Letter to the Editor 899
Letter to the Editor Blood Coagulation and Fibrinolysis 2013, 24:899
Mean platelet volume and mitral annular calcification Sevket Baltaa, Sait Demirkola, Mustafa Cakarb, Omer Kurtb, Murat Unlua and Ugur Kucuka a Department of Cardiology and bDepartment of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
Correspondence to Dr Sevket Balta, MD, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey Tel: +90 312 3044281; fax: +90 312 3044250; e-mail: [email protected]
We read the article ‘Relationship between mean platelet volume and mitral annular calcification’ written by Varol et al. [1] with a great interest. They have shown that mean platelet volume (MPV) and platelet distribution width (PDW) were significantly elevated in patients with mitral annular calcification (MAC) compared with controls. MPV was correlated with MAC, atrial fibrillation and left atrial and negatively correlated with platelet count. MPV and PDW were independently associated with the MAC independent of confounding factors. The authors suggested that elevated MPV values may indicate that patients with MAC have a higher risk of systemic thromboembolism due to increased platelet activation. The study is designed and presented successfully. We believe that these findings will work as a guide for further studies about the effect of inflammation on platelet indices in patients with mitral annular calcification. We thank the authors for their contribution to the literature. MAC represents a chronic and degenerative calcification of the surrounding fibrous support of the mitral valve. This process is a common finding on echocardiographic examination and progresses with advanced age. Although the exact mechanism is not well understood, MAC appears to be associated with cardiovascular risk factors and clinical atherosclerosis, thus giving additional evidence for the hypothesis that annular calcification is a form of atherosclerosis. The MPV and PDW are indicators of platelet activation, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction [2]. MPV is also used as a marker of inflammation. Platelet parameters can be affected by coronary risk
0957-5235 ß 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
factors including age, obesity, smoking, diabetes mellitus, hypertension, hypercholesterolemia and metabolic syndrome [3]. It can also be affected by any abnormality in thyroid function tests, malignancy and medications such as anticoagulant therapy [4]. In this study, although atrial fibrillation was seen in 38 patients of the MAC group, the authors did not show why anticoagulant therapy was not used in these patients. In addition, in a previous study, the authors had shown that systemic coagulation activity is increased in the patients with rheumatic mitral valve abnormality [5]. In this point of view, it can contribute to the study if the authors provide information about this condition. Therefore, MPV itself alone without other inflammatory markers may not give information to clinicians about the endothelial inflammatory condition of the patient. So, we think that it should be evaluated together with other serum inflammatory markers such as C-reactive protein. Finally, in multivariate regression analysis, when adjusted for other related univariate factors (diabetes mellitus, hypertension, hyperlipidemia and rheumatic mitral valves abnormality), there could be different results in present study.
Acknowledgements Conflicts of interest
There is no conflict of interests.
References 1
2
3
4
5
Varol E, Aksoy F, Ozaydin M, Erdogan D, Dogan A. Relationship between mean platelet volume and mitral annular calcification. Blood Coagul Fibrinolysis 2012;1–5. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, et al. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sa˜o Paulo, Brazil) 2012; 67:1019–1022. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Prac 2009; 63:1509–1515. Sinauridze EI, Panteleev MA, Ataullakhanov FI. Anticoagulant therapy: basic principles, classic approaches and recent developments. Blood Coagul Fibrinolysis 2012; 23:482–493. Bu¨yu¨kas¸ik Y, Ileri M, Ozcebe OI, Haznedaroglu IC, Yetkin E, Kirazli S, et al. Increased systemic coagulation activity in patients with rheumatic mitral stenosis: assessment of the clinical and echocardiographic determinants. Blood Coagul Fibrinolysis 1999; 10:417–421.
DOI:10.1097/MBC.0b013e328362df02
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Letter to the Editor Blood Coagulation and Fibrinolysis 2013, 24:899
Mean platelet volume and mitral annular calcification Sevket Baltaa, Sait Demirkola, Mustafa Cakarb, Omer Kurtb, Murat Unlua and Ugur Kucuka a Department of Cardiology and bDepartment of Internal Medicine, Gulhane Medical Academy, Ankara, Turkey
Correspondence to Dr Sevket Balta, MD, Department of Cardiology, Gulhane School of Medicine, Tevfik Saglam St., 06018 Etlik-Ankara, Turkey Tel: +90 312 3044281; fax: +90 312 3044250; e-mail: [email protected]
We read the article ‘Relationship between mean platelet volume and mitral annular calcification’ written by Varol et al. [1] with a great interest. They have shown that mean platelet volume (MPV) and platelet distribution width (PDW) were significantly elevated in patients with mitral annular calcification (MAC) compared with controls. MPV was correlated with MAC, atrial fibrillation and left atrial and negatively correlated with platelet count. MPV and PDW were independently associated with the MAC independent of confounding factors. The authors suggested that elevated MPV values may indicate that patients with MAC have a higher risk of systemic thromboembolism due to increased platelet activation. The study is designed and presented successfully. We believe that these findings will work as a guide for further studies about the effect of inflammation on platelet indices in patients with mitral annular calcification. We thank the authors for their contribution to the literature. MAC represents a chronic and degenerative calcification of the surrounding fibrous support of the mitral valve. This process is a common finding on echocardiographic examination and progresses with advanced age. Although the exact mechanism is not well understood, MAC appears to be associated with cardiovascular risk factors and clinical atherosclerosis, thus giving additional evidence for the hypothesis that annular calcification is a form of atherosclerosis. The MPV and PDW are indicators of platelet activation, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction [2]. MPV is also used as a marker of inflammation. Platelet parameters can be affected by coronary risk
0957-5235 ß 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
factors including age, obesity, smoking, diabetes mellitus, hypertension, hypercholesterolemia and metabolic syndrome [3]. It can also be affected by any abnormality in thyroid function tests, malignancy and medications such as anticoagulant therapy [4]. In this study, although atrial fibrillation was seen in 38 patients of the MAC group, the authors did not show why anticoagulant therapy was not used in these patients. In addition, in a previous study, the authors had shown that systemic coagulation activity is increased in the patients with rheumatic mitral valve abnormality [5]. In this point of view, it can contribute to the study if the authors provide information about this condition. Therefore, MPV itself alone without other inflammatory markers may not give information to clinicians about the endothelial inflammatory condition of the patient. So, we think that it should be evaluated together with other serum inflammatory markers such as C-reactive protein. Finally, in multivariate regression analysis, when adjusted for other related univariate factors (diabetes mellitus, hypertension, hyperlipidemia and rheumatic mitral valves abnormality), there could be different results in present study.
Acknowledgements Conflicts of interest
There is no conflict of interests.
References 1
2
3
4
5
Varol E, Aksoy F, Ozaydin M, Erdogan D, Dogan A. Relationship between mean platelet volume and mitral annular calcification. Blood Coagul Fibrinolysis 2012;1–5. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, et al. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics (Sa˜o Paulo, Brazil) 2012; 67:1019–1022. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Prac 2009; 63:1509–1515. Sinauridze EI, Panteleev MA, Ataullakhanov FI. Anticoagulant therapy: basic principles, classic approaches and recent developments. Blood Coagul Fibrinolysis 2012; 23:482–493. Bu¨yu¨kas¸ik Y, Ileri M, Ozcebe OI, Haznedaroglu IC, Yetkin E, Kirazli S, et al. Increased systemic coagulation activity in patients with rheumatic mitral stenosis: assessment of the clinical and echocardiographic determinants. Blood Coagul Fibrinolysis 1999; 10:417–421.
DOI:10.1097/MBC.0b013e328362df02
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
