D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy

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.

核素心肌灌注显像在左心衰竭与心肌缺血相关性研究中的临床价值

目的利用核素心肌灌注显像,分析左心衰竭与心肌缺血之间的相关性,为临床心力衰竭治疗决策提供重要依据。方法选取临床确诊的各类左心衰竭住院患者75例,其中男性46例,女性29例,年龄35～85岁,平均(60±24)岁,行核素心肌灌注显像,对其中阳性显像追加冠状动脉造影检查。将患者分为心肌灌注显像阴性组和心肌灌注显像阳性组,分别对负荷和静息2次左心室收缩末期容积、舒张末期容积进行行×列表χ2检验,观察缺血面积与心室容量整体的相互差异。同时对其中符合临床支架植入指征的30例患者进行了冠状动脉支架植入术,术后21例复查了核素心肌灌注显像并与术前进行了对比分析。结果核素心肌灌注显像结果无明显异常者15例,轻度缺血15例,中度缺血36例,且均为负荷显像阳性,静息显像阴性的可逆性缺血;严重缺血9例,均为负荷、静息显像阳性的不可逆性缺血。缺血面积百分比为(15±10)%,严重程度标准差值平均为-2.7±1.8,射血分数(EF)值为(43±8)%。不同缺血范围水平级的左心室容积和缺血范围,按α=0.05检验水准,呈现缺血越严重,心室容积越大趋势,心室射血功能也相应下降。缺血面积与负荷舒张末期容积、静息舒张末期容积、负荷收缩未期容积、静息收缩末期容积的相关系数(r值)分别为0.68、0.70、0.65、0.73,P值均<0.01。60例核素心肌灌注显像阳性组患者行冠状动脉造影检查,结果为46例有不同程度狭窄(≥50%)。21例支架植入术后患者左心室容量恢复具有统计学意义(P<0.05)。结论核素心肌灌注显像为临床早期判断左心衰竭病因,从而做出及时正确的决策有着重要临床意义。

心功能不全对血浆D-二聚体的影响

目的：观察充血性心力衰竭患者血浆D-二聚体特点，以指导临床抗凝治疗。方法：采用Latex法对正常对照组30例，心功能正常组28例，心衰组58例及心衰缓解后7－10天进行血浆D-二聚体检测。结果：心衰组D-二聚体阳性率显著高于心功能正常组（P＜0.01），心功能缓解后7-10天显著下降（P＜0.05），心房纤颤组显著高于非心房纤颤组（P＜0.01），瓣膜病组显著高于非瓣膜病组（P＜0.01）。结论：充血性心力衰竭患者存在凝血及纤溶异常，心房纤颤或瓣膜病变是血栓形成的危险因素，检测血浆D-二聚体可指导抗凝治疗。

N末端B型脑钠肽前体在心力衰竭中的诊断和预后价值

【目的】探讨N末端B型脑钠肽前体（NT-proBNP）对心力衰竭（简称心衰）的诊断意义以及对心衰的预后价值。【方法】设心衰组65例，对照组92例，测定血浆NT—ProBNP、左室射血分数（LVEF），左室舒张末内径（LVDd）及评价NYHA心功能分级。出院复查一次，随访病人3个月内的再入院率。【结果】①心衰组NYHAⅡ、Ⅲ、Ⅳ级与对照组的血浆lnNT-proBNP水平两两比较有统计学差异（P〈0．01），心功能越差血浆lnNT—proBNP水平显著升高。②lnNT—proBNP（取自然对数ln）与LVDd呈正相关（r=0．423，P〈0．01），lnNT—proBNP与LVEF呈负相关（r=-0．407，P〈0．01）。③NT—proBNP诊断心衰的ROC曲线显示，当cut—Off值定为459pg／mL时，正确诊断指数最高（0．578），此时敏感度76．7％，特异度100％。④心衰患者出院时NT—proBNP升高组45例，正常组20例。升高组3个月内因心衰再住院者20例（44．4％），正常组2例（10％）。【结论】NT—proBNP是诊断心衰的可靠指标，与心衰的严重程度密切相关，动态观察NT—proBNP变化水平可有效地判断心衰患者的预后。