TY - JOUR
T1 - 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
AU - Krishnamoorthy, Suresh
AU - Khoo, Chee Wah
AU - Lim, Hoong S
AU - Lane, Deirdre A
AU - Pignatelli, Pasquale
AU - Basili, Stefania
AU - Violi, Francesco
AU - Lip, Gregory Y H
N1 - © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
PY - 2013/10
Y1 - 2013/10
N2 - 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.
AB - 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.
KW - Aged
KW - Atrial Fibrillation
KW - E-Selectin
KW - Endothelium, Vascular
KW - Enzyme-Linked Immunosorbent Assay
KW - Epidemiologic Methods
KW - Female
KW - Humans
KW - Male
KW - Myocardial Infarction
KW - Prognosis
KW - Stroke
KW - von Willebrand Factor
U2 - 10.1111/eci.12140
DO - 10.1111/eci.12140
M3 - Article
C2 - 23961715
SN - 0014-2972
VL - 43
SP - 1032
EP - 1038
JO - European journal of clinical investigation
JF - European journal of clinical investigation
IS - 10
ER -