Correlation of Coagulation Pathway Parameters with BNP, Ejection Fraction and NYHA Class in Heart Failure

Nandini Nair, Enrique Gongora





The upregulation of inflammation and coagulation in addition to the sympathetic nervous system is known and reported in congestive heart failure. This study was undertaken to assess the correlations of the changes in coagulation parameters with functional class, ejection fraction and brain natriuretic peptide levels.



A small prospective study was conducted in dilated cardiomyopathy (DCM) patients.

The protocol was approved by the Hospital IRB ( Scott and White Memorial, Temple, TX 76508). Statistical analysis was conducted using the online Vassar stats system . Spearman’s rank order correlation was derived for all the correlations mentioned in this paper.



PT, PTT, INR and d-dimer levels were significantly different in the two groups and correlated positively and significantly with BNP and New York Heart Association class . Statistically significant negative correlation was noted with ejection fraction. fibrinogen levels did not correlate significantly with BNP, New York Heart Association class or ejection fraction.



Coagulation pathway parameters correlate significantly with BNP, functional class and ejection fraction in this study. The study is limited by its size and the fact that only dilated non- ischemic cardiomyopathy patients were included.   Larger studies are required to further understand the complex interactions of biochemical pathways noted in heart failure.



fibrinogen; d-dimer; PT; functional class

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Cugno M, Marl D, Meroni PL, Gronda E, Vicari F, Frigerio M, et al. Haemostatic and inflammatory biomarkers in advanced chronic heart failure: role of oral anticoagulants and successful heart transplantation. Br J Haematol 2004;126:85-92. DOI: 10.1111/j.1365-2141.2004.04977.x

Vlla V, Martinez-Sales V, Almenar L et al. Inflammation, endothelial dysfunction and angio- genesis markers in chronic heart failure patients. lnt J Cardiol 2008;130:276-7. doi:10.1016/j.ijcard.2007.07.010

Sanchez-Lazaro U, Almenar L. Reganon E. et al. Inflammatory markers in stabile heart failure and their relationship with functional class. Int J Cardiol 2008;129:388-93. doi:10.1016/j.ijcard.2007.07.138

Urban A U1f D. Tomas L. Elevated D-dimer level is an independent risk factor for cardiovascular death in out -patients with symptoms compatible with heart failure. Thromb Haemost 2004:92:1250-8.

Chong AY, Freestone B, Patel J et al. Endothelial activation, dysfunction and damage in congestive heart failure and the relation to brain natriuretic peptide and outcomes. Am J Cardiol 2006:97:671-5. doi:10.1016/j.amjcard.2005.09.113

Chong AY, Freestone B, Lim HS et al Plasma von Willebrand factor and soluble E-selectin levels in stabile outpatients with systolic heart failure: the Fredericksburg heart failure study. lnt J Cardiol 2007:119:80-2. doi:10.1016/j.ijcard.2006.07.085

Chung L Choudhury A, Lip GY. Platelet adhesion in congestive heart failure. Thromb Res 2008;121:885-8. doi:10.1016/j.thromres.2007.07.011

Shlyakhto E, Khmelnitskaya K, Sitnikova M. Endothelium-dependent hemostasis factors in patients with chronic heart failure lnt J Cardiol 2007:119 S7-8

Boman K, Jansson JH, Nuson T et al Effects of carvedilol or metoprolol on PAl- l. tPA-mass concentration or yon Willebrand factor in chronic heart failure - a COMET substudy. Thromb Res 2010:125: e46-e50 doi: 10.1016/j.thromres.2009.08.010

Williams SG, Ng LL, O'Brien RJ et al Complementary roles of simple variables, NYHA and N-BNP, in indicating aerobic capacity and severity of heart failure Int J Cardiol. 2005 ;102:279-86. doi:10.1016/j.ijcard.2004.05.054

Leto L, Testa M, Feola M Correlation between B-Type Natriuretic Peptide and Functional/Cognitive Parameters in Discharged Congestive Heart Failure Patients. Int J Endocrinol. 2015;2015:239136. doi: 10.1155/2015/239136

Jourdain P, Funck F, Bellorini M et al Bedside B-type natriuretic peptide and functional capacity in chronic heart failure Eur J Heart Fail. 2003 ;5:155-60. DOI: 10.1016/S1388-9842(02)00247-7


Stokol T, Brooks M, Rush JE et al Hypercoagulability in cats with cardiomyopathyJ Vet Intern Med. 2008 ;22:546-52. doi: 10.1111/j.1939-1676.2008.0098.

Lip GY. The coagulation system is activated in idiopathic cardiomyopathyJ Am Coll Cardiol. 1995;26:1757-8

Yamamoto K, Ikeda U, Furuhashi K et al, The coagulation system is activated in idiopathic cardiomyopathy.J Am Coll Cardiol. 1995;25:1634-40.

Higuchi Y, Kubota T, Koyanagi M, et al Upregulation of anticoagulant proteins, protein S and tissue factor pathway inhibitor, in the mouse myocardium with cardio-specific TNF-α overexpression Am J Physiol Heart Circ Physiol. 2012 ;302:H2352-62. doi: 10.1152/ajpheart.01026.2011.

Volpe M, Carnovali M, Mastromarino VThe natriuretic peptides system in the pathophysiology of heart failure: from molecular basis to treatment.Clin Sci (Lond). 2016 ;130:57-77. doi: 10.1042/CS20150469.

Neurohormonal regulation of cardiac ion channels in chronic heart failure.Kurokawa J, Abriel H.J Cardiovasc Pharmacol. 2009 ;54:98-105. doi:10.1097/FJC.0b013e3181b2b6d4

Coats, A., & Shewan, L. The Management of Heart Failure with Preserved Ejection Fraction (HFpEF). International Cardiovascular Forum Journal. 2014;1:108-112.

Sanderson, J. Comments on "The management of Heart Failure with preserved

ejection fraction". International Cardiovascular Forum Journal. 2014;1:166.

Szelényi Z, Fazakas Á, Szénási G et al Inflammation and oxidative stress caused by nitric oxide synthase uncoupling might lead to left ventricular diastolic and systolic dysfunction in patients with hypertension J Geriatr Cardiol. 2015;12:1-10. doi: 10.11909/j.issn.1671-5411.2015.01.001.

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4


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