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Takiguchi H, Miura M, Shirai SI, Soga Y, Hanyu M, Sakaguchi G, Soga Y, Arai Y, Watanabe S, Kimura T, Takahama H, Yasuda S, Nakayoshi T, Fukumoto Y, Yaoita N, Shimokawa H, Sakatsume K, Saiki Y, Kaikita K, Tsujita K, Tamura T, Doman T, Yamashita M, Suzuki M, Eura Y, Kokame K, Hayakawa M, Matsumoto M, Okubo N, Sugawara S, Fujimaki SI, Kawate Y, Ando K, Horiuchi H. Mitral regurgitation is associated with similar loss of von Willebrand factor large multimers but lower frequency of anemia compared with aortic stenosis. Res Pract Thromb Haemost 2024; 8:102431. [PMID: 38840664 PMCID: PMC11152679 DOI: 10.1016/j.rpth.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
Background Various cardiovascular diseases cause acquired von Willebrand syndrome (AVWS), which is characterized by a decrease in high-molecular-weight (large) von Willebrand factor (VWF) multimers. Mitral regurgitation (MR) has been reported as a cause of AVWS. However, much remains unclear about AVWS associated with MR. Objectives To evaluate VWF multimers in MR patients and examine their impact on clinical characteristics. Methods Moderate or severe MR patients (n = 84) were enrolled. VWF parameters such as the VWF large multimer index (VWF-LMI), a quantitative value that represents the amount of VWF large multimers, and clinical data were prospectively analyzed. Results At baseline, the mean hemoglobin level was 12.9 ± 1.9 g/dL and 58 patients (69.0%) showed loss of VWF large multimers defined as VWF-LMI < 80%. VWF-LMI in patients with degenerative MR was lower than in those with functional MR. VWF-LMI appeared to be restored the day after mitral valve intervention, and the improvement was maintained 1 month after the intervention. Seven patients (8.3%) had a history of bleeding, 6 (7.1%) of whom had gastrointestinal bleeding. Gastrointestinal endoscopy was performed in 23 patients (27.4%) to investigate overt gastrointestinal bleeding, anemia, etc. Angiodysplasia was detected in 2 of the 23 patients (8.7%). Conclusion Moderate or severe MR is frequently associated with loss of VWF large multimers, and degenerative MR may cause more severe loss compared with functional MR. Mitral valve intervention corrects the loss of VWF large multimers. Gastrointestinal bleeding may be relatively less frequent and hemoglobin level remains stable in MR patients.
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Affiliation(s)
- Hiroshi Takiguchi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mizuki Miura
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shin-ichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Takahama
- Cardiovascular Department, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Cardiovascular Department, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaharu Nakayoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ko Sakatsume
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Tsuyoshi Doman
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mihoko Yamashita
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Misako Suzuki
