Significant Difference In Median Levels Research Articles

Association of Lipid Ratios and Neutrophil-lymphocyte Ratio in Type 2 Diabetic Moroccan Patients Without Chronic Kidney Disease

Background: Atherogenic dyslipidemia and currently chronic inflammation are among the factors of atherosclerosis in type 2 diabetes mellitus patients (T2DM). This retrospective study conducted at Mohammed VI University Hospital, Morocco, from January 2020 to June 2021, aimed to investigate the association between the lipid profile, lipid ratios and neutrophil to lymphocyte ratio (NLR), among T2DM Moroccan patients without chronic kidney disease and to find out the possible correlation between these parameters and glycated hemoglobin (HbA1c). Methods: 274 T2DM patients and 88 non-diabetic controls aged over 40 years old were analyzed. Fasting plasma glucose, lipid profile tests, liver and renal function tests, and HbA1c test were measured. The NLR and lipid ratios including total cholesterol / HDL-c, non- HDL-c and atherogenic index of plasma were calculated. Results: There was no significant difference in median level of all lipid profile parameters between the poor controlled T2DM group (HbA1c > 7%) compared to the well controlled group (HbA1c ≤ 7%) and control group (all <I>P</I> > 0.05). All lipid ratios were lower in the good controlled group compared to the poor controlled diabetes group, but the difference did not reach statistical significance (all <I>P</I> > 0.05). HbA1c was correlated with FPG, and neutrophils (r = 0.655, r = 0.263, <I>P</I> < 0.001 respectively). NLR was weekly correlated with HDL (r = -0.14, <I>P</I> = 0.01). By using multivariate logistic regression, FPG was the only factor significantly predictive of well diabetic control. Conclusion: This study did not show significant association between HbA1c, lipid ratios and NLR.

Effect of Remote Ischemic Postconditioning on miRNA-145 and Troponin I levels in STEMI patients undergoing primary percutaneous coronary intervention

Background: Primary Percutaneous Coronary Intervention Procedure (PPCI) results in reperfusion injury which will result in more extensive infarction. Remote Ischemic Postconditioning (RIPC) is a protective strategy to reduce the increase in the area of ??infarction. miRNA-145 also plays a role in the protective effect of IPC and RIPC.&#x0D;  &#x0D; Research Methods: This study uses a pre and post test approach only with control group design with experimental research designs. Data is taken at the Integrated Heart Services Installation RSUP Dr. M. Djamil Padang from July to November 2019, 40 patients with ST-segment elevation myocardial infarction (STEMI) performed RIPC. Bivariate analysis was performed to determine differences in levels of miRNA-145 and troponin I in STEMI patients underwent PPCI with and without RIPC using the Wilcoxon test and the Mann Whitney test.&#x0D;  &#x0D; Results:A total of 40 patients who underwent the PPCI procedure were divided into two groups PPCI + RIPC (n = 20) and PPCI without RIPC (n = 20). There were no significant differences in the basic characteristics between the two groups. There were no significant difference in escalation of median expression of miRNA-145 in PPCI+ RIPC [pre test 36.33 (27.44-52.39), post test 34.83 (27.65-65.26), p = 0.765] compared to PPCI without RIPC [pre test 31.66 (26.31-43.28), post test 33.43 (26.83-64.97), p = 0.765]. There were an increase in median troponin I levels in both groups, PPCI+ RIPC [pretest 4,104.70 (67.30-40,000.00), post test 30,448.50 (120.00-16.3192.20), p = 0.001] and PPCI without RIPC [pretest 826.50 (17.00-48.259.00), post test 42.784.50 (2,119.00-162.897.00), p = &lt;0.001].&#x0D;  &#x0D; Conclusion:There were no significant difference in median expression of miRNA-145 in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. There were a significant difference in median levels of troponin I in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC.&#x0D; Keywords: Remote Ischemic Postconditioning, miRNA-145, troponin I

Sputum neutrophil elastase associates with microbiota and Pseudomonas aeruginosa in bronchiectasis.

Neutrophilic inflammation is a major driver of bronchiectasis pathophysiology, and neutrophil elastase activity is the most promising biomarker evaluated in sputum to date. How active neutrophil elastase correlates with the lung microbiome in bronchiectasis is still unexplored. We aimed to understand whether active neutrophil elastase is associated with low microbial diversity and distinct microbiome characteristics. An observational, cross-sectional study was conducted at the bronchiectasis programme of the Policlinico Hospital in Milan, Italy, where adults with bronchiectasis were enrolled between March 2017 and March 2019. Active neutrophil elastase was measured on sputum collected during stable state, microbiota analysed through 16S rRNA gene sequencing, molecular assessment of respiratory pathogens carried out through real-time PCR and clinical data collected. Among 185 patients enrolled, decreasing α-diversity, evaluated through the Shannon entropy (ρ -0.37, p<0.00001) and Pielou's evenness (ρ -0.36, p<0.00001) and richness (ρ -0.33, p<0.00001), was significantly correlated with increasing elastase. A significant difference in median levels of Shannon entropy as detected between patients with neutrophil elastase ≥20 µg·mL-1 (median 3.82, interquartile range 2.20-4.96) versus neutrophil elastase <20 µg·mL-1 (4.88, 3.68-5.80; p<0.0001). A distinct microbiome was found in these two groups, mainly characterised by enrichment with Pseudomonas in the high-elastase group and with Streptococcus in the low-elastase group. Further confirmation of the association of Pseudomonas aeruginosa with elevated active neutrophil elastase was found based on standard culture and targeted real-time PCR. High levels of active neutrophil elastase are associated to low microbiome diversity and specifically to P. aeruginosa infection.

The Effect of Remote Ischemic Postconditioning on miRNA-145 and Troponin I levels in STEMI patients undergoing primary percutaneous coronary intervention

Background: Primary Percutaneous Coronary Intervention Procedure (PPCI) results in reperfusion injury which will result in more extensive infarction. Remote Ischemic Postconditioning (RIPC) is a protective strategy to reduce the increase in the area of ​​infarction. miRNA-145 also plays a role in the protective effect of IPC and RIPC.&#x0D;  &#x0D; Research Methods: This study uses a pre and post test approach only with control group design with experimental research designs. Data is taken at the Integrated Heart Services Installation RSUP Dr. M. Djamil Padang from July to November 2019, 40 patients with ST-segment elevation myocardial infarction (STEMI) performed RIPC. Bivariate analysis was performed to determine differences in levels of miRNA-145 and troponin I in STEMI patients underwent PPCI with and without RIPC using the Wilcoxon test and the Mann Whitney test.&#x0D;  &#x0D; Results:A total of 40 patients who underwent the PPCI procedure were divided into two groups PPCI + RIPC (n = 20) and PPCI without RIPC (n = 20). There were no significant differences in the basic characteristics between the two groups. There were no significant difference in escalation of median expression of miRNA-145 in PPCI+ RIPC [pre test 36.33 (27.44-52.39), post test 34.83 (27.65-65.26), p = 0.765] compared to PPCI without RIPC [pre test 31.66 (26.31-43.28), post test 33.43 (26.83-64.97), p = 0.765]. There were an increase in median troponin I levels in both groups, PPCI+ RIPC [pretest 4,104.70 (67.30-40,000.00), post test 30,448.50 (120.00-16.3192.20), p = 0.001] and PPCI without RIPC [pretest 826.50 (17.00-48.259.00), post test 42.784.50 (2,119.00-162.897.00), p = &lt;0.001].&#x0D;  &#x0D; Conclusion:There were no significant difference in median expression of miRNA-145 in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. There were a significant difference in median levels of troponin I in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC.&#x0D; Keywords: Remote Ischemic Postconditioning, miRNA-145, troponin I

Interleukin 15 and granulocytes colony stimulating factor levels in relation to ICSI outcome in subfertile PCOS women

Polycystic Ovary Syndrome constitutes a complex heterogeneous disorder, considered one of the leading cause of delayed conception in women. Serum and follicular fluid cytokines are subject of extensive studies to identify their role in subfertility with controversial results. This study was aimed to evaluate the relation of Granulocytes Colony Stimulating Factor (G-CSF) and Interleukin 15 (IL 15) levels to ovarian response and ICSI outcome in PCOS women undergoing ICSI. This cross-sectional study conducted at High Institute of Infertility Diagnosis and Assisted Reproductive Technique and Baghdad IVF Private Centre. Which include 80 women divided into two groups: 40 PCOS women without other causes of subfertility and 40 non PCOS women with other causes of subfertility. Ovarian hormonal stimulation conducted according to GnRH antagonist protocol, then serum &amp; follicular fluid obtained at the day of oocyte retrieval for measurement of G-CSF &amp; IL 15 concentration measured by ELISA method, then statistical analysis is used to correlate the concentration of the cytokine with follicle number, retrieved oocyte number, oocyte maturity, number of 2PN oocytes, number of grade1 embryones, biochemical pregnancies and clinical pregnancy rates. The results of currents study revealed that Serum estradiol (E2) on hCG day was (2238.70 ±468.95 vs. 1997.40 ±291.95 pg/ml), endometrial thickness (10.80 ±1.49 vs. 10.24 ±0.98 mm), total follicle number (15.53 ±3.86 versus 12.43 ±2.25), oocyte number (13.03 ±3.10 vs. 9.83 ±1.52), mature oocyte (MII) number (9.48 ±2.45 vs. 7.75 ±1.48) mean number of fertilized oocytes (2PN) was (6.25 ±1.41 vs. 5.35 ±1.08), being higher in PCOS women compared to the control group. On day of oocytes retrieval, both median level of serum G-CSF (54.30) (35.35) and follicular G-CSF (59.00) (38.72) levels were significantly higher in PCOS than control groups, while there was no significant difference in median level of serum IL15 (59.10) (17.75) and median level of follicular IL-15(61.40) (16.00) between PCOS and control groups.  The study concluded that in spite of higher levels of G-CSF and IL15 in serum and follicular fluid of PCOS women, a relation between G-CSF and IL15 with ovarian response could not be established in comparison to control group, however, both (G-CSF and IL15) may be a predictor of pregnancy among the same group of women both PCOS and controls.

Chemokine RANTES and IL-1β in mild therapeutic hypothermia-treated patients after out-of-hospital sudden cardiac arrest.

IntroductionCCL5/RANTES and IL-1β, which regulate the immune response, may have an impact on survival in patients with acute coronary syndrome (ACS) and sudden cardiac arrest (SCA).AimTo evaluate levels of CCL5/RANTES and IL-1β in patients with ACS complicated by SCA, treated with coronary angioplasty (PCI) and mild therapeutic hypothermia (MTH), and these chemokines’ impact on the 30- and 180-day survival.Material and methodsThirty-three unconscious patients admitted after SCA with ACS underwent PCI and MTH treatment. CCL5/RANTES and IL-1β were evaluated on admission (T0), at 12–24 h (T1) and at 48–72 h (T2). All-cause mortality was recorded at 30 and 180 days.ResultsWe observed a statistically significant decrease in median levels of CCL/RANTES at T0, T1 and T2 (24.69 ng/ml vs. 3.89 ng/ml vs. 2.71 ng/ml; p < 0.001), and significant differences in median levels of IL-1β (0.196 pg/ml vs. 0.171 pg/ml vs. 0.214 pg/ml; p = 0.034). Initial levels of CCL5/RANTES and IL-1β correlated significantly (r = –0.360; p = 0.045). At T2, CCL5/RANTES correlated with the maximum levels of hs-TnT and CK-MB (r = –0.594; p < 0.001 and r = –0.389; p = 0.030), and at T0 with BNP (r = –0.521; p = 0.003). Mortality rate at 30 days and 180 days was 18.2% and 45.5%, respectively. At 30 days, we observed a trend to significance for IL-1β at T0 and T1 (p = 0.078 and p = 0.079), but not for CCL5/RANTES (p = 0.284 and p = 0.351). For 180-day survival curves, only the IL-1β level at T1 was associated with mortality (p = 0.028).ConclusionsAlthough CCL5/RANTES levels correlate with cardiac injury and heart failure markers and they decrease during MTH, they failed to predict early and late mortality. In contrast, IL-1β level was associated with 180-day survival.

Is there an optimal initial amount of activation for midpalatal suture expansion?

Accelerated bone-borne expansion protocols on sutural separation and sutural bone formation were evaluated via histomorphometry and immunohistochemistry to determine the optimal initial activation without disruption of bone formation. Sixteen New Zealand white rabbits were randomly divided into fourgroups. Modified Hyrax expanders were placed across the midsagittal sutures and secured with miniscrew implants with the following activations: group1 (control), 0.5 mm expansion/day for 12days; group2, 1 mm instant expansion followed by 0.5 mm expansion/day for 10days; group3, 2.5 mm instant expansion followed by 0.5 mm expansion/day for 7days; and group4, 4 mm instant expansion followed by 0.5 mm expansion/day for 4days. After 6weeks, sutural expansion and new bone formation were evaluated histomorphometrically. Statistical analysis was performed using Kruskal-Wallis/Mann-WhitneyU tests and Spearman's rho correlation (p < 0.05). The smallest median sutural separation was observed in group1 (3.05 mm) and the greatest in group4 (4.57 mm). The lowest and highest amount of bone formation were observed in group4 (55.82%) and in group3 (66.93%), respectively. Immunohistochemical analysis revealed significant differences in median levels of alkaline phosphatase and osteopontin expression between all experimental groups. The highest level of these proteins was attained in group3, followed by groups2, 1, and 4, respectively. Sutural appositional bone formation corresponded with the amount of initial expansion to apoint. When initial expansion was increased to 4 mm, sutural bone remodeling was disturbed and new bone formation was decreased. The most effective sutural expansion was achieved with 2.5 mm initial activation followed by 0.5 mm expansion/day for 7days.

Vitamin B12 Deficiency Among A Mendelian Population of North India

Prevalence of vitamin B12 deficiency has increased in community in recent time. The present study was done to assess vitamin B12 status with respect to age and sex. Vitamin B12 assays were performed on 1512 individuals from a North Indian Lacto vegetarian community and further validated on a familial sample of 79 individuals. Individuals were considered to be deficient, if vitamin B12 levels were <220 pg mL−1. Median levels of vitamin B12 was below the normal range i.e. <220 pg mL−1. Significant differences in median levels between males and females were observed (Mann-Whitney p<0.01). The results revealed no significant differences in females (χ2 value = 37.82, p<0.01). Similar results among the families possibly indicate multigenerational dietary inadequacy along with the changes in lifestyle apart from vegetarian diet.

P140 HLA match and donor-derived cell-free DNA levels in kidney transplant recipients

Circulating cell-free DNA (cfDNA) has been correlated with allograft rejection in organ transplant recipients and is proposed as a biomarker to assess graft injury that may be reflective of allograft rejection or immunosuppression toxicity. We have validated a method for quantifying donor-derived cfDNA (dd-cfDNA) based on targeted amplification of SNPs and next-generation sequencing (NGS) that does not require genotyping of the donor or recipient (AlloSure®). The test measures alleles for 266 SNPs distributed across the genome and quantifies the proportion of dd-cfDNA present in the recipient’s plasma. The aim of this study was to identify relationships between levels of dd-cfDNA in kidney transplant patients and the degree of HLA mismatch with the donor, living or deceased donor type, and donor relationship to recipient. Testing was performed using cfDNA extracted from plasma collected in Streck Cell-Free DNA BCT blood collection tubes from kidney recipients enrolled in a multicenter observational study. Median values of dd-cfDNA were calculated from all visits for each recipient. Recipients were stratified by the total number of mismatches in HLA A, B and DR loci. Further stratifications were based on the donor type (living or deceased) as well as relationship to the donor (related or unrelated). Median dd-cfDNA levels were calculated from 208 recipients with 4 or more visits (median of 6 visits each). There were no statistically significant differences in median levels of dd-cfDNA associated with degree of donor HLA match. The between-patient variability trended higher for mismatched recipients compared to those with no mismatches to their donor and for recipients who received a kidney from a deceased donor compared to those recipients who received a kidney from a living donor, but the differences were not statistically significant. In samples collected on a surveillance schedule from study recipients, degree of HLA mismatch at HLA A, B, and DR were not predictive of dd-cfDNA overall nor when stratified by donor type and donor relationship. These results indicate that the level of dd-cfDNA in kidney recipients is independent of these variables and that these variables do not confound interpretation of the AlloSure results.

Cross-sectional study of serum parathyroid hormone level in high-risk pregnancies as compared to nonpregnant control.

Objectives:To note the value of serum parathyroid hormone (PTH) levels in normal and high-risk pregnancies (HRP) in patients attending antenatal visits at All India Institute of Medical Sciences (AIIMS).Materials and Methods:This is a cross-sectional study where a total of 282 patients attending Gynecology Outpatient Department at AIIMS, New Delhi were recruited. Among the 282 subjects, 251 were pregnant, and 31 were controls. The serum was tested for serum PTH levels using Beckman coulter access 2 immunoassay.Results:The median value of PTH level in pregnant women was 31.6 pg/ml with range being 0.8–505.5 pg/ml in contrast to 45.9 pg/ml with range being 19–102.7 pg/ml in nonpregnant female. This difference was statistically significant (P = 0.0012). There was no significant difference in median level of PTH in different age group. Although the median PTH levels were lower in second trimester (25.25 pg/ml) than in first trimester (35.5 pg/ml) and in third trimester (32.4 pg/ml), the difference was not statistically significant. There was no significant difference in PTH level in HRP (median value – 31.6 pg/ml) as compared to low-risk pregnancies (31.5 pg/ml).Conclusion:Serum PTH levels are significantly lower during pregnancy as compared to nonpregnant state. However, age, parity, and HRP did not alter PTH level during pregnancy.

Randomized clinical trial investigating the stress response from two different methods of analgesia after laparoscopic colorectal surgery.

One of the key elements of managed recovery is thought to be suppression of the neuroendocrine response using regional analgesics. This may be superfluous in laparoscopic colorectal surgery with small wounds. This trial assessed the effects of spinal analgesia versus intravenous patient-controlled analgesia (PCA) on neuroendocrine responses in that setting. A randomized clinical trial was conducted with participation of patients undergoing laparoscopic colorectal surgery within a managed recovery programme. Consenting patients were allocated randomly to spinal analgesia or morphine PCA as primary postoperative analgesia. The primary outcome was interleukin (IL) 6 levels; secondary outcomes were levels of cortisol, glucose, insulin and other cytokines, pain scores, morphine use and length of hospital stay. Stress response analysis was conducted before operation, and 3, 6, 12, 24 and 48 h after surgery. Of 143 eligible patients, 133 were randomized and 120 completed the study. Baseline patient characteristics were similar in the two groups. There were no significant differences in median levels of insulin, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, interferon γ, tumour necrosis factor α or vascular endothelial growth factor between the spinal analgesia and PCA groups at any time point. Three hours after surgery (but at no other time point) median (i.q.r.) levels of cortisol (468 (329-678) versus 701 (429-820) nmol/l; P = 0.004) and glucose (6.1 (5.4-7.5) versus 7.0 (6.0-7.7) mmol/l; P = 0.012) were lower in the spinal analgesia group than in the PCA group. Median (i.q.r.) levels of total intravenous morphine were lower in the spinal analgesia group (10.0 (3.3-15.8) versus 45.5 (34.0-60.5) mg; P < 0.001). Spinal analgesia reduced early neuroendocrine responses and overall parenteral morphine use. NCT01128088 (http://www.clinicaltrials.gov).

Mlecular Monitoring of Acute Myeloid Leukemia Patients Carrying Nucleophosmin (NPM1) Mutations Undergoing An Autologous Peripheral Blood Stem Cell Transplantation

Nucleophosmin (NPM1) gene mutations represent the most common genetic alterations in adult acute myeloid leukemia (AML), accounting for about 30% of cases and 50–60% of AML with normal karyotype. In addition to their recognized prognostic value (when combined with analysis of the FLT3 gene), NPM1 mutations represent an ideal marker for monitoring of minimal residual disease (MRD) since they are very stable during the course of the disease. PCR quantitative monitoring of NPM1 mutant copies has been mainly restricted to patients treated with conventional chemotherapy. In our study, we retrospectively analyzed, by RQ-PCR, MRD in 12 consecutive NPM1-mutated AML patients who underwent an autologous peripheral blood stem cell transplantation (PBSCT) between September 2000 and March 2008 at the Division of Hematology, “Sapienza” University of Rome. By sequencing of the region encompassing NPM1 exon 12, we demonstrated the presence of a type A mutation in 10/12 patients and of a type B in the remaining 2. Moreover, at diagnosis molecular analysis of the FLT3 gene revealed an internal tandem duplication (ITD) in 7/12 patients. Cytogenetic analysis showed a normal karyotype in 11/12, whereas 1 patient presented a minor karyotype aberration (trisomy 4). RQ-PCR was retrospectively performed on bone marrow samples in all patients at diagnosis, in 11/12 patients before the transplant and in 9/12 after the graft. Six of the 12 patients are at present in continuous complete remission (CCR) with a median follow-up of 54 months (range 4–89), 1 patient has died in CCR 55 months after PBSCT due to a pancreatic carcinoma and 5/12 have relapsed. Four of the latter 5 patients relapsed shortly after the transplant (range 3–10 months); 2 of them died of disease progression and 2 of salvage chemotherapy toxicity. One patient, who relapsed 92 months from PBSCT, is alive in second hematological remission following re-induction and consolidation chemotherapy. No significant differences in median levels of transcript at diagnosis were found between relapsing and non-relapsing patients (93,000 and 68,000; range: 86,000–103,000 and 37,000–116,000, respectively). Nine patients were analyzed after PBSCT: 3 persistently positive relapsed and the copy number of the transcript was always higher than at diagnosis. In the other 6 patients, the transcript was undetectable (3 of them were already in molecular remission pre-transplant): 5 are still in CCR while 1 patient relapsed 92 months after the graft. Regarding the FLT3-ITD status at diagnosis, 3/7 patients are in CCR whereas 4 have relapsed. The retention of NPM1 mutations even at relapse further confirms that NPM1 alterations are highly stable, pointing to this event as critical for leukemia growth and survival. Moreover, in our study long-term survival was always associated with a copy number of NPM1 mutant transcripts below the detectable level of the method, suggesting that disappearance of the transcript should be the primary clinical endpoint. Prospective studies and larger case series are necessary in an attempt to identify a cut-off level during treatment which could be predictive of the clinical outcome of AML patients harboring NPM1 mutations and help in therapeutic choices.

Childhood weight, stature, and body mass index among never overweight, early-onset overweight, and late-onset overweight groups.

To determine the effects of timing of onset of overweight (OW) on childhood anthropometric adiposity levels using long-term serial data from the Fels Longitudinal Study. OW was defined as body mass index (BMI; kg/m(2)) >25, and the age at first measurement of BMI >25 was the age of onset of OW. Early onset of OW (early-OW) and late onset of OW (late-OW) were defined as having onset of OW before and after 25 years of age, respectively, whereas never OW (never-OW) was defined as never having a BMI >25. Subjects consisted of 67 males and 47 females in early-OW groups, 62 males and 48 females in late-OW groups, and 80 males and 114 females in never-OW groups. Levels of weight and BMI in early-OW males and females were significantly greater than those in never-OW and late-OW males and females beginning at the time of adiposity rebound, which generally occurs between 4 and 8 years of age. Median BMI and weight patterns between never-OW and late-OW males were similar throughout childhood. However, significant differences in median levels of BMI for never-OW and late-OW females began at 11 years of age, although onset of OW was not until >25 years of age in the latter group. For both males and females, adiposity rebound is likely an effective time in a child's development to detect and initiate prevention for childhood and early adulthood onset of OW. Although later-onset OW needs additional study, puberty seems to be a critical phase in the development of later adult onset of OW in females.

Is diastolic dysfunction associated with thrombogenesis? A study of circulating markers of a prothrombotic state in patients with coronary artery disease

Clinical data on the contributory role of heart failure to thromboembolic risk does not differentiate between systolic and diastolic left ventricular dysfunction. We therefore conducted a population-controlled cross-sectional study to determine levels of plasma fibrinogen (associated with thromboembolism), fibrin D-dimer (a marker of fibrin turnover) and von Willebrand factor (a marker of endothelial dysfunction) in patients with ischaemic heart disease (a common cause of diastolic dysfunction) in whom left ventricular diastolic function was defined by echocardiography. We studied 106 patients: those with normal left ventricular function ( n = 42, Group 1); those with left ventricular dysfunction but without aneurysms ( n = 34, Group 2); and those with left ventricular aneurysm formation ( n = 30, Group 3). Each of these groups was subdivided into those with (a) and without (b) diastolic dysfunction. Diastolic dysfunction was present in over 60% of patients, irrespective of left ventricular systolic impairment. There were no significant differences in median levels of plasma fibrinogen, fibrin D-dimer or von Willebrand factor in each group of patients with ischaemic heart disease, whether or not left ventricular diastolic dysfunction was present (Mann-Whitney test; P = N.S.). Systolic (rather than diastolic) dysfunction was the main correlate of these (analysis of variance, general linear model — ANOVA-GLM — P < 0.05) and the greatest abnormalities of fibrinogen, endothelial dysfunction and intravascular fibrin turnover were seen in patients with left ventricular aneurysms whether or not diastolic dysfunction was present. This study demonstrates that there is no evidence of a significant additional contribution to thrombotic risk (as assessed by plasma fibrinogen, von Willebrand factor and fibrin D-dimer) for patients with left ventricular diastolic dysfunction. A relationship is noted between some prothrombotic factors and Doppler indices of flow, which suggests a possible association between cardiac haemodynamics and thrombogenesis.