D-dimer levels and outcomes in heart failure with mildly reduced ejection fraction

The study investigates the influence of D-dimer levels on the prognosis of patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).

The prognostic impact of D-dimer levels has not yet been investigated in patients with HFmrEF.

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.

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.

Elevated D-dimer levels were independently associated with a higher risk of all-cause mortality in HFmrEF patients.