| BackgroundThe total annual incidence of acute heart failure is 2.3‰-2.7‰and acute heart failure brings great social and medical pressure. Acute left heart failure is after secondary to organic lesions of heart and its path physiological mechanism includes abnormal blood flow mechanics, myocardial damage, ventricular remodeling and neuroendocrine activation which provide structure basis of the emerging and development of atrial fibrillation. Current researches mainly focus on the prothrombotic state and long-term prognosis of chronic heart failure patients, especially patients with atrial fibrillation. However, the association between the levels of D-dimer in plasma of patients having acute heart failure with atrial fibrillation and the in-hospital incidence of cardiovascular events is still not so many in China.ObjectiveTo investigate the association between the levels of D-dimer in plasma of patients having acute heart failure with atrial fibrillation and the in-hospital incidence of cardiovascular events within 24 hours after admission, identify the influence of D-dimer in plasma on the short-term prognosis of patients having acute heart failure with atrial fibrillation and found the basis for clinical treatment.MethodsSelect 155 patients having acute heart failure with atrial fibrillation admitting in our hospital from March 2009 to September 2010 and they are divided into three groups. The three groups are as follows:group B,50 patients (25 males while 25 females) with chronic atrial fibrillation and without heart failure whose average age is (70.08±10.45) years; group C,52 patients (27 males while 25 females) with acute left heart failure and sinus rhythm whose average age is (70.23±11.57) years; group D,53 patients (27 males while 26 females) with acute left heart failure and chronic artial fibrillation whose average age is (70.26±10.72) years. In addition, select 50 patients (25 males while 25 females) without heart failure or atrial fibrillation as group A whose average age is (69.32±12.06) years. Take 2ml elbow vein blood within 24 hours after admission and measure the level of D-dimer by enzyme-linked immunosorbent assay (ELISA). Combining with the general clinical features of patients, investigate the association between the changes of D-dimer in plasma level and short-term cardiovascular events (recurrent acute left heart failure, cardiac shock, new symptoms cardiac death and cerebral infarction).Results(1) TC, CRP, PT, APPT, Fg, BNP, LAD, LVD, LVEF values of four groups are significantly different from each other after variance analysis, P< 0.05. While there is no significant differences on TG, LDL-C, HDL-C, INR values of four groups (P> 0.05). The level of CRP,BNP,LVD. LVEF values of group D is higher than that in group A or B (P<0.05), but the level of PT. APTT,Fg values of group D is only higher than that in group A (P< 0.05), without significant difference in group B (P> 0.05); The level of CRP,BNP,LVD,LVEF values of group C is higher than that in group A or B (P<0.05)(2) The level of D-dimer in plasma in group D is higher than that in group B and the levels are (0.63±0.11)ug/ml and (0.36±0.03ug/ml) respectively, the difference is statistically significant; the level in group D is higher than that in group C, and they are (0.63±0.11) ug/ml and (0.42±0.09) ug/ml respectively with significant difference; the level in group C is higher than that in group B, and they are (0.42±0.09)ug/ml and (0.36±0.03)ug/ml respectively without significant difference; The levels in group B, group C and group D are all higher than that in group A with significant difference.(3) The regression analysis results of short-term cardiovascular events and the level of D-dimer in four groups have shown that P value corresponding to t value of the D-dimer level is less than 0.01 with statistically significance. This has indicated that the D-dimer level may have a significant impact on death, the recurrence of heart failure, cardiogenic shock and cerebral infarction. The higher the D-dimer level, the higher the incidence of short-term cardiovascular events.Conclusions(1) The level of D-dimer in plasma:patients with acute left heart failure and atrial fibrillation>patients with acute left heart failure and sinus rhythm>patients without heart failure and atrial fibrillation>patients without heart failure or atrial fibrillation.(2) The level of D-dimer in plasma of acute left heart failure is positively correlated with short-term cardiovascular events (recurrent acute left heart failure, cardiac shock, new symptoms cardiac death and cerebral infarction). The incidence of cardiovascular events increases with the increasing of D-dimer level. |
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