© 2004 Schattauer GmbH, Stuttgart Theme Issue Article 1250 Introduction Heart failure (HF) has become one of the most important prob- lems in health care in the western world today, described in a review by Rich (1). The prognosis for severe HF is worse than many malignant diseases, with less than 50% survival after 5 years (2). Even in patients with less severe HF, the prognosis is poor (3-5). In an elderly population with symptoms associat- ed with HF, it is important to establish the diagnosis and to start appropriate therapy as fast as possible. It is also important to identify patients with increased risk of cardiovascular (CV) mortality in order to optimise their management. As degradation products of fibrin, fragments of varying sizes containing the D-dimer epitope are markers of fibrin turn- over (6). In the literature, reports have been published concern- ing possible prognostic markers for increased risk of cardiovas- cular mortality among HF patients. The best-known indicators are impaired left ventricular function on Doppler echocardiog- raphy (7) and impaired functional capacity (8). Patients with increased plasma concentration of noradrenalin have also been Elevated D-dimer level is an independent risk factor for cardiovascular death in out-patients with symptoms compatible with heart failure Urban Alehagen 1 , Ulf Dahlström 1 ,Tomas L. Lindahl 2 1 Department of Cardiology, Heart Center, University Hospital of Linköping, Linköping, Sweden 2 Department of Clinical Chemistry, Laboratory Medicine Östergötland, and Department of Biomedicine and Surgery, University Hospital of Linköping, Linköping, Sweden Thromb Haemost 2004; 92: 1250–8 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 medi- an follow-up period of 5.5 years, 68 (14%) patients died of car- diovascular 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. Keywords Heart failure, elderly patients, primary health care, D-dimer, prognosis Summary D-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 addition- al 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 eld- erly population with symptoms associated with heart failure. A cardiologist examined 458 elderly patients, out of 548 invit- ed, 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 Correspondence to: Urban Alehagen Department of Cardiology Heart Center University Hospital of Linköping Linköping, SE-581 85 Sweden Tel.: +46-13-22 20 00, Fax: +46-13-222224 E-mail: urban.alehagen@ihs.liu.se Received May 5, 2004 Accepted after resubmission August 26, 2004 Prepublished online October 5, 2004 DOI: 10.1160/TH04-05-0278 For personal or educational use only. No other uses without permission. All rights reserved. Downloaded from www.thrombosis-online.com on 2015-09-13 | IP: 54.152.109.166