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

Finn Kronberg1, Tobias Schupp1, Michael Behnes1

  • 1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.

International Journal of Cardiology. Heart & Vasculature
|April 13, 2026
PubMed

Insights

Elevated D-dimer levels indicate a worse prognosis for patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF). Higher D-dimer levels are independently linked to an increased risk of all-cause mortality in these patients.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Biomarkers

Background:

  • Prognostic impact of D-dimer levels in heart failure with mildly reduced ejection fraction (HFmrEF) remains understudied.
  • HFmrEF affects a significant patient population, necessitating better prognostic tools.

Purpose of the Study:

  • To investigate the association between D-dimer levels and prognosis in hospitalized patients with HFmrEF.
  • To determine if D-dimer levels can predict all-cause mortality and heart failure rehospitalization in this cohort.

Main Methods:

  • Retrospective analysis of 1126 HFmrEF patients from 2016-2022.
  • Patients categorized into quartiles based on D-dimer levels.
  • Primary endpoint: 30-month all-cause mortality; secondary endpoint: HF-related rehospitalization.

Main Results:

  • Higher D-dimer levels correlated with increased all-cause mortality risk (Q4 vs. Q1: aHR 3.228).
  • This association remained significant after multivariable adjustment and exclusion of patients with conditions causing elevated D-dimer.
  • Median D-dimer level was 0.87 µg/mL.

Conclusions:

  • Elevated D-dimer levels are an independent predictor of mortality in HFmrEF patients.
  • D-dimer may serve as a valuable prognostic biomarker in HFmrEF management.
Abstract

Keywords:
BiomarkersD-dimerHFmrEFHeart failure with mildly reduced ejection fraction

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