The prothrombotic potential of diabetic patients with ischemic heart failure is associated with impaired left ventricular contractility and endothelial dysfunction.

PURPOSE We sought to investigate whether left ventricular (LV) contractility and endothelial dysfunction in diabetic patients with ischemic heart failure (HF) are associated with enhanced thrombin generation and altered fibrin clot properties compared with individuals without HF.

MATERIALS AND METHODS The study included 85 HF patients with type 2 diabetes (T2DM) and ischemic heart disease (IHD). Based on echocardiographic examination, 39 (45.9%) patients were identified as having LV ejection fraction (LVEF) of <40% (HFrEF) while 46 patients (54.1%) of ≥50% (HFpEF). The control group (n=43) consisted of diabetic and IHD participants without HF (non-HF). In all groups, endogenous thrombin potential (ETP), fibrin clot permeability (Ks), brachial artery flow-mediated dilation (FMD), and nitroglycerin-mediated dilatation (NMD) were assessed.

RESULTS HFrEF and HFpEF patients had less permeable fibrin clots than non-HF by 45.4% and by 14.6%, respectively (P<0.05 both). HFrEF patients had higher ETP by 14.4% (P=0.004), lower Ks by 16.9% (P=0.037) and lower NMD by 34.7% (P=0.001) without differences in FMD as compared with HFpEF. Multivariable analysis adjusted for fibrinogen levels showed that lower LVEF (β-coefficient -0.195, 95% confidence interval [CI] for β-coefficient -0.385- -0.015), reduced NMD (β-coefficient -0.230, 95%CI -0.399- -0.061), and increased total cholesterol level (β-coefficient 0.286, 95%CI 0.108-0.464) influenced enhanced ETP in HF population.

CONCLUSIONS In diabetic patients with IHD, the diagnosis of HF is associated with more dense fibrin clots. HF patients with reduced versus preserved LVEF have shown enhanced thrombin generation and reduced clot permeability. Impairment of both LV systolic and vascular vasodilator function affected thrombin generation.