The Clinical Respiratory Journal LETTER TO THE EDITOR
Higher mean platelet volume level in patients with pulmonary embolism
We have read the recently published article entitled ‘Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism (PE)?’ by Gunay and co-workers (1). In that very well-designed and presented study by Gunay and co-workers tried to evaluate the relationship between computed tomography pulmonary arterial obstruction index ratio and platelet indices and the utility of these parameters in the determination of PE severity. They have shown mean platelet volume (MPV) and platelet distribution width can be used for the determination of disease severity, and lead to therapeutic strategies for pulmonary embolism patients. Acute PE is an important cardiovascular disease with a higher mortality rate. Platelets play a pivotal role in the occurrence and course of the cardiovascular disease. MPV, a measure of platelet size available in every blood count, is increasingly recognized as an important marker of platelet activity. MPV has been well demonstrated to influence mortality and morbidity based on endothelial dysfunction. Platelet parameters might be influenced by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, obesity, hyperlipidemia, metabolic syndrome (2). Some other recent studies have demonstrated that an elevated MPV is linked with peripheral artery disease, stroke and atrial fibrillation, all related to atherosclerosis on the basis of inflammation (3). The MPV can also be affected by thyroid and rheumatic diseases (4), chronic inflammatory diseases such as Behçet’s disease (5), malignancy (6), deep vein thrombosis (2) and medications such as anticoagulant therapy and statins. Additionally, obstructive sleep apnoea syndrome (OSAS) may be associated with increased cardiovascular morbidity and mortality based on coronary
Conflict of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2013 John Wiley & Sons Ltd
atherothrombosis. Also, platelet activation is increased in patients with OSAS (7). Platelet activation and aggregation are central processes in the pathophysiology of atherothrombosis (8). MPV represents a platelet activation, is a newly emerging risk factor for atherothrombosis. Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is common in overweight/obese people and may have an association with cardiovascular risk factors and atherosclerosis. NAFLD incidence is significantly higher with increased MPV, and after controlling for factors associated with NAFLD, there was a significant correlation between MPV and NAFLD (9). Furthermore, because the authors assessed patients with acute PE retrospectively in their study, the authors might not accurately define how much time elapsed before measuring MPV levels; delaying blood sampling may lead to abnormal results in MPV measurements (4). In conclusion, the MPV may be affected by many factors. So, not only MPV but also red cell distribution width, platelet distribution width, neutrophil lymphocyte ratio, C-reactive protein and uric acid are easy methods to evaluate the obstruction level of pulmonary vascular bed in patients with acute PE (4). MPV might be evaluated together with other inflammatory markers like neutrophil lymphocyte ratio (10) and red cell distribution width (11). Sevket Balta, Sait Demirkol, Murat Unlu, Ugur Kucuk, Zekeriya Arslan and Mustafa Demir Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
References 1. Günay E, Sarinc Ulasli S, Kacar E, Halici B, Unlu E, Tünay K, Ozkececi G, Koken T, Unlu M. Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clin Respir J. 2013; doi: 10.1111/crj.12031. 2. Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets. 2013;24(8): 590–3.
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Letter to the editor
3. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets. 2013; doi: 10.3109/09537104.2013.778398. 4. Balta S, Demirkol S, Unlu M, Celik T. Other inflammatory markers should be kept in mind when assessing the mean platelet volume. Platelets. 2013; doi: 10.3109/ 09537104.2013.775643. 5. Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, Demirkol S. Mean platelet volume in recurrent aphthous stomatitis and Behcet disease. Angiology. 2013; Jun 13 [Epub ahead of print]. 6. Demirkol S, Balta S, Kucuk U, Celik T. Mean platelet volume may indicate early diagnosed gastric cancer based on inflammation. Platelets. 2013; doi: 10.3109/09537104.2013.799646. 7. Karakas¸ MS, Altekin RE, Baktır AO, Küçük M, Cilli A, Yalçınkaya S. Association between mean platelet volume and severity of disease in patients with
252
Balta et al.
8.
9.
10.
11.
