Does von Willebrand factor improve the predictive ability of current risk stratification scores in patients with atrial fibrillation?

Abstract

Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA). 1215 patients (49% males, age 76 (71-81) years) were included. Follow-up was almost 7 years. Significant associations were found between vWF and cardiovascular events, stroke, mortality and bleeding. Based on IDI and NRI, addition of vWF to CHA2DS2-VASc statistically improved its predictive value, but c-indexes were not significantly different. For major bleeding, the addition of vWF to HAS-BLED improved the c-index but not IDI or NRI. DCA showed minimal net benefit. vWF acts as a simple prognostic biomarker in AF and, whilst its addition to current scores statistically improves prediction for some endpoints, absolute changes and impact on clinical decision-making are marginal.

• Authors: Amaya García-Fernández, Vanessa Roldán, José Miguel Rivera-Caravaca, Diana Hernández-Romero, Mariano Valdés, Vicente Vicente, Gregory Y H Lip, Francisco Marín
• Journal: Scientific reports (Sci Rep) Vol. 7 Pg. 41565 (01 30 2017) ISSN: 2045-2322 [Electronic] England
• PMID: 28134282 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Reactive Oxygen Species
• von Willebrand Factor

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (blood, diagnosis, metabolism, mortality)
• Clinical Decision-Making
• Comorbidity
• Female
• Humans
• Male
• Prognosis
• Proportional Hazards Models
• ROC Curve
• Reactive Oxygen Species
• Risk Assessment
• Risk Factors
• von Willebrand Factor (metabolism)