D-Dimer predicts mortality in a real-life cohort of patients with indication for right heart catheterization

Abstract

Background: Elevated D-Dimer levels are predictive of long-term outcomes in patients with high risk for cardiovascular events, however, little is known about their value in patients with indication for right heart catheterization (RHC). We hypothesized that D-Dimer levels are predictive of long-term outcome in consecutive patients with indication for RHC.

Methods: Patients who underwent diagnostic RHC between 2011 and 2019 were included after written informed consent. Plasma samples were collected during RHC and stored at the institutional biobank at -80°C. D-Dimer levels were assessed using the LOCI high-sensitive immunoturbidimetric assay. Median follow-up was 46.1 months (IQR:21.8-72.4).

Results: Baseline D-dimer levels of the n=442 patients (n=171 no pulmonary hypertension (PH), n= 71 pulmonary arterial hypertension, n=55 PH due to left heart disease, n=77 PH due to lung disease, n=47 chronic thromboembolic PH, n=21 PH due to unclear or multifactorial mechanisms) were grouped by quartiles (Q1≤ 237, Q2:237-413, Q3:413-765, Q4>765 µg/L). Within the follow-up period, n=109 patients died. After adjusting for age and sex, elevated D-Dimer levels were associated with increased risk for all-cause mortality (p= 0.001; reference group:Q1; HR=1.83, 95%CI: 0.95-3.56 for Q2, HR=2.15, 95%CI: 1.13-4.09 for Q3, HR=3.35, 95%CI: 1.82-6.18 for Q4). PH patients showed higher D-Dimer values (p=0.005) than those without PH (median: 457 µg/L (IQR:693-994) vs. 339 µg/L (IQR:503-809)). D-dimer levels were not significantly correlated with any hemodynamic parameter.

Conclusions: D-Dimer appears as an independent predictor of mortality in a real-life cohort of patients with an indication for RHC.