Elevated D-dimer level is an independent risk factor for cardiovascular death in out-patients with symptoms compatible with heart failure

2004 ◽  
Vol 92 (12) ◽  
pp. 1250-1258 ◽  
Author(s):  
Ulf Dahlström ◽  
Tomas Lindahl ◽  
Urban Alehagen
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Plasma Concentration ◽  
Cardiovascular Mortality ◽  
Independent Risk Factor ◽  
Systolic Function ◽  
Venous Flow ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
D Dimer

SummaryD-dimer, a marker of fibrin turnover, exhibits many interesting properties as a biological marker of thrombosis. Some of the properties of D-dimer might also be used to provide additional information about patients with heart failure. In this study, we evaluate the prognostic information acquired from D-dimer concerning increased risk of cardiovascular mortality in an elderly population with symptoms associated with heart failure. A cardiologist examined 458 elderly patients, out of 548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema and assessed NYHA functional class and cardiac function. Abnormal systolic function was defined as EF <40% on Doppler echocardiography. Abnormal diastolic function was defined as reduced E/A ratio and/or an abnormal pattern of pulmonary venous flow. Blood samples were drawn, and BNP and D-dimer were analysed. D-dimer was analysed using an automated micro-latex assay. A statistical analysis was performed to identify the prognostic value of increased plasma concentration of D-dimer. Results showed that during a median follow-up period of 5.5 years, 68 (14%) patients died of cardiovascular disease. No gender difference was noted. A plasma concentration of D-dimer >0.25mg/L increased the risk almost 4-fold. In conclusion, D-dimer is an independent risk factor for cardiovascular mortality that may be used to risk-stratify patients with heart failure.

Is Chagas cardiomyopathy an independent risk factor for patients with heart failure?

2008 ◽  
Vol 126 (2) ◽  
pp. 276-278 ◽  
Author(s):  
Julio Cesar Vieira Braga ◽  
Francisco Reis ◽  
Roque Aras ◽  
Nei Dantas ◽  
Almir Bitencourt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Chagas Cardiomyopathy ◽  
Patients With Heart Failure

Abstract 118: Right Bundle Branch Block and Clinical Outcomes in Patients with Heart Failure: A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Meta Analysis ◽  
Bundle Branch Block ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Importance: Right bundle branch block (RBBB) is observed in approximately 5-14% of patients with heart failure (HF). Multiple observational studies have reported the association of RBBB with clinical outcomes in patients with HF. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with HF. Data Sources: We have systematically searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts that described all cause or cardiovascular mortality in patients with RBBB and HF. We excluded studies that reported unadjusted outcome, i.e.: unadjusted event rates. Knowledge synthesis: We pooled reported risk ratio and hazard ratio. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: We found 12 relevant observational studies enrolling over 38,000 patients. Risk of bias was assessed using the Newcastle-Ottawa Scale. Included studies had at least a moderate quality. Seven of those evaluated prognosis of patients with RBBB and heart failure. After a mean follow up period of 2.5 years (range: 1-5 years), RBBB was associated with a statistically significant increased risk of all-cause mortality compared to patients with heart failure but no BBB, RR 1.27, 95% CI (1.08-1.50), Figure 1. The other 5 studies evaluated CHF patients receiving cardiac resynchronization therapy (CRT), comparing outcomes of patients with RBBB to those with LBBB. After a mean f/u period of 3 years, patients with RBBB were once again found to have an increased risk of all-cause mortality, RR 1.45, 95% CI 1.12-1.89. Conclusion and Relevance: RBBB in patients with HF is associated with higher all-cause mortality in comparison to patients without inter-ventricular conduction defects, as well as LBBB patients in patients undergoing CRT setting.

scholarly journals Effect of early cardiac rehabilitation on prognosis in patients with heart failure following acute myocardial infarction

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
He Cai ◽  
Pengyu Cao ◽  
Wenqian Zhou ◽  
Wanqing Sun ◽  
Xinying Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Anaerobic Threshold ◽  
Independent Risk Factor ◽  
Major Adverse Cardiovascular Events ◽  
Patients With Heart Failure

Abstract Objective The purpose of this retrospective study is to evaluate the effectiveness of early cardiac rehabilitation on patients with heart failure following acute myocardial infarction. Methods Two hundred and thirty-two patients who developed heart failure following acute myocardial infarction were enrolled in this study. Patients were divided into heart failure with reduced ejection fraction group (n = 54) and heart failure with mid-range ejection fraction group (n = 178). Seventy-eight patients who accepted a two-week cardiac rehabilitation were further divided into two subgroups based on major adverse cardiovascular events. Key cardio-pulmonary exercise testing indicators that may affect the prognosis were identified among the cardiac rehabilitation patients. Results Early cardiac rehabilitation significantly reduced cardiac death and re-hospitalization in patients. There was more incidence of diabetes, hyperkalemia and low PETCO2 in the cardiac rehabilitation group who developed re-hospitalization. Low PETCO2 at anaerobic threshold (≤ 33.5 mmHg) was an independent risk factor for re-hospitalization. Conclusions Early cardiac rehabilitation reduced major cardiac events in patients with heart failure following acute myocardial infarction. The lower PETCO2 at anaerobic threshold is an independent risk factor for re-hospitalization, and could be used as a evaluating hallmark for early cardiac rehabilitation.

