Yoshihisa Akiomi, Sato Yu, Kimishima Yusuke, Ichijo Yasuhiro, Yokokawa Tetsuro, Misaka Tomofumi, Sato Takamasa, Oikawa Masayoshi, Kobayashi Atsushi, Nakazato Kazuhiko, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Int J Cardiol Heart Vasc. 2020 Dec 24;32:100697. doi: 10.1016/j.ijcha.2020.100697. eCollection 2021 Feb.
A biomarker of fibrin formation, the soluble fibrin monomer complex (SFMC), is abnormally elevated in a variety of clinical situations of hypercoagulability. The aim of the present study was to examine the prognostic impact of SFMC, with regard to increased risk of major cardio- and cerebrovascular events (MACCE) and all-cause mortality, on patients with heart failure (HF).
We conducted a prospective observational study where we analyzed data of 723 hospitalized patients with decompensated HF who were discharged alive and whose SFMC had been measured in a stable condition prior to discharge. The patients were divided into tertiles based on SFMC levels: the first (SFMC < 1.7 μg/ml, n = 250), second (≤1.8 SFMC < 2.9 μg/ml, n = 233), and third (3.0 μg/ml ≤ SFMC, n = 240) tertiles. The prevalence of chronic kidney disease and anemia was significantly higher in the third tertile than in the first and second tertiles. In contrast, age, sex, CHADS-Vasc score, left ventricular ejection fraction, and prevalence of hypertension, diabetes and atrial fibrillation did not differ among the tertiles. In the Kaplan-Meier analysis, accumulated event rates of both MACCE and all-cause mortality progressively increased from the first to third tertiles (log-rank P < 0.05, respectively). In the multivariate Cox proportional hazard analysis, the third tertile was found to be an independent predictor of MACCE (HR 2.014, P = 0.046) and all-cause mortality (HR 1.792, P = 0.036).
SFMC is an independent predictor of adverse prognosis in patients with HF.
作为纤维蛋白形成的生物标志物，可溶性纤维蛋白单体复合物（SFMC）在多种高凝临床情况下会异常升高。本研究旨在探讨SFMC对心力衰竭（HF）患者发生主要心脑血管事件（MACCE）风险增加及全因死亡率的预后影响。
我们进行了一项前瞻性观察性研究，分析了723例因失代偿性HF住院且出院时存活、出院前在稳定状态下测量了SFMC的患者的数据。根据SFMC水平将患者分为三分位数：第一三分位数（SFMC < 1.7μg/ml，n = 250）、第二三分位数（≤1.8 SFMC < 2.9μg/ml，n = 233）和第三三分位数（3.0μg/ml≤SFMC，n = 240）。第三三分位数中慢性肾脏病和贫血的患病率显著高于第一和第二三分位数。相比之下，三分位数之间的年龄、性别、CHADS-Vasc评分、左心室射血分数以及高血压、糖尿病和心房颤动的患病率并无差异。在Kaplan-Meier分析中，MACCE和全因死亡率的累积事件发生率从第一三分位数到第三三分位数逐渐增加（对数秩检验P均<0.05）。在多变量Cox比例风险分析中，发现第三三分位数是MACCE（HR 2.014，P = 0.046）和全因死亡率（HR 1.792，P = 0.036）的独立预测因素。
SFMC是HF患者不良预后的独立预测因素。
