Abstract 13007: Prognostic Significance of Persistent D-dimer Elevation in Patients With Acute Decompensated Heart Failure
Backgrounds: Heart failure is associated with a prothrombotic state. D-dimer (DD) is a marker of fibrin turn over, and increased DD levels predict poor outcomes in patients with chronic heart failure. However, data regarding the DD level in patients with acute heart failure (AHF) are limited.
Methods: Of 651 consecutive AHF patients who admitted to our institution between January 2013 and March 2015 from prospective registry, patients with acute coronary syndrome, oral anticoagulant therapy, and venous thromboembolism were excluded. Finally, 296 patients were divided into two groups according to the higher DD (above 2.7 μg/ml, the median), or lower DD (below 2.7 μg/ml) on admission. DD level was measured within 24 hours from admission and at discharge.
Results: Although patients with higher DD were older (77±11 vs. 73±14 years; P<0.01), other baseline characteristics in terms of sex, NYHA classification, prevalence of co-morbidities including atrial fibrillation, and echocardiographic parameters including left ventricular ejection fraction were comparable between the two groups. During the median follow-up of 281 days, 4 patients died during hospitalization and 19 patients died after discharge. Kaplan-Meier curves for all-cause mortality are shown in the figure. Higher DD level on admission was associated with higher mortality (HR: 2.78, 95% CI: 1.19-7.25, P=0.02), even after adjustment by age. At discharge, DD level was persistently elevated (above 2.7 μg/ml) in 62% of patients with higher DD on admission. Among patients with higher DD on admission, persistent elevation of DD level during hospitalization was associated with higher mortality after discharge (HR: 7.00, 95% CI: 1.33-128.52, P=0.02).
Conclusions: In patients with AHF, higher DD level on admission, especially persistently higher DD level during hospitalization, was associated with higher all-cause mortality, suggesting an importance of DD level as a prognostic surrogate marker of AHF.
Author Disclosures: Y. Hamatani: None. T. Nagai: None. Y. Sugano: None. S. Honda: None. A. Okada: None. Y. Asaumi: None. T. Aiba: None. T. Noguchi: None. K. Kusano: None. H. Ogawa: Other Research Support; Modest; Astellas, Bristol-Myers Squibb, Chugai Pharmaceutical, Dainippon Sumitomo Pharma, MSD, Mochida Pharmaceutical, Ono Pharmaceutical, Otsuka, Pfizer, Takeda Pharmaceutical. Other Research Support; Significant; Bayer, Daiichi Sankyo, Novartis Pharma, Sanofi. Honoraria; Modest; AstraZeneca, Boehringer Ingelheim,Bristol-Myers Squibb, Mitsubishi Tanabe Pharma, Pfizer, Sanofi, Teijin Pharma. Honoraria; Significant; Bayer, Daiichi Sankyo, MSD, Takeda Pharmaceutical. S. Yasuda: None. T. Anzai: None.
- © 2015 by American Heart Association, Inc.