obstructive sleep apnea syndrome without risk factors for cardiovascular disease. Turk Kardiyol Dern Ars. 2013;41(1): 14–20. Balta S, Demirkol S, Celik T, et al. Association between coronary artery ectasia and neutrophil-lymphocyte ratio. Angiology. 2013;64(8): 627–32. Shin W-Y, Jung D-H, Shim J-Y, Lee H-R. The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population. Platelets. 2011;22(6): 442–6. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, Kucuk U, Yokusoglu M. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics. 2012;67(9): 1019–22. Demirkol S, Balta S, Unlu M, et al. Neutrophils/ lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost. 2012; doi: 10.1177/ 1076029612467227.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2013 John Wiley & Sons Ltd
Higher mean platelet volume level in patients with pulmonary embolism
We have read the recently published article entitled ‘Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism (PE)?’ by Gunay and co-workers (1). In that very well-designed and presented study by Gunay and co-workers tried to evaluate the relationship between computed tomography pulmonary arterial obstruction index ratio and platelet indices and the utility of these parameters in the determination of PE severity. They have shown mean platelet volume (MPV) and platelet distribution width can be used for the determination of disease severity, and lead to therapeutic strategies for pulmonary embolism patients. Acute PE is an important cardiovascular disease with a higher mortality rate. Platelets play a pivotal role in the occurrence and course of the cardiovascular disease. MPV, a measure of platelet size available in every blood count, is increasingly recognized as an important marker of platelet activity. MPV has been well demonstrated to influence mortality and morbidity based on endothelial dysfunction. Platelet parameters might be influenced by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, obesity, hyperlipidemia, metabolic syndrome (2). Some other recent studies have demonstrated that an elevated MPV is linked with peripheral artery disease, stroke and atrial fibrillation, all related to atherosclerosis on the basis of inflammation (3). The MPV can also be affected by thyroid and rheumatic diseases (4), chronic inflammatory diseases such as Behçet’s disease (5), malignancy (6), deep vein thrombosis (2) and medications such as anticoagulant therapy and statins. Additionally, obstructive sleep apnoea syndrome (OSAS) may be associated with increased cardiovascular morbidity and mortality based on coronary
Conflict of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2013 John Wiley & Sons Ltd
atherothrombosis. Also, platelet activation is increased in patients with OSAS (7). Platelet activation and aggregation are central processes in the pathophysiology of atherothrombosis (8). MPV represents a platelet activation, is a newly emerging risk factor for atherothrombosis. Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is common in overweight/obese people and may have an association with cardiovascular risk factors and atherosclerosis. NAFLD incidence is significantly higher with increased MPV, and after controlling for factors associated with NAFLD, there was a significant correlation between MPV and NAFLD (9). Furthermore, because the authors assessed patients with acute PE retrospectively in their study, the authors might not accurately define how much time elapsed before measuring MPV levels; delaying blood sampling may lead to abnormal results in MPV measurements (4). In conclusion, the MPV may be affected by many factors. So, not only MPV but also red cell distribution width, platelet distribution width, neutrophil lymphocyte ratio, C-reactive protein and uric acid are easy methods to evaluate the obstruction level of pulmonary vascular bed in patients with acute PE (4). MPV might be evaluated together with other inflammatory markers like neutrophil lymphocyte ratio (10) and red cell distribution width (11). Sevket Balta, Sait Demirkol, Murat Unlu, Ugur Kucuk, Zekeriya Arslan and Mustafa Demir Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
References 1. Günay E, Sarinc Ulasli S, Kacar E, Halici B, Unlu E, Tünay K, Ozkececi G, Koken T, Unlu M. Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clin Respir J. 2013; doi: 10.1111/crj.12031. 2. Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets. 2013;24(8): 590–3.
251
Letter to the editor
3. Balta S, Demirkol S, Kucuk U, Unlu M. Hemostatic markers can be pivotal roles of risk factors for new-onset atrial fibrillation. Platelets. 2013; doi: 10.3109/09537104.2013.778398. 4. Balta S, Demirkol S, Unlu M, Celik T. Other inflammatory markers should be kept in mind when assessing the mean platelet volume. Platelets. 2013; doi: 10.3109/ 09537104.2013.775643. 5. Ekiz O, Balta I, Sen BB, Rifaioglu EN, Ergin C, Balta S, Demirkol S. Mean platelet volume in recurrent aphthous stomatitis and Behcet disease. Angiology. 2013; Jun 13 [Epub ahead of print]. 6. Demirkol S, Balta S, Kucuk U, Celik T. Mean platelet volume may indicate early diagnosed gastric cancer based on inflammation. Platelets. 2013; doi: 10.3109/09537104.2013.799646. 7. Karakas¸ MS, Altekin RE, Baktır AO, Küçük M, Cilli A, Yalçınkaya S. Association between mean platelet volume and severity of disease in patients with
252
Balta et al.
8.
9.
10.
11.
obstructive sleep apnea syndrome without risk factors for cardiovascular disease. Turk Kardiyol Dern Ars. 2013;41(1): 14–20. Balta S, Demirkol S, Celik T, et al. Association between coronary artery ectasia and neutrophil-lymphocyte ratio. Angiology. 2013;64(8): 627–32. Shin W-Y, Jung D-H, Shim J-Y, Lee H-R. The association between non-alcoholic hepatic steatosis and mean platelet volume in an obese Korean population. Platelets. 2011;22(6): 442–6. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, Kucuk U, Yokusoglu M. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics. 2012;67(9): 1019–22. Demirkol S, Balta S, Unlu M, et al. Neutrophils/ lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost. 2012; doi: 10.1177/ 1076029612467227.
The Clinical Respiratory Journal (2014) • ISSN 1752-6981 © 2013 John Wiley & Sons Ltd
