title: Procoagulant state in heart failure with preserved left ventricular ejection fraction.
abstract: The impact of heart failure with preserved left ventricular ejection fraction (LVEF) on activated hemostasis is still unclear. We sought to compare the activation of hemostasis in patients with heart failure with preserved LVEF, with impaired LVEF, and in healthy controls. Biomarkers of coagulation and fibrinolysis (D-dimer, tPA and PAI-1) were determined in outpatients with chronic stable (NYHA I-III), optimally managed heart failure with preserved LVEF (n = 46) and with impaired LVEF (n = 52), and in healthy age- and gender-matched controls (n = 14). In comparison to healthy controls, patients with heart failure and preserved LVEF had increased median D-dimer levels (606 [330-1222] microg/L versus 174 [86-249] microg/L; P < 0.001), and median PAI-1 (20 [15.3-33.1] microg versus 6.2[3.4-8.9] microg/L; P < 0.001) and tPA antigen concentrations (9.6 [8.1-13.3] versus 3.6 [2.2-5.0] microg/L; P < 0.001). However, unlike tPA and PAI antigens, D-dimer levels in preserved LVEF did not reach values as high as in impaired LVEF (917 [454-1185] microg/L; P = 0.013). Moreover, in patients with impaired LVEF, but not in those with preserved LVEF, age and NT-proBNP emerged as independent predictors of log-transformed D-dimer levels. Heart failure with preserved LVEF is associated with a procoagulant state as determined by increased levels of D-dimer, tPA and PAI-1 antigens. D-dimer levels are significantly higher in patients with impaired LVEF, while tPA and PAI-1 levels are increased regardless of LVEF.
authors.affiliation: Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Ljubljana, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Jug
authors.forename: Nina
authors.initials: N
authors.lastname: Vene
authors.forename: Barbara Guzic
authors.initials: BG
authors.lastname: Salobir
authors.forename: Miran
authors.initials: M
authors.lastname: Sebestjen
authors.forename: Miso
authors.initials: M
authors.lastname: Sabovic
authors.forename: Irena
authors.initials: I
authors.lastname: Keber
mesh_terms: D000368:Aged; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006333:Heart Failure / Q000503:physiopathology*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D015849:Plasminogen Inactivators / Q000097:blood; D013318:Stroke Volume; D010959:Tissue Plasminogen Activator / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D015849:Plasminogen Inactivators; C036309:fibrin fragment D; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D010959:Tissue Plasminogen Activator