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This Article Full Text (PDF) All Versions of this Article: chest.07-2557v1 133/5/1203    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Freestone, B. Articles by Lip, G. Y. PubMed PubMed Citation Articles by Freestone, B. Articles by Lip, G. Y.

Influence of Atrial Fibrillation on Plasma Von Willebrand Factor, Soluble E-Selectin and NT-pro B-type Natriuretic Peptide Levels in Systolic Heart Failure

¹Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Dudley Rd, Birmingham, UK ²Department of Cardiology B, Rigshospitalet, Denmark ³Department of Cardiology & Endocrinology E, Frederiksberg University Hospital, Denmark ⁴Department of Endocrinology, Herlev University Hospital, Denmark ⁵Department of Medicine, Roskilde University Hospital, Denmark

G.Y.H.LIP{at}bham.ac.uk

Abstract

Background Endothelial dysfunction is present in patients with heart failure (HF) due to left ventricular systolic dysfunction, as well as in patients with atrial fibrillation (AF) who have normal cardiac function. It is unknown whether AF influences the degree of endothelial dysfunction in patients with systolic HF.

Methods We measured levels of plasma von Willebrand factor (vWF) and E-selectin (sE-sel) (as indices of endothelial damage/dysfunction and endothelial activation, respectively; both ELISA) in patients with HF and AF [AF-HF], and compared with patients with HF and sinus rhythm [SR-HF], as well as in age matched healthy controls. We also assessed the relationship of vWF and sE-sel to plasma N-terminal pro B-type natriuretic peptide (NTpro-BNP), a marker for heart failure severity and prognosis).

Results 190 patients (73% men, mean age 69.0±10.1 years) with systolic HF were studied, who were compared to 117 healthy controls: 52 (27%) were in AF whilst 138 (73%) were in sinus rhythm. AF-HF patients were older than SR-HF patients (p=0.046) but left ventricular ejection fraction (LVEF) and NYHA class were similar. There were significant differences in NT-proBNP (p<0.0001) and plasma vWf (p=0.003) between patients and controls. On Tukey's posthoc analysis, AF-HF patients had significantly increased NT-proBNP (p<0.001) and vWF (p=0.0183), but not sE–sel(p=0.071) levels, when compared to SR-HF patients. On multivariate analysis, the presence of AF was related to plasma vWF levels (P=0.018). Plasma vWF was also significantly correlated with NT-proBNP levels (Spearman, r=0.139; p=0.017).

Conclusions There is evidence of greater endothelial damage/dysfunction in HF patients in AF, when compared to those in SR. The clinical significance of this is unclear but may have prognostic value

Key Words: atrial fibrillation • heart failure • von Willebrand factor • N-terminal pro B-type natriuretic peptide