Thrombotic biomarkers and left ventricle characteristics as short-term predictors of thrombotic events in patients hospitalized for acute decompensated heart failure

Abstract

Background: Hospitalized acute decompensated heart failure (ADHF) patients have high risk of thromboembolic events (TE). The aim of this study is to determine the short-term prognostic value of TE for different thrombotic biomarkers (fibrinogen; D-dimer; tissue plasminogen activator antigen, t-PA; and plasminogen-activator inhibitor type 1 antigen, PAI-1) and left ventricle echocardiographic characteristics (diastolic diameter, LVDD; ejection fraction, LVEF) in admitted ADHF patients.

Methods and results: We included 140 patients with ADHF in NYHA classes III-IV (October 2009 to November 2011). Subjects with anticoagulant drugs, arrhythmias, or thrombosis were excluded. Biochemical and echocardiographic data were obtained within 12h after admission and all patients were given enoxaparin 40 mg/day. Throughout hospitalization (median, 11 days), 14 subjects (10.0%) with ADHF received a TE diagnosis. Pulmonary embolism (PE, 5.0%), deep-vein thrombosis (DVT, 7.1%), or a combination of these were confirmed in 3, 6 and 4 patients respectively. Cardioembolic stroke was diagnosed in 1 subject (0.7%) associated with left ventricular intracavitary thrombus developed after admission. The following determinations most strongly predicted the short-term risk of TE: fibrinogen>500 mg/dL (Odds Ratio [OR] 6.19; p=.0019), D-dimer>600 ng/dL (OR 7.84; p=.0009), t-PA>10 ng/dL (OR 7.22; p=.0007), PAI-1>30 ng/dL (OR 8.70; p<.0006), LVDD>50mm (OR 5.67; p=.0039), and LVEF<30% (OR 5.48; p=.0163).

Conclusions: Elevated levels of fibrinogen, D-dimer, t-PA and PAI-1 antigens as well as a dilated left ventricle with poor systolic function determined at admission are associated with a significantly high short-term risk of TE.