Abstract 14708: Prothrombin Time is a Novel Marker for Congestion in Acute Decompensated Heart Failure Patients Without Anticoagulants

Abstract

Background: Where prothrombin time is widely used to monitor anticoagulation in cardiology patients, it is also a classical marker of liver damage. However, the clinical significance of prothrombin time in heart failure patients without anticoagulants is unknown. Therefore, we investigated the prevalence, relationship with clinical characteristics, and prognostic value of prothrombin time in acute decompensated heart failure (ADHF). Method: We prospectively studied 651 consecutive patients admitted for ADHF. Prothrombin time internationalized normalized ratio (PT-INR) was measured on admission in all patients. By excluding patients with oral anticoagulants, acute coronary syndrome and liver diseases, 308 patients were assessed. We assessed the relationship between PT-INR and blood tests, echocardiogram, and hemodynamic parameters from right heart catheterization. Cox regression hazard analysis was performed to assess prognostic value of PT-INR on all-cause mortality and cardiovascular mortality. Results: Of the 308 patients (75±13 years, 192 male), the mean PT-INR value was 1.10. Patients with prolonged PT-INR(>1.10, n=104) had significantly higher total bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase (all p<0.05), however, had similar LVEF, blood urea nitrogen, creatinine, and BNP compared to those with less PT-INR(≦1.10, n=204). PT-INR value had strong correlation with pulmonary capillary wedge pressure (r=-0.61, p<0.01) and right atrial pressure (r=-0.59, p<0.01), but not with cardiac index (r=0.23, p=ns.). Twenty-two patients (7%) died during a mean follow up of 317 days, and Cox proportional hazards analysis showed that PT-INR was an independent predictor of both all-cause mortality (HR=1.14, p<0.05) and cardiovascular mortality (HR=1.12, p<0.05) even after adjusted by age, sex, LVEF, creatinine, BNP and hemoglobin. Conclusion: Prolonged PT-INR in ADHF patients without anticoagulants was associated with clinical markers of hepatic congestion and elevated right sided pressure. It was also an independent predictor of all-cause and cardiovascular mortality.