Hemostatic abnormalities in patients with congestive heart failure: diagnostic significance and clinical challenge

Davis, Christopher J.; Gurbel, Paul A.; Gattis, Wendy A.; Fuzaylov, Sergey Y.; Nair, Girish V.; O’Connor, Christopher M.; Serebruany, Victor L.

doi:10.1016/s0167-5273(00)00300-4

Cited by 63 publications

(35 citation statements)

References 57 publications

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“…The pathophysiological concept of heart failure has changed dramatically during the last decade with increased understanding of a multiorgan neurohormonal response (1,2 ) as well as activation of immunological (3,4 ) and inflammatory systems (5)(6)(7). As a consequence, new biomarkers for diagnosis and prognosis in heart failure have emerged (8 -10 ).…”

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confidence: 99%

“…The use of biomarkers extends from diagnostic assessment to identification of patients at high risk for hospitalization or cardiovascular mortality. B-type natriuretic peptide (BNP) 3 and the N-terminal fragment of the biosynthetic precursor (N-terminal pro-B-type natriuretic peptide [NT-proBNP]) have been intensively examined as heart failure biomarkers (11 ).…”

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confidence: 99%

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Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro–B-Type Natriuretic Peptide Measurements

et al. 2010

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BACKGROUND N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a useful biomarker in heart failure assessment, whereas measurement of cardiac troponin is central in the diagnosis of patients with acute coronary syndromes. This report examined the prognostic use of combining high-sensitivity cardiac troponin T (hs-cTnT) and NT-proBNP measurements in elderly patients presenting to a primary care center with symptoms associated with heart failure. METHODS A total of 470 elderly patients (age range 65–86 years) presenting with symptoms of heart failure were recruited from primary healthcare. In addition to clinical examination and echocardiography, hs-cTnT and NT-proBNP plasma concentrations were measured. All patients were followed for 10 years, and cardiovascular mortality was registered. RESULTS By use of the hs-cTnT assay, 80.4% of the population had plasma concentrations above the lower detection limit of the assay. Of those displaying a plasma concentration of hs-cTnT >99th percentile of a healthy population, 43% also had an NT-proBNP concentration in the fourth quartile (>507 ng/L). In the multivariate analysis, we observed a 2.5-fold increased risk for cardiovascular mortality in individuals with a plasma NT-proBNP concentration >507 ng/L (P < 0.0001). Conversely, patients with hs-cTnT >99th percentile displayed an approximately 2-fold increased risk for cardiovascular mortality (P = 0.0002). Combining the 2 biomarkers, NT-proBNP concentrations >507 ng/L with hs-cTnT >99th percentile increased the risk 3-fold, even after adjustment for clinical variables such as age, sex, impaired estimated glomerular filtration rate, and anemia (P < 0.0001). CONCLUSIONS hs-cTnT and NT-proBNP measurements combined provide better prognostic information than using either biomarker separately in elderly patients with symptoms associated with heart failure.

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confidence: 99%

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confidence: 99%

Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro–B-Type Natriuretic Peptide Measurements

et al. 2010

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“…The mechanisms leading to increased VTE risk in HF are multifactorial and relate to the Virchow Triade (abnormal blood constituents, blood flow, and vessel wall), which defines a hypercoagulable state 18 (Figure 1). Blood constituent abnormalities are due to platelet and thrombin activation, which result in abnormal coagulation and increased plasma viscosity.…”

Section: Pathophysiologymentioning

confidence: 99%

Thromboembolism and Antithrombotic Therapy in Patients With Heart Failure in Sinus Rhythm

