Prognostic value of plasma von Willebrand factor and its cleaving protease ADAMTS13 in patients with atrial fibrillation

被引：23

作者：

Freynhofer, Matthias K. ^{[1
,2
]}

Gruber, Susanne C. ^{[1
]}

Bruno, Veronika ^{[1
,3
]}

Hoechtl, Thomas ^{[1
]}

Farhan, Serdar ^{[1
]}

Zaller, Vera ^{[4
]}

Wojta, Johann ^{[2
,5
]}

Huber, Kurt ^{[1
,2
]}

机构：

[1] Wilhelminenhosp, Med Dept Cardiol & Emergency Med 3, Vienna, Austria

[2] Ludwig Boltzmann Cluster Cardiovasc Res, Vienna, Austria

[3] Wilhelminenhosp, Dept Obstet & Gynaecol, Vienna, Austria

[4] Med Univ Vienna, Dept Paediat, Vienna, Austria

[5] Med Univ Vienna, Dept Cardiol, Vienna, Austria

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2013年 / 168卷 / 01期

关键词：

Atrial fibrillation; von Willebrand factor; ADAMTS13; CHADS(2); CHA(2)DS(2)VASc; INDEPENDENT RISK-FACTOR; PLATELET-ADHESION; PREDICTING STROKE; GLYCOPROTEIN-IB; DISEASE; IMPACT; ATHEROSCLEROSIS; DYSFUNCTION; MECHANISMS; THROMBOSIS;

D O I：

10.1016/j.ijcard.2012.09.056

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The von Willebrand factor (vWF) is essential for platelet adhesion and arterial thrombosis. It is degraded into less active multimers by ADAMTS13. Patients with atrial fibrillation (AF) exhibit higher plasma vWF and lower ADAMTS13 antigen levels. The vWF/ADAMTS13-ratio might help to estimate the pro-thrombotic risk of patients with AF. We therefore investigated whether a high ratio of vWF/ADAMTS13, independently of clinical risk scores, predicts major adverse cardiovascular events (MACE) in patients with AF. Methods: This prospective longitudinal single center study included 269 patients with AF. Blood samples were analyzed for vWF and ADAMTS13-antigen concentration by means of enzyme-linked immunoassay kits. Results: After adjustment for all univariable predictors for MACE (p <= 0.1), ADAMTS13 <= 49.77% (HR 1.833 (95% CI 1.089-3.086); p=0.023) and vWF/ADAMTS13-ratio > 27.57 (HR 2.174 (95% CI 1.238-3.817); p=0.007) remained independently associated with outcome. vWF> 1434.92 mU/ml (HR 1.539 (95% CI 0.883-2.682); p=0.128) alone failed to independently predict MACE. In patients with low and intermediate risk for MACE according to the CHADS(2)-score the addition of high vWF/ADAMTS13-ratio levels (> 27.57) had significant impact on the patients' outcome. Conclusion: A high ratio of vWF/ADAMTS13 independently predicts MACE in patients with AF. Therefore, vWF and its cleaving protease ADAMTS13 might play an important role in the development and perpetuation of vascular disease in AF patients. This might be a novel target for future treatment strategies or an additional help for risk stratification in AF patients. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

引用

页码：317 / 325

页数：9

共 43 条

[1] Hemostatic markers are associated with the risk and prognosis of atrial fibrillation: The ARIC study [J].

Alonso, Alvaro ;

Tang, Weihong ;

Agarwal, Sunil K. ;

Soliman, Elsayed Z. ;

Chamberlain, Alanna M. ;

Folsom, Aaron R. .

INTERNATIONAL JOURNAL OF CARDIOLOGY, 2012, 155 (02) :217-222

[2] Left Atrial Blood Stasis and Von Willebrand Factor-ADAMTS13 Homeostasis in Atrial Fibrillation [J].

Ammash, Naser ;

Konik, Ewa A. ;

McBane, Robert D. ;

Chen, Dong ;

Tange, Julie I. ;

Grill, Diane E. ;

Herges, Regina M. ;

McLeod, Thomas G. ;

Friedman, Paul A. ;

Wysokinski, Waldemar E. .

ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2011, 31 (11) :2760-2766

[3] Ultralarge multimers of von Willebrand factor form spontaneous high-strength bonds with the platelet glycoprotein Ib-IX complex:: studies using optical tweezers [J].

Arya, M ;

Anvari, B ;

Romo, GM ;

Cruz, MA ;

Dong, JF ;

McIntire, LV ;

Moake, JL ;

López, JA .

BLOOD, 2002, 99 (11) :3971-3977

[4] Impact of atrial fibrillation on the risk of death [J].

Benjamin, EJ ;

Wolf, PA ;

D'Agostino, RB ;

Silbershatz, H ;

Kannel, WB ;

Levy, D .

CIRCULATION, 1998, 98 (10) :946-952

[5] The role of platelet adhesion receptor GPIbα far exceeds that of its main ligand, von Willebrand factor, in arterial thrombosis [J].

Bergmeier, Wolfgang ;

Piffath, Crystal L. ;

Goerge, Tobias ;

Cifuni, Stephen M. ;

Ruggeri, Zaverio M. ;

Ware, Jerry ;

Wagner, Denisa D. .

PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 2006, 103 (45) :16900-16905

[6] Lower levels of ADAMTS13 are associated with cardiovascular disease in young patients [J].

Bongers, T. N. ;

de Bruijne, E. L. E. ;

Dippel, D. W. J. ;

de Jong, A. J. ;

Deckers, J. W. ;

Poldermans, D. ;

de Maat, M. P. M. ;

Leebeek, F. W. G. .

ATHEROSCLEROSIS, 2009, 207 (01) :250-254

[7]

Camm AJ, 2010, EUROPACE, V12, P1360, DOI [10.1093/europace/euq350, 10.1093/eurheartj/ehq278]

[8] ADAMTS13: a new link between thrombosis and inflammation [J].

Chauhan, Anil K. ;

Kisucka, Janka ;

Brill, Alexander ;

Walsh, Meghan T. ;

Scheiflinger, Friedrich ;

Wagner, Denisa D. .

JOURNAL OF EXPERIMENTAL MEDICINE, 2008, 205 (09) :2065-2074

[9] Prognostic value of plasma von Willebrand factor and soluble P-selectin as indices of endothelial damage and platelet activation in 994 patients with nonvalvular atrial fibrillation [J].

Conway, DSG ;

Pearce, LA ;

Chin, BSP ;

Hart, RG ;

Lip, GYH .

CIRCULATION, 2003, 107 (25) :3141-3145

[10] Evidence that high von Willebrand factor and low ADAMTS-13 levels independently increase the risk of a non-fatal heart attack [J].

Crawley, J. T. B. ;

Lane, D. A. ;

Woodward, M. ;

Rumley, A. ;

Lowe, G. D. O. .

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2008, 6 (04) :583-588

← 1 2 3 4 5 →