Bohdan Nessler

Altered fibrin clot properties in patients with chronic heart failure and sinus rhythm: a novel prothrombotic mechanism

Background Thromboembolic complications occur more frequently in patients with chronic heart failure (CHF) than in the general population. Formation of a compact fibrin clot resistant to lysis has been shown in arterial and venous thrombosis. Objective To investigate fibrin clot properties in patients with CHF. Method Plasma clot permeability, compaction, turbidity and fibrinolysis were assessed in 36 consecutive patients with stable CHF (30M, 6F; aged 64±10 years, left ventricular ejection fraction (LVEF) 34.9±6.7%) and 36 controls matched for age, sex, cardiovascular risk factors and medication. Exclusion criteria were LVEF >40%, anticoagulant therapy, previous thromboembolic events, atrial fibrillation. Results Clots obtained from plasma of patients with CHF had 23% lower clot permeability (p<0.0001), 13% less clot compaction (p<0.001), 15% faster fibrin polymerisation (p<0.0001) and tended to have prolonged fibrinolysis time (p=0.1) compared with controls. C-reactive protein and fibrinogen were associated inversely with clot permeability (R2=0.84, p<0.0001 and R2=0.79, p<0.0001, respectively) and positively with fibrinolysis time (R2=0.88, p<0.0001 and R2=0.80, p<0.0001, respectively) in patients with CHF. Plasma thrombin–antithrombin complex concentrations were inversely correlated with clot permeability (R2=0.88, p<0.0001) and positively with fibrinolysis time (R2=0.91, p<0.0001). Left atrium diameter, but not LVEF, correlated with fibrinolysis time (R2=0.61, p=0.027). Conclusions Patients with CHF with sinus rhythm are characterised by faster formation of compact plasma fibrin clots, which might predispose to thromboembolic complications.

Serum biomarkers and clinical outcomes in heart failure patients treated de novo with carvedilol

BACKGROUND The role of inflammatory and hemodynamic stress biomarkers in heart failure (HF) patients treated de novo with beta-blockers has been poorly studied. METHODS A total of 86 patients (age 56 ± 9 years, 81 men) with left ventricular ejection fraction (LVEF) < 40% and previously not treated with beta-blockers were initiated on carvedilol. At baseline and 12 months later we performed echocardiography, cardiopulmonary exercise testing, and determined serum levels of B-type natriuretic peptide (BNP), endothelin-1 (ET-1), C-reactive protein (CRP), interleukin-6, and tumor necrosis factor alpha (TNF -a). Patients were followed up over a total period of 9 ± 3 years from baseline. RESULTS Increased baseline CRP and its on-treatment decrease were associated with improvement of LVEF (est. coefficient per one SD: 1.6; 95% CI: -0.05,3.28; p = 0.056, and -1.80; -3.43, -0.18; p = 0.030, respectively) and diminishing of LV end-systolic volume index [mL/m2] (-6.83; -11.32; -2.34; p = 0.003, and 5.85; 1.23; -10.46; p = 0.014, respectively). Higher baseline ET-1 and on-treatment increase in TNF-a predicted frequent admissions (> 1) for cardiac complications (odds ratio per one SD: 1.98; 95% CI: 1.09-3.59; p = 0.025, and 2.07, 1.12-3.84, p = 0.021, respectively) whereas higher baseline BNP was associated with increased mortality (hazard ratio per one SD: 2.09, 95% CI: 1.26-3.45; p = 0.004). CONCLUSIONS Serum biomarkers may have different roles in prediction of clinical outcomes among HF patients treated de novo with carvedilol.

C-reactive protein as a marker of heart failure.

Committees • European Society of Cardiology: Working Group on Valvular Heart Disease Chairperson: Christa Gohlke-Bärwolf Vice-chairperson: Roger J.C. Hall • Presidents of the Organizing Committee and Guest Editors Wies¥awa Tracz – Director of the Institute of Cardiology, Jagiellonian University, Krakow Piotr Podolec – President of the Polish Cardiac Society, Krakow Division • Secretaries: Piotr Musia¥ek, Wojciech P¥azak, Monika Pieculewicz