Abstract
The prognostic role of D-dimer in different types of heart failure (HF) is poorly understood. We investigated the prognostic value of D-dimer on admission, both independently and in combination with the Get With The Guidelines—Heart Failure (GWTG-HF) risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP), in patients with preserved left ventricular ejection fraction (LVEF) and acute decompensated HF (HFpEF) or reduced LVEF (HFrEF). Baseline D-dimer levels were measured on admission in 1670 patients (mean age: 75 years) who were hospitalized for worsening HF. Of those patients, 586 (35%) were categorized as HFpEF (LVEF ≥ 50%) and 1084 as HFrEF (LVEF < 50%). During the 12-month follow-up period after admission, 360 patients died. Elevated levels (at least the highest tertile value) of D-dimer, GWTG-HF risk score, and NT-proBNP were all independently associated with mortality in all HFpEF and HFrEF patients (all p < 0.05). Adding D-dimer to a baseline model with a GWTG-HF risk score and NT-proBNP improved the net reclassification and integrated discrimination improvement for mortality greater than the baseline model alone in all populations (all p < 0.001). The number of elevations in D-dimer, GWTG-HF risk score, and NT-proBNP were independently associated with a higher risk of mortality in all study populations (HFpEF and HFrEF patients; all p < 0.001). The combination of D-dimer, which is independently predictive of mortality, with the GWTG-HF risk score and NT-proBNP could improve early prediction of 12-month mortality in patients with acute decompensated HF, regardless of the HF phenotype.
Highlights
D-dimer is the end product of plasmin-mediated degradation of cross-linked fibrin.Plasma concentrations of D-dimer, a marker of coagulation, are dependent on fibrin generation and subsequent degradation by the endogenous fibrinolytic system [1]
586 (35%) patients were categorized as HF with preserved ejection fraction (HFpEF) and 1084 as HF with reduced ejection fraction (HFrEF)
Similar results dently associated with all-cause mortality when assessed as either continuous variables or were obtained when patients were divided into tertiles according to GWTG-heart failure (HF) risk score categorized into two groups the ≥43 thirdpoints) tertile value in all patients,(1st, a subcohort of
Summary
D-dimer is the end product of plasmin-mediated degradation of cross-linked fibrin. Plasma concentrations of D-dimer, a marker of coagulation, are dependent on fibrin generation and subsequent degradation by the endogenous fibrinolytic system [1]. Several studies have suggested that elevated D-dimer levels are associated with adverse outcomes in patients hospitalized for HF [4,5,6,7]. The Get With The Guidelines—Heart Failure (GWTG-HF) risk score was established to predict in-hospital mortality in patients with acute HF [12]. Previous studies have shown improved predictions of adverse outcomes following the addition of natriuretic peptides to the GWTG-HF risk score in patients with acute HF [18,19,20,21]. We assessed the prognostic value of D-dimer levels both independently and in combination with the GWTG-HF risk score and NT-proBNP levels, for acute decompensated HF patients with HFpEF and HFrEF
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