D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy
Bi HUANG
Yuan-Jing LI
Jian SHEN
Yuan YANG
Gang LIU
Su-Xin LUO
摘要：Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices,represented by elevated D-dimer,had prognostic significance in patients with compatible or acute decompensated HF.However,the impact of D-dimer on the outcome in patients with end-stage HF remains unclear.Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014.D-dimer levels were measured and its prognostic value was assessed.Primary endpoint was all-cause mortality during the follow-up period.Secondary endpoints were stroke,bleeding,occurrence of sustained ventricular tachycardia or ventricular fibrillation,and major adverse cardiovascular events (MACE).Results D-dimer was significantly elevated in the non-survivors (median:0.8 vs.1.1 mg/L,P ＜ 0.001).Traditional markers including B-type natriuretic peptide,troponin I,left ventricular ejection fraction,and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification.The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis.Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR =2.315,95％ CI:1.570-3.414,P ＜ 0.001) and MACE (HR =1.256,95％ CI:1.058-1.490,P =0.009),and the predictive value was independent of age,sex,atrial fibrillation and anticoagulation status.Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM,and the predictive value was superior to that of traditional prognostic markers.
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论文发表日期：2019-01-01
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：9( 621-629 )
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