Altered Fibrin Clot Properties and Long-term Mortality are Associated with Biventricular Decompensation in Heart Failure with Reduced Contractility

Background: Prothrombotic risk in heart failure (HF) decompensation remains incompletely understood; therefore, we sought to investigate fibrin clot properties, their determinants, and their impact on long-term mortality in HF patients with reduced ejection fraction (HFrEF) and symptoms of biventricular (BVHF) versus isolated left ventricular (LVHF) decompensation. Methods: In this prospective study, 85 consecutive patients with sinus rhythm and HFrEF decompensation were enrolled. Clot permeability (Ks), reflecting fibrin pore size, and lysis time (CLT) along with thrombin generation and liver-dependent metabolites including succinic, amino, and bile acids were assessed during index hospitalization and after 3-month pharmacotherapy. Long-term mortality and HF rehospitalizations were recorded within a median follow-up time of 27 (17-38) months. Results: = 0.049, respectively). Conclusion: BVHF decompensation was associated with formation of more compact fibrin clots in the acute phase and with a higher long-term mortality. Fibrin clot permeability improvement following 3-month pharmacotherapy was driven by the favorable changes in BVHF patients.