[Elevated D-dimer in patients with cardiovascular diseases free from thromboembolic complications: what is it associated with and what has to be done?]

To study the factors associated with an elevated content of D-dimer in patients diagnosed as having cardiovascular diseases (CVD) with no apparent thromboembolic complications.

A retrospective analysis of 1,000 case histories of patients (624 men and 376 women) aged from 19 to 93 years and undergoing treatment at the Institute of Cardiology named after A.L. Myasnikov in 2009. The sole criterion for inclusion into the study was the fact of hospitalization for any CVD and an altered content of D-dimer. The D-dimer levels were determined by latex agglutination using reagent kits «ST ALIATES® D-DF» (Diagnostica Stago). The upper limit of the normal distribution of the D-dimer amounted to 0.5 μg/ml.

Thromboembolic complications were encountered in 13% of patients. Search for increased D-dimer predictors was carried out amongst a total of 867 CVD patients with no manifest thromboembolic complications. The D-dimer levels ranged widely from 0.01 to 16.97 (median 0.32, interquartile range 0.20-0.63) mg/ml and exceeded the upper limit of the normal distribution in 32% of the patients. Based on the findings of the univariate analysis we selected 14 parameters with the level of significance P<0.05, associated with an elevated D-dimer content. These parameters included but were not limited to: female gender, age >68 years, a history of venous thromboembolic events, no cardiac angina, the presence of ciliary arrhythmia and functional class III-IV chronic cardiac insufficiency (CCI), decompensated CCI, the presence of a permanent artificial pacemaker, an acute inflammatory process, chronic obstructive pulmonary disease, active cancer, pulmonary hypertension, and dilatational cardiomyopathy. The subsequent multivariate analysis showed that female gender, age >68 years, an acute inflammatory process, pulmonary hypertension, and decompensated CCI were independent predictors of an elevated D-dimer level in patients with CVD without apparent thromboembolic complications.

The D-dimer level exceeded the upper limit of the normal distribution in 32% of CVD patients without manifest thromboembolic complications. Independent predictors of elevated D-dimer in CVD patients with no visible thromboses are as follows: female gender, age >68 years, acute inflammation, pulmonary hypertension, and decompensation of CCI.