Prognostic role of plasma von Willebrand factor and soluble E-selectin levels for future cardiovascular events in a 'real-world' community cohort of patients with atrial fibrillation.

Abstract

BACKGROUND:

Endothelial damage/dysfunction may contribute to a prothrombotic state in patients with atrial fibrillation (AF) and the increased risk of thromboembolism and cardiovascular events. Raised plasma von Willebrand factor (vWf), an established marker of endothelial damage/dysfunction, has been associated with stroke and vascular events, at least in a clinical trial population. Soluble E-selectin (sE-sel) is another biomarker of endothelial activation/dysfunction, with more limited data on prognostic outcomes in AF.

OBJECTIVE:

To assess the relationship between the levels of vWf, sE-sel and clinical adverse outcomes (including stroke, MI and all-cause mortality) in a 'real-world' community cohort of patients with AF.

METHODS:

We studied 423 patients (mean age 72·7 ± 8·4 years, 55·6% male) with nonvalvular AF, with a median follow-up of 19 (9-31) months. Plasma vWf and sE-sel levels were measured using enzyme-linked immunosorbent assay (ELISA).

RESULTS:

There were 94 clinical adverse events (22·2%) observed during a median follow-up of 19 months. Patients with clinical events had significantly higher vWf (P < 0·001) and sE-sel levels at baseline (P < 0·001) compared with those who were event free. Kaplan-Meir analyses demonstrated that more clinical adverse events occurred in the upper tertile of vWf [upper vs. lowest tertile, RR 3·8, 95% CI (2·63-5·57), P < 0·001; upper vs. middle tertile, RR 10·5, 95% CI (5·33-20·60), P < 0·001]. Similarly, the highest tertile of sE-sel was associated with more adverse events [upper vs. lowest tertile, RR 3·7, 95% CI (2·51-5·31), P < 0·001; upper vs. middle tertile, RR 6·5, 95% CI (3·56-11·91), P < 0·001].

CONCLUSION:

High plasma vWf and soluble E-selectin levels are associated with an increased risk of clinical adverse events (acute myocardial infarction, ischaemic stroke and all-cause mortality) in 'real-world' patients with AF. These soluble biomarkers may potentially aid clinical risk stratification in this common arrhythmia.

• Authors: Suresh Krishnamoorthy, Chee Wah Khoo, Hoong S Lim, Deirdre A Lane, Pasquale Pignatelli, Stefania Basili, Francesco Violi, Gregory Y H Lip
• Journal: European journal of clinical investigation (Eur J Clin Invest) Vol. 43 Issue 10 Pg. 1032-8 (Oct 2013) ISSN: 1365-2362 [Electronic] England
• PMID: 23961715 (Publication Type: Journal Article)
• Copyright: © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• E-Selectin
• von Willebrand Factor

Topics

• Aged
• Atrial Fibrillation (blood, mortality)
• E-Selectin (metabolism)
• Endothelium, Vascular (physiology)
• Enzyme-Linked Immunosorbent Assay
• Epidemiologic Methods
• Female
• Humans
• Male
• Myocardial Infarction (etiology, mortality)
• Prognosis
• Stroke (etiology, mortality)
• von Willebrand Factor (metabolism)