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Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair
BACKGROUND AND HYPOTHESIS: The acquired von Willebrand syndrome (AvWS), which predisposes to bleeding events, is often related to valvular heart diseases. We investigated possible implications of AvWS and factor VIII levels in patients with moderate to severe mitral regurgitation (MR) undergoing tra...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wiley Periodicals, Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852171/ https://www.ncbi.nlm.nih.gov/pubmed/33372698 http://dx.doi.org/10.1002/clc.23538 |
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author | Meindl, Christine Paulus, Michael Koller, Theresia Rogalski, Dominik Hamerle, Michael Schach, Christian Buchner, Stefan Zeman, Florian Maier, Lars S. Debl, Kurt Unsöld, Bernhard Birner, Christoph |
author_facet | Meindl, Christine Paulus, Michael Koller, Theresia Rogalski, Dominik Hamerle, Michael Schach, Christian Buchner, Stefan Zeman, Florian Maier, Lars S. Debl, Kurt Unsöld, Bernhard Birner, Christoph |
author_sort | Meindl, Christine |
collection | PubMed |
description | BACKGROUND AND HYPOTHESIS: The acquired von Willebrand syndrome (AvWS), which predisposes to bleeding events, is often related to valvular heart diseases. We investigated possible implications of AvWS and factor VIII levels in patients with moderate to severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). METHODS AND RESULTS: 123 patients with moderate to severe MR were prospectively enrolled. Complete measurements of von Willebrand Factor activity (vWFAct), von Willebrand Factor antigen (vWFAg), and factor VIII expression before and 4 weeks after TMVR were available in 85 patients. At baseline, seven patients had a history of gastrointestinal bleeding, two patients suffered bleeding events during their hospital stay, and one patient had a bleeding 4 weeks after TMVR. Even though vWFAct, vWFAct/vWFAg ratio and vWFAg values did not change after TMVR, we observed a significantly lower vWFAct/vWFAg ratio in patients with primary MR as compared to patients with secondary MR both at baseline (p = 0.022) and 4 weeks following the TMVR procedure (p = 0.003). Additionally, patients with a mean mitral valve gradient ≥4 mmHg after TMVR had significantly lower vWFAct/vWFAg ratios as compared to patients with a mean mitral valve gradient <4 mmHg (p = 0.001). CONCLUSIONS: MR of primary etiology was associated with lower vWFAct/vWFAg ratio, hinting toward HMWM loss due to shear stress caused by eccentric regurgitation jets. In addition, morphological changes leading to postprocedural transmitral gradients ≥4 mmHg were related to lower vWFAct/vWFAg ratio 4 weeks after the procedure. Alterations of the vWFAct/vWFAg ratio in turn did not translate into a greater risk for bleeding events. |
format | Online Article Text |
id | pubmed-7852171 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wiley Periodicals, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78521712021-02-05 Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair Meindl, Christine Paulus, Michael Koller, Theresia Rogalski, Dominik Hamerle, Michael Schach, Christian Buchner, Stefan Zeman, Florian Maier, Lars S. Debl, Kurt Unsöld, Bernhard Birner, Christoph Clin Cardiol Clinical Investigations BACKGROUND AND HYPOTHESIS: The acquired von Willebrand syndrome (AvWS), which predisposes to bleeding events, is often related to valvular heart diseases. We investigated possible implications of AvWS and factor VIII levels in patients with moderate to severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). METHODS AND RESULTS: 123 patients with moderate to severe MR were prospectively enrolled. Complete measurements of von Willebrand Factor activity (vWFAct), von Willebrand Factor antigen (vWFAg), and factor VIII expression before and 4 weeks after TMVR were available in 85 patients. At baseline, seven patients had a history of gastrointestinal bleeding, two patients suffered bleeding events during their hospital stay, and one patient had a bleeding 4 weeks after TMVR. Even though vWFAct, vWFAct/vWFAg ratio and vWFAg values did not change after TMVR, we observed a significantly lower vWFAct/vWFAg ratio in patients with primary MR as compared to patients with secondary MR both at baseline (p = 0.022) and 4 weeks following the TMVR procedure (p = 0.003). Additionally, patients with a mean mitral valve gradient ≥4 mmHg after TMVR had significantly lower vWFAct/vWFAg ratios as compared to patients with a mean mitral valve gradient <4 mmHg (p = 0.001). CONCLUSIONS: MR of primary etiology was associated with lower vWFAct/vWFAg ratio, hinting toward HMWM loss due to shear stress caused by eccentric regurgitation jets. In addition, morphological changes leading to postprocedural transmitral gradients ≥4 mmHg were related to lower vWFAct/vWFAg ratio 4 weeks after the procedure. Alterations of the vWFAct/vWFAg ratio in turn did not translate into a greater risk for bleeding events. Wiley Periodicals, Inc. 2020-12-29 /pmc/articles/PMC7852171/ /pubmed/33372698 http://dx.doi.org/10.1002/clc.23538 Text en © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Investigations Meindl, Christine Paulus, Michael Koller, Theresia Rogalski, Dominik Hamerle, Michael Schach, Christian Buchner, Stefan Zeman, Florian Maier, Lars S. Debl, Kurt Unsöld, Bernhard Birner, Christoph Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title | Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title_full | Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title_fullStr | Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title_full_unstemmed | Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title_short | Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
title_sort | acquired von willebrand syndrome and factor viii in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair |
topic | Clinical Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852171/ https://www.ncbi.nlm.nih.gov/pubmed/33372698 http://dx.doi.org/10.1002/clc.23538 |
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