Abstract
OBJECTIVE: The study investigates the influence of D-dimer levels on the prognosis of patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). BACKGROUND: The prognostic impact of D-dimer levels has not yet been investigated in patients with HFmrEF. METHODS: We retrospectively included consecutive patients with HFmrEF at one institution from 2016 to 2022. Patients were divided in quartiles according to their D-dimer levels, further sub-analyses were performed after excluding patients with conditions associated with increased D-dimer levels. The primary endpoint was all-cause mortality at 30 months (median follow-up), key secondary endpoint was the risk of heart failure (HF)-related rehospitalization. RESULTS: In total, 1126 patients with HFmrEF were included with a median D-dimer level of 0.87 µg/mL (interquartile range 0.42-2.19 µg/mL). Higher D-dimer levels were associated with an increased risk of all-cause mortality (Q4 vs. Q1: hazard ratio (HR) 6.817; 95% confidence interval (95% CI) 4.401-10.561, p = 0.001), which was still observed after multivariable adjustment (Q4 vs. Q1: adjusted (a)HR 3.228; 95% CI 1.901-5.479; p = 0.001). This association was still observed after excluding patients with conditions associated with elevated D-dimer levels. CONCLUSION: Elevated D-dimer levels were independently associated with a higher risk of all-cause mortality in HFmrEF patients.