Altered Fibrin Clot Properties and Long-term Mortality are Associated with Biventricular Decompensation in Heart...

Prothrombotic risk in heart failure (HF) decompensation remains incompletely understood; therefore, we sought to investigate fibrin clot properties, their determinants, and their impact on long-term mortality in HF patients with reduced ejection fraction (HFrEF) and symptoms of biventricular (BVHF) versus isolated left ventricular (LVHF) decompensation.

In this prospective study, 85 consecutive patients with sinus rhythm and HFrEF decompensation were enrolled. Clot permeability (Ks), reflecting fibrin pore size, and lysis time (CLT) along with thrombin generation and liver-dependent metabolites including succinic, amino, and bile acids were assessed during index hospitalization and after 3-month pharmacotherapy. Long-term mortality and HF rehospitalizations were recorded within a median follow-up time of 27 (17-38) months.

LVHF decompensation was identified in 46 (54.1%) patients, while BVHF in 39 (45.9%) patients. At baseline, subjects with BVHF had lower Ks by 31.9% (p = 0.002). Following 3-month pharmacotherapy, Ks increased in BVHF patients (p < 0.001) reaching values similar to those in LVHF group. Baseline Ks was independently associated with BVHF (R² = 0.346, p < 0.001). Ks improvement was five times (p < 0.001) higher in BVHF than in LVHF group and was associated with baseline INR (p = 0.04), creatinine (p = 0.011), and a non-ischemic etiology of HF (p = 0.033). Regardless of baseline Ks, the long-term mortality was higher in BVHF versus LVHF patients (12.5 versus 5.8%/year, p = 0.049, respectively).

BVHF decompensation was associated with formation of more compact fibrin clots in the acute phase and with a higher long-term mortality. Fibrin clot permeability improvement following 3-month pharmacotherapy was driven by the favorable changes in BVHF patients.