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document
Effects of congestive heart failure on plasma von Willebrand factor and soluble P-selectin concentrations in patients with non-valvar atrial fibrillation . OBJECTIVE To examine further the relations of plasma von Willebrand factor ( vWf , an index of endothelial damage and dysfunction ) and soluble P-selectin ( sP-sel , an index of platelet activation ) concentrations to the presence and onset of clinical congestive heart failure ( CHF ) and the degree of left ventricular ( LV ) dysfunction in patients taking part in the SPAF ( stroke prevention in atrial fibrillation ) study . METHODS Plasma concentrations of vWf and sP-sel were measured by enzyme linked immunosorbent assay ( ELISA ) in 1321 participants in the SPAF III study and related to the presence and onset of clinical CHF , as well as echocardiographic findings . Of the 1321 patients with atrial fibrillation ( AF ) , 331 ( 25 % ) had a documented history of clinical heart failure , of which 168 cases were related to a new or recurrent episode of acute decompensated heart failure occurring within the preceding three months . RESULTS Mean plasma vWf was higher among patients with AF and CHF ( 154 ( 29 ) v 144 ( 31 ) IU/dl , p < 0.001 ) , particularly those with acute or recent decompensated symptoms . Patients with severe LV dysfunction on two dimensional echocardiography and low fractional shortening also had significantly higher vWf concentrations than those with no LV dysfunction . CHF patients with clinical features -- with ( 156 ( 28 ) IU/dl ) and without ( 152 ( 31 ) IU/dl ) LV dysfunction -- also had higher mean vWf concentrations than patients with asymptomatic LV dysfunction ( 146 ( 31 ) IU/dl , p < 0.001 ) . The presence of mitral regurgitation in CHF was associated with lower vWf concentrations . Plasma sP-sel concentrations were not affected by presence , onset , or severity of heart failure . CONCLUSIONS CHF may contribute to hypercoagulability and thrombotic risk in AF through increased endothelial damage and dysfunction . Patients with acute or recent decompensated features have the highest degree of endothelial damage and dysfunction . The presence of CHF clinical features was an important determinant of plasma vWf concentrations .
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Intervention_Physical
Willebrand factor
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Intervention_Physical
P-selectin
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Intervention_Psychological
vWf
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Intervention_Educational
and
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Intervention_Psychological
sP-sel
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Outcome_Physical
plasma von Willebrand factor
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Outcome_Physical
soluble P-selectin concentrations
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Outcome_Physical
plasma von Willebrand factor ( vWf , an index of endothelial damage and dysfunction )
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Outcome_Physical
soluble P-selectin ( sP-sel , an index of platelet activation )
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Outcome_Physical
Plasma concentrations of vWf
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Outcome_Physical
sP-sel
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Outcome_Physical
Mean plasma vWf
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Outcome_Physical
severe LV dysfunction
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Outcome_Physical
vWf concentrations
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Outcome_Physical
mean vWf concentrations
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Outcome_Physical
mitral regurgitation in CHF
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Outcome_Physical
Plasma sP-sel concentrations
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Outcome_Physical
endothelial damage and dysfunction
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Outcome_Physical
endothelial damage and dysfunction
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Participant_Condition
patients with non-valvar atrial fibrillation .