The relationship between D-dimer level and the development of atrial fibrillation in patients with systolic heart failure

Abstract

Heart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 ± 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be >792 ng/ml. D-dimer >792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels >792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.

Elevated D‐dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure

“…In our study, the D‐dimer level was found to be a better predictor of all‐cause death in patients with HFPEF than in patients with HFREF, partly because more patients with HFPEF also had atrial fibrillation (AF) . In addition, an elevated D‐dimer level is associated with the development of AF in hospitalised heart failure . Patients with concomitant heart failure and AF have a worse prognosis.…”

“…20 In addition, an elevated D-dimer level is associated with the development of AF in hospitalised heart failure. 21 Patients with concomitant heart failure and AF have a worse prognosis. However, numerous prognostic markers, such as AF, hypertension, smoking, obesity, diabetes, renal impairment, sleep apnoea and CAD and/or heart failure hospitalisation, have been identified in patients with heart failure.…”

Association of D-Dimer Levels On Admission With Outcomes in Elderly Patients With Chronic Obstructive Pulmonary Disease Exacerbation

“…Therefore, these characteristics may limit the generalizability of our ndings to this age bracket. D-dimer is also in uenced by other concomitant medical conditions, such as atrial brillation, heart failure, peripheral artery disease and renal failure [39][40][41][42]. Moreover, in this study, we did not exclude the patients exhibiting these concomitant medical conditions, which may have reduced the speci city of D-dimer in predicting mortality.…”

Association of Hemostatic Markers with Atrial Fibrillation: A Meta-Analysis and Meta-Regression

“…Thus, RAAS may contribute to prothrombotic state through inflammation. On the other hand, the innate alteration in some hemostatic markers at baseline may increase the risk of AF development in the future as suggested by some cohort studies [ 69 – 72 ]. However, the relevant large cohort studies are scarce and a synthetic conclusion is difficult to be drawn.…”