Abstract 12968: Decreased Levels of Alpha 2 Plasmin Inhibitor Predicts Cardiac Events in Patients with Heart Failure
It was reported that heart failure is associated with a prothrombotic state. A modified Virchow triad as blood stasis in enlarged cardiac chambers, endothelial abnormalities and abnormalities of blood coagulation properties has been proposed as a predisposing mechanism to a procoagulant state in heart failure. However, it is unclear whether a prothrombotic state is associated with cardiac prognosis in patients with heart failure. Therefore, we examined feasibility of several hemostatic markers for cardiac events in patients with heart failure. We measured alpha-2 plasmin inhibitor (α2PI), fibrin degradation product (FDP), and D-dimer in 287 consecutive patients with heart failure (155 male, 72±13 years). The primary end-point was heart failure related-deaths or ospitalizations for worsening heart failure. One hundred and fifty seven patients (45%) had cardiac events during a median follow-up period of 379 days. Levels of α2PI were significantly lower in patients with cardiac events than in those without events (P < 0.0001), while there were no significant differences in levels of FDP and D-dimer between them. Multivariate Cox proportional hazard analysis demonstrated that α2PI independently predicted cardiac events (hazard ratio 1.231, 95% confidence interval 1.033-1.475; P < 0.001).Levels of α2PI levels were not altered by anticoagulant and antiplatelet therapy. The study subjects were divided into 4 groups according to quartile for α2PI level. Kaplan-Meier analysis demonstrated that cardiac event rates were significantly increased with decreasing α2PI levels (Figure). In conclusions, α2PI is a feasible prognostic marker in patients with heart failure. Hemostatic abnormality may be partly associated with the pathophysiology of adverse outcomes in heart failure.
- © 2012 by American Heart Association, Inc.