Left atrial blood stasis and von willebrand factor-adamts13 homeostasis in atrial fibrillation

Naser Ammash, Ewa A. Konik, Robert D. McBane, Dong Chen, Julie I. Tange, Diane E. Grill, Regina M. Herges, Thomas G. McLeod, Paul A. Friedman, Waldemar E. Wysokinski

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

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 63±13 years; 25% women) and in 100 patients (age 64±14 years; 39% women) with normal sinus rhythm. Spontaneous echocardiographic contrast (SEC), left atrial appendage emptying velocity, and LAAT were assessed by transesophageal echocardiography. Presence and intensity of SEC varied directly with VWF:Ag and VWF:Act but not with ADAMTS13 activity. AF patients with LAAT had higher VWF:Ag (200±61 versus 155±52, P=0.0006) and VWF:Act (179±57 versus 141±51 P=0.0026) compared with those without LAAT. VWF:Ag and VWF:Act were independent predictors of LAAT after adjustment for CHADS 2 score (P=0.0179 and P=0.0497, respectively). Conclusion-: The association between VWF and SEC may explain the thrombotic propensity in AF. Elevated VWF:Ag may help identify AF patients at risk for LAAT.

Original languageEnglish (US)
Pages (from-to)2760-2766
Number of pages7
JournalArteriosclerosis, thrombosis, and vascular biology
Volume31
Issue number11
DOIs
StatePublished - Nov 1 2011

Keywords

  • atrial fibrillation
  • stroke
  • thrombosis
  • von Willebrand factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ammash, N., Konik, E. A., McBane, R. D., Chen, D., Tange, J. I., Grill, D. E., Herges, R. M., McLeod, T. G., Friedman, P. A., & Wysokinski, W. E. (2011). Left atrial blood stasis and von willebrand factor-adamts13 homeostasis in atrial fibrillation. Arteriosclerosis, thrombosis, and vascular biology, 31(11), 2760-2766. https://doi.org/10.1161/ATVBAHA.111.232991