Bettari

Fiuzat

Becker

et al. 2011

Circ: Heart Failure

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H eart failure (HF) represents a major and growing public health problem because of its prevalence, incidence, morbidity, mortality, and economic costs. The prevalence of HF is 2% to 3% of the general population. 1 Five million Americans are affected, with Ͼ550 000 cases diagnosed each year. 2 The mortality rate from severe HF remains Ͼ60% within 5 years of diagnosis, and 50% of hospitalized patients with HF require readmission within 6 months of discharge. In the US estimated costs amount to Ͼ $35 billion per year. 3 Although several therapies (eg, ␤-blockers, angiotensinconverting enzyme [ACE] inhibitors, and cardiac resynchronization therapy) have been proven effective in improving HF outcomes, many unanswered questions about optimal treatment remain. One area of ongoing uncertainty is the appropriate role for antithrombotic therapy in patients with HF. Observational data suggest that patients with HF have an increased venous thromboembolism (VTE) risk (deep venous thromboembolism [DVT], pulmonary embolism [PE], peripheral arterial thromboembolism, and stroke). 4 These epidemiological findings are supported by multiple mechanisms that can contribute to a hypercoagulable state in patients with HF. Despite this increased risk of VTE, the role of antithrombotic therapy remains unclear. In this article, we provide an overview of epidemiology, pathophysiology, clinical trial data, and therapeutic recommendations for prevention of thromboembolism in HF. Search StrategyWe searched PubMed for articles published between 1958 and 2010 using the following search terms: epidemiology of heart failure, thromboembolism and heart failure, thrombogenesis and heart failure, anticoagulation in heart failure, antiplatelet agent and heart failure, aspirin and heart failure, bleeding risk and anticoagulation, and aspirin and angiotensin-converting enzyme inhibitors. We also studied abstracts from national and international cardiovascular meetings to identify unpublished studies using the key words anticoagulation and dilated cardiomyopathy. EpidemiologyData from published observational studies and secondary analyses of randomized controlled trials (RCTs) indicate that patients with HF patients have a higher risk for VTE than the general population. Observational CohortsDVT and PE Several case-cohort studies have shown that HF is associated with a 2-to 3-fold increased risk of DVT and PE compared with other medical conditions. 5 Retrospective analyses report an annual VTE incidence of 1.0% to 4.5% in patients with HF. 6 In RCTs of thromboprophylaxis in hospitalized patients with HF followed for 90 days, DVT rates ranged from 4.0% to 14.6%. 7,8 The Prophylaxis in Medical Patients With Enoxaparin trial evaluated VTE incidence in hospitalized patients with (nϭ353) and without (nϭ749) HF during a follow-up of 14 days after discharge and found that 15% of patients with HF not treated with enoxaparin developed VTE. 9 Beemath et al, 4 using data from the National Hospital Discharge Survey, found an increased risk of VTE in hospitalized p...

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“…One such potential mechanism is platelet activation. 5,6 The activation of neurohormonal, inflammatory, and thrombotic pathways [7][8][9] is known to be associated with enhanced platelet reactivity in AHF. [10][11][12][13][14] However, whether increased platelet activity is simply a marker of this systemic imbalance or an actual contributor to acute decompensation is incompletely understood.…”

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confidence: 99%

“…Several pathophysiologic mechanisms that may explain a possible detrimental role of platelet activation on the myocardium have been described. 6,15,16 Myocardial injury, as manifest clinically by elevations of cardiac troponin, 17,18 may represent a connection between platelet activation and poor prognosis. If a causal role for platelet activation can be confirmed in the AHF setting, specific antiplatelet therapies might improve prognosis in this high-risk population.…”

mentioning

confidence: 99%

Is There a Rationale for Antiplatelet Therapy in Acute Heart Failure?

Mentz

Lazzarini²,

Fiuzat³

et al. 2013

Circ: Heart Failure

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Hemostatic abnormalities in patients with congestive heart failure: diagnostic significance and clinical challenge

Cited by 63 publications

References 57 publications

Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro–B-Type Natriuretic Peptide Measurements

Prognostic Assessment of Elderly Patients with Symptoms of Heart Failure by Combining High-Sensitivity Troponin T and N-Terminal Pro–B-Type Natriuretic Peptide Measurements

Thromboembolism and Antithrombotic Therapy in Patients With Heart Failure in Sinus Rhythm

Is There a Rationale for Antiplatelet Therapy in Acute Heart Failure?

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