
diagnostics. However, this method is invasive, causes in patients with vein thrombosis in inferior limbs. [7,11]
various complications and is not widely available. If we take considering that even moderate
In most cases, PATE diagnosis is based on the hyperhomocysteinemia can cause oxidative stress
combination of laboratory tests and radio-diagnostics, (homocysteine oxidation results in the formation of free
such as perfusive radionuclide scintigraphy and radicals, which activate the formation of thrombi, in turn
echocardiography (cardiac ultrasound), which reveal resulting in hypercoagulation), then the mechanism
indirect symptoms of embolism (dilatation of the of the results observed in patients with thrombosis
right ventricle of heart and pulmonary hypertension), of proximal deep veins and in thromboembolism of
observed in severe forms of PATE. CT allows the pulmonary artery becomes evident. [11,12]
visualisation of pulmonary arteries and thrombi
themselves, as well as the ability to assess structures It can be concluded that multilayer CT
of mediastinum and parenchyma, which is the main pulmoangiography is a non-invasive highly
advantage of CT. According to some authors, two thirds informative method, providing a very low level
of patients with suspected PATE were diagnosed as of complications, and is thus indicated for acute
having aorta dissection, pneumonia, lung carcinoma, PATE diagnostics, and for control of the disease
and pneumothorax. In addition, the presence of dynamics after anticoagulation treatment. Moderate
complicated pulmonary embolism (pulmonary hyperhomocysteinemia, observed in cases of vein
infarction, pleural effusion, re-induced vascular picture) thrombosis of inferior limbs, uncomplicated by PATE,
is possible. [5,8] deserves further attention to determine the fate
of these patients and the appropriate treatment to
With the introduction of high resolution multilayer CT, all provide. The changes in homocysteine levels can be
the problems associated with the lack of accuracy using considered as a separate independent factor for PATE
spiral CT in PATE diagnostics have been overcome. diagnostics. The interdependence between D-dimer
Using of 14-16 and 64-layer CT decreases the number and concomitant hyperhomocysteinemia can be used
of unrevealed cases of deseases. Furthermore, not only for diagnostics, but also for the assessment
visualization of proximal, lobar, and more distal artery of the effectiveness of PATE treatment.
branches (at segmental and sub-segmental levels)
is provided, revealing peripheral emboli, with precise Authors’ contributions
assessment of their extent being possible. [9]
Concept: F. Todua
Moreover, to reveal deep vein thromboses, it is Design: M. Akhvlediani
possible to combine chest examination with vein CT Definition of intellectual content: M. Akhvlediani, E.
angiography. Vorobiova
Literature search: A. Baramidze

Using reconstructive images, left and right ventricles Clinical studies: F. Todua, G. Tsivtsivadze
in axial and four-chamber projections can be Data acquisition: G. Tsivtsivadze
assessed and measured. Right ventricle dilation is an Statistical analysis: A. Baramidze
unfavourable prognostic factor. [10] Manuscript preparation, editing and review: M.
Akhvlediani, E. Vorobiova
We recommend CT examination to be performed Financial support and sponsorship
at 3 months after diagnosis of PATE, as this period
is sufficient for thrombus resolution. Perfusive None.
radionuclide scintigraphy, recommended for a more
accurate diagnosis is characterized with high radiation Conflicts of interest
exposure, compared to MLCT, and is not useful for There are no conflicts of interest.
Vessel Plus ¦ Volume 1 ¦ March 31, 2017 41