Altered fibrin clot properties in patients with decompensated heart failure with reduced ejection fraction and sinus rhythm: an association with biventricular dysfunction.

Abstract Background Decompensated heart failure (HF) is a multifaceted clinical problem associated with the increased thrombotic risk. Purpose We sought to investigate whether patients with left ventricular (LVHF) versus biventricular (BVHF) acute decompensation of HF with sinus rhythm differ in terms of prothrombotic biomarkers and to assess the influence of endothelial dysfunction in generation of hypercoagulability. Methods We enrolled 85 adult patients diagnosed with decompensated chronic HF with reduced ejection fraction (HFrEF) and sinus rhythm. We measured fibrin clot parameters including clot permeability (Ks) and lysis time (CLT). Thrombin generation was reflected by endogenous thrombin potential (ETP). Endothelial and vascular dysfunction were assessed by flow (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery. We recorded data during index hospitalization and after median time of follow-up equaled 3 (2.5-3.5) months. Results The symptoms of LVHF decompensation were observed in 45 subjects (54.1%), whereas 36 (45.9%) presented BVHF. Subjects with BVHF decompensation had by 31.9% lower Ks and presented higher echocardiographic parameters of right cavities dysfunction and overload. Biventricular HF was independently associated with Ks (R2=0.346, P0.001), whereas pulmonary valve maximal velocity (R2=0.538, P0.001) with CLT. NMD, pulmonary trunk, left atrium, and right ventricular outflow tract proximal diameters along with high-density lipoproteins levels were correlated with ETP (R2=0.369, P0.001), while NMD with Peak (R2=0.257, P=0.002). We observed that after follow-up clot permeability increased by 27.6% and potential to fibrinolysis by 13.0% in the whole population. The clot permeability improvement during follow-up was driven by the modification in the BVHF group. Conclusions The symptoms of BVHF are related to more compact fibrin clots in decompensated chronic HFrEF patients with sinus rythm. The right ventricle enlargement is associated with reduced thrombin generation. After stabilization, the prothrombotic fibrin clot indices improved in HFrEF patients, mainly in the BVHF population.