Abstract 3148: Atrial Fibrillation Is Associated With Increased Risk Of Fatal And Non-fatal Cardiovascular Events In Patients With Heart Failure And Preserved Ejection Fraction - Findings From The Irbesartan In Heart Failure With Preserved Systolic Function Trial (I-PRESERVE)

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael R Zile ◽  
Michel Komajda ◽  
Robert McKelvie ◽  
John McMurray ◽  
Mark Donovan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Independent Predictor ◽  
Systolic Function ◽  
Clinical History ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Lower Egfr ◽  
One Year

Background: Atrial fibrillation (AF, documented by ECG) is present in 15% of patients with heart failure and a reduced LV ejection fraction (HF-REF) and is an independent predictor of cardiovascular (CV) events. The prevalence of AF in patients with HF and preserved EF (HF-PEF) and whether AF is an independent predictor of CV outcomes in HF-PEF have not been defined. Methods: The Irbesartan in Heart Failure with Preserved Systolic Function Trial (I-PRESERVE) randomized 4128 patients with an EF ≥ 45% to receive Irbesartan or placebo. The prevalence of AF was established by ECG at randomization. The “ primary” outcome (475 events/3796 patients) of all-cause mortality or CV hospitalization (myocardial infarction, stroke, worsening heart failure, atrial or ventricular arrhythmia, unstable angina) and a “ secondary” outcome (294 events/3796 patients) of HF mortality and HF hospitalizations were compared over one year of follow-up between patients with and without AF. The independent predictive role of AF was examined in a multivariable model (including symptoms, clinical history, CV examination, biochemistry, hematology). Results: In I-PRESERVE, 16% of patients had AF by ECG at randomization. Patients with AF, compared to patients without AF, were older (74 ± 0.3 vs 71 ± 0.1 yrs, mean ± SEM), less often female (54% vs 62%), had lower EF (58 ± 0.4% vs 60 ± 0.2%), lower eGFR (68 ± 0.8 vs 73 ± 0.4), higher incidence of previous HF hospitalization (61% vs 41%), less frequent history of hypertension and MI (84 & 17% vs 89 & 25%), lower systolic BP (134 ± 0.6 vs 137 ± 0.3 mmHg), higher heart rate (76 ± 0.5 vs 71 ± 0.2 BPM), all p < 0.05. The primary and secondary outcomes occurred in 19 & 15% of patients with AF and 12 & 6% of patients without AF at 1 year. In a multivariate analysis AF remained a significant predictor of increased risk of the primary (Hazard Ratio, HR 1.33 [95% CI 1.07, 1.65]) and secondary (HR 1.81 [95% CI 1.40, 2.33]) outcomes. Conclusions: At randomization to I-PRESERVE, the prevalence of AF by ECG in HF-PEF patients was similar to patients with HF-REF in previous studies. HF-PEF patients with AF had a significantly worse outcome than those without AF and this increased risk of fatal and non-fatal CV events was independent of other factors associated with a worse prognosis.

scholarly journals Insufficient Self-Care Is an Independent Risk Factor for Adverse Clinical Outcomes in Japanese Patients With Heart Failure

2013 ◽  
Vol 54 (6) ◽  
pp. 382-389 ◽  
Author(s):  
Naoko Kato ◽  
Koichiro Kinugawa ◽  
Etsuko Nakayama ◽  
Takako Tsuji ◽  
Yumiko Kumagai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Factor ◽  
Clinical Outcomes ◽  
Independent Risk Factor ◽  
Self Care ◽  
Japanese Patients ◽  
Patients With Heart Failure

scholarly journals Early cardiac rehabilitation improved prognosis in patients with heart failure following acute myocardial infarction

2020 ◽  
Author(s):  
He Cai ◽  
Pengyu Cao ◽  
Wanqing Sun ◽  
Xinying Zhang ◽  
Rongyu Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Risk Factor ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Serum Potassium ◽  
Independent Risk Factor ◽  
Exercise Intolerance ◽  
Patients With Heart Failure

Abstract Background: Cardiac rehabilitation (CR) has been shown to improve exercise intolerance and QoL, and minimize re-hospitalizations in patients with congestive heart failure (CHF). However, studies on early CR in patients with acute myocardial infarction (AMI) who developed CHF following percutaneous coronary intervention (PCI) are rare. The purpose of this study is to evaluate the effectiveness of early CR on patients with CHF after AMI following PCI.Methods: Two hundred thirty-seven patients who developed heart failure after AMI following PCI were enrolled. Patients were divided into heart failure with reduced ejection fraction (HFrEF) group (n=55) and heart failure with mid-range ejection fraction (HFmrEF) group (n=182). Of the 237 patients, 78 (22 in HFrEF group and 56 in HFmrEF group) who accepted a two-week CR were further divided into two subgroups based on major adverse cardiovascular events (MACE). Key cardio-pulmonary exercise testing (CPX) variables that may affect the prognosis were identified among the CR patients.Results: Early CR significantly reduced cardiac death in patients with HFrEF (18.2% vs. 60.6%, P=0.02), and reduced re-hospitalization in patients with HFmrEF after AMI (3.6% vs. 21.4%, P=0.02). Serum potassium and CR ratio were independent risk factors for MACE in patients with both HFrEF and HFmrEF after AMI. In the CR group who developed MACE, there were more diabetics (22.2% vs. 66.7%, P=0.035), with higher serum potassium (3.96mmol/l vs. 4.31mmol/l, P=0.043), and lower PETCO2 at ventilatory threshold (VT) (P=0.016). PETCO2 at VT was an independent risk factor for re-hospitalization. The incidence of re-hospitalization was significantly lower when the PETCO2 at VT was greater than 33.5mmHg (0(0.00% vs. 6(13.64%), P=0.03).Conclusions: Early CR reduced the incidence of MACE in patients with heart failure after AMI following PCI. The PETCO2 at VT is an independent risk factor for re-hospitalization, and could be used as a key evaluating hallmark for early CR in patients who developed heart failure after AMI.

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