Utility of D-Dimer for mortality prediction in patients at risk for pulmonary hypertension

Aim: We aimed to assess if D-Dimer, a marker of fibrinolyis is associated with pulmonary hypertension (PH) and if it has a prognostic role in patients with PH risk. Patients and Methods: N=295 patients (n=54 PAH; n=39 PH due to left heart disease; n=56 PH due to lung diseases; n=31 chronic thromboembolic PH; n=16 PH due to unclear or multifactorial mechanisms; n=99 PH excluded by RHC) between 2011 and 2017 were prospectively enrolled. Plasma samples were collected during RHC and stored at the institutional biobank at -80°C. D-Dimer levels were assessed using the LOCI high-sensitive immunoturbidimetric assay. Results: D-Dimer was reproducibly measured in n=266 patients (mean age=63±13 yr, mean pulmonary arterial pressure (mPAP)=33±14 mmHg, pulmonary arterial wedge pressure: 11±5 mmHg, pulmonary vascular resistance (PVR)=3.55 WU (IQR: 2.3-8.6), cardiac index=2.6±0.8 L/min/m2). During the median follow-up time of 48 months (range: 24-84), n=63 patients died. After adjustment for sex and age, a D-Dimer cut-off value of 402ug/L predicted all-cause mortality (HR=1.7 95%CI 1.0 – 2.9; p Conclusion: D-Dimer appears to be a new age- and sex- independent predictor of mortality in a mixed population with PH risk.