Prognostic impact of haemostatic derangements in chronic heart failure

Borut Jug; Nina Vene; Barbara Gužic Salobir; Miran Šebeštjen; Mišo Šabovic; Irena Keber

doi:10.1160/TH08-11-0721

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2009; 102(02): 314-320
DOI: 10.1160/TH08-11-0721

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Prognostic impact of haemostatic derangements in chronic heart failure

Borut Jug

¹Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Slovenia

,

Nina Vene

¹Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Slovenia

,

Barbara Gužic Salobir

²Clinic of Nuclear Medicine, University Clinical Center Ljubljana, Slovenia

,

Miran Šebeštjen

¹Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Slovenia

,

Mišo Šabovic

¹Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Slovenia

,

Irena Keber

¹Department of Vascular Diseases, Clinic of Internal Medicine, University Clinical Center Ljubljana, Slovenia

› Institutsangaben

Abstract

Summary

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] µg/l; p=0.033) and D-dimer (938 [485–1269] vs. 620 [37–1076] µg/l; p=0.018). However, on Cox multivariate analysis, only tPA levels above optimal cut-off value of 10.2 µg/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.

Keywords

Congestive heart failure - prognosis - haemostasis

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Referenzen

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