RELATIONSHIP BETWEEN HEMOSTATIC ABNORMALITIES AND NEUROENDOCRINE ACTIVITY IN HEART-FAILURE

Thromboembolism is an important complication of heart failure. To test the hypothesis that heart failure may be associated with hemostatic d ysfunction, we studied hemostatic function in 21 patients with stable chronic heart failure and related these measures to the severity of he art failure as assessed by clinical evaluation, neuroendocrine activat ion, radionuclide ventriculography, and cardiopulmonary exercise testi ng. Plasma and blood viscosity were elevated; all patients showed evid ence of platelet activation, and many had elevated plasma concentratio ns of fibrinopeptide A, D-dimer, and von Willebrand factor. The plasma concentrations of these variables were poorly interrelated and relate d poorly to the severity of heart failure. Plasma concentrations of an giotensin II and endothelin were correlated, and the latter was also c orrelated with the plasma concentration of von Willebrand factor. Pati ents with chronic heart failure have hemostatic abnormalities that may predispose them to thromboembolic events and may be in part due to ne uroendocrine activation.