A Study of blood soluble P-selectin, fibrinogen, and von Willebrand factor levels in idiopathic and lone atrial fibrillation

Fu, Ruibin; Wu, Shulin; Wu, Peng; Qiu, Jian

doi:10.1093/europace/euq346

Cited by 43 publications

(34 citation statements)

References 36 publications

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“…Others have reported conflicting results of VWF levels in AF patients compared with NSR controls. [12][13][14][15][16] These findings may reflect differences in accrual rates of AF patients with SEC which was not accounted for in those studies. [12][13][14][15][16] Furthermore, VWF:Ag and VWF:Act are independent predictors for LAAT after adjustment for CHADS 2 score …”

Section: Discussionmentioning

confidence: 84%

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Ammash

Konik

McBane

et al. 2011

ATVB

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Objective-Left atrial blood stasis is associated with increased risk for left atrial appendage thrombus (LAAT) and stroke in atrial fibrillation (AF). Von Willebrand factor (VWF) is associated with thromboembolism in AF. VWF thrombogenic activity is proportional to multimer size, which is regulated by VWF-cleaving protease (ADAMTS13). Methods and Results-To assess the association between left atrial blood stasis and VWF-ADAMTS13 system, plasma VWF antigen (VWF:Ag), VWF activity (VWF:Act), and ADAMTS13 activity were measured in 414 consecutive patients with nonvalvular AF (age 63Ϯ13 years; 25% women) and in 100 patients (age 64Ϯ14 years; 39% women) with normal sinus rhythm. Key Words: stroke Ⅲ thrombosis Ⅲ von Willebrand factor Ⅲ atrial fibrillation C ardioembolic stroke in the setting of atrial fibrillation (AF) begins with the left atrial appendage thrombus (LAAT) formation. 1-3 The risk for LAAT development and stroke increases with left atrium mechanical function deterioration that is reflected by reduction in left atrial appendage emptying velocity (LAAEV), development of spontaneous echocardiographic contrast (SEC), and progression of left atrial distension. 4 -7 However, the underlying mechanism behind the relationship between AF, atrial stasis, and thrombotic propensity is complex and poorly understood.Von Willebrand factor (VWF) a large plasma glycoprotein that mediates platelet adhesion and aggregation, 8 has been associated with stroke risk in AF. 9 -13 Prior studies comparing VWF levels between AF patients and subjects in normal sinus rhythm (NSR) were limited by small sample size. 14 -16 Assessment of archived plasma samples from Stroke Prevention in Atrial Fibrillation III participants lacked a comparator. 9 -11 Moreover, a prior association between elevated VWF and stroke became nonsignificant after adjustment for other clinical predictors. 11 The association between VWF and AF therefore remains largely unexplored.The thrombogenic potential of VWF is directly proportional to VWF activity (VWF:Act) determined by both plasma concentration and multimer size, 17 which is regulated by VWF-specific protease ADAMTS13. 18 Two patients may have similar plasma VWF content, yet thrombotic propensity will vary considerably depending on the proportion of highmolecular-weight multimer content. This nuance would be missed if mere antigen content was assessed.Atrial distension is associated with overexpression of VWF multimers, 19 and blood stasis has been shown to downregulate ADAMTS13 activity. 20 Previous studies, however, have not systematically accounted for degrees of atrial stasis or measured complete variables within the VWF system. We hypothesized that atrial distension and stasis in AF are associated with the higher VWF and increased proportion of large multimers that lead to the development of LAAT. To address this hypothesis, transesophageal echocardiography (TEE) measures of stasis and LAAT and measures of VWF antigen (VWF:Ag), VWF:Act, and ADAMTS13 activity were compared in consecutive patients wi...

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Section: Discussionmentioning

confidence: 84%

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Ammash

Konik

McBane

et al. 2011

ATVB

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“…AF also produces a hypercoagulable state [44–46]. This is above all a consequence of abnormal blood flow in the left atrium but abnormal changes in blood constituents are also described [45, 46].…”

Section: Discussionmentioning

confidence: 99%

“…This is above all a consequence of abnormal blood flow in the left atrium but abnormal changes in blood constituents are also described [45, 46]. There are numerous studies linking hypercoagulable state to liver fibrosis [47–51].…”

Section: Discussionmentioning

confidence: 99%

Presence of atrial fibrillation is associated with liver stiffness in an elderly Finnish population

et al. 2017

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BackgroundChronic liver injury from different etiologies drives liver fibrosis. However, little is known about the associated factors, systemic factors in particular. Recently, non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation have been shown to be associated with each other. Thereby, we aimed to study the association between atrial fibrillation and liver stiffness.StudyExtensive clinical measurements including echocardiography of the heart, transient elastography (TE) of the liver and the presence of atrial fibrillation were determined in elderly Finnish study subjects (n = 76, mean age 73 years) from OPERA (Oulu Project Elucidating the Risk of Atherosclerosis) study cohort. Half of the study subjects had non-alcoholic fatty liver disease, whereas others did not have any known hepatic morbidity. The present study was cross-sectional by nature.ResultsThe subjects with atrial fibrillation had higher TE values (with atrial fibrillation TE = 9.3kPa, without atrial fibrillation TE = 6.3kPa, p = 0.018). When the cohort was divided to four subgroups (those without NAFLD or atrial fibrillation, with NAFLD but without atrial fibrillation, with both conditions, and with atrial fibrillation but without NAFLD), the TE value was the highest in the subjects with both conditions (5.3kPa, 7.4kPa, 10.8kPa and 7.8kPa, respectively, p = 0.019). Moreover, the higher the TE value, the more prevalent atrial fibrillation was (the atrial fibrillation prevalence by tertiles of TE 27% / 36% / 77%, p = 0.001). Likewise, the greater the TE value, the greater the left atrial diameter, a collateral of atrial fibrillation (left atrial diameters by tertiles of TE 39mm / 45mm / 48mm, p<0.001) was. All these p-values for continuous variables remained statistically significant even after adjustment for common clinically relevant risk factors.ConclusionsThere is an association between atrial fibrillation and liver stiffness. This novel association may have multiple explanations and mechanistic links, which are discussed here and need further studies, prospective studies in particular.

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“…This also translates into altered levels of blood coagulation markers like P-selectin and fibrinogen [25]. The two risk scores most widely used to assess the severity of thrombotic changes and the risk of thrombosis in AF patients are CHADS 2 and CHA 2 DS 2 -VASc scores [13,14].…”

Section: Discussionmentioning

confidence: 99%

Can thromboembolic risk be associated with erectile dysfunction in atrial fibrillation patients?

et al. 2015

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A Study of blood soluble P-selectin, fibrinogen, and von Willebrand factor levels in idiopathic and lone atrial fibrillation

Abstract: Both platelet activation and abnormal changes in coagulation were suggested in idiopathic AF and a platelet activation state in lone AF. This supports the notion that AF per se contributes to a state of hypercoagulation.

Cited by 43 publications

References 36 publications

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Presence of atrial fibrillation is associated with liver stiffness in an elderly Finnish population

Can thromboembolic risk be associated with erectile dysfunction in atrial fibrillation patients?

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