Prognostic impact of haemostatic derangements in chronic heart failure.
Heart failure is characterised by activation of haemostasis. We sought to explore the prognostic impact of deranged haemostasis in chronic heart failure. In stable, optimally managed outpatients with chronic heart failure, baseline levels of prothrombin fragment F1+2, D-dimer, and tPA and PAI-1 antigens were determined. Clinical follow-up was obtained and the rate of events (heart failure related deaths or hospitalisations) was recorded. We included 195 patients [32.3% female, NYHA class II (66.2%) or III (33.8%), mean age 71 years]. During a median follow up of 693 (interquartile range [IQR] 574-788) days, 63 (30.9%) patients experienced an event; those with an event had higher levels of tPA antigen (median 11.8 [IQR 8.7-14.0] vs. 9.4 [7.9-12.1] microg/l; p = 0.033) and D-dimer (938 [485-1269] vs. 620 [37-1076] microg/l; p = 0.018). However, on Cox multivariate analysis, only tPA levels above optimal cut-off value of 10.2 microg/l (but not D-dimer) emerged as an independent predictor of prognosis (HR(adjusted) 2.695, 95% confidence interval 1.233-5.363; p = 0.017). Our findings suggest that elevated tPA antigen levels are an independent prognostic predictor in patients with chronic stable heart failure.
Jug
Borut
B
Department of Vascular Diseases, University Clinical Center Ljubljana, Zaloska 7/VI, Ljubljana, Slovenia. borut.jug@gmail.com
Vene
Nina
N
Salobir
Barbara Guzic
BG
Sebestjen
Miran
M
Sabovic
Miso
M
Keber
Irena
I
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006333:Heart Failure / Q000097:blood* / Q000150:complications* / Q000401:mortality; D020141:Hemostatic Disorders / Q000097:blood* / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011379:Prognosis; D011516:Prothrombin; D010959:Tissue Plasminogen Activator / Q000097:blood
D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D010959:Tissue Plasminogen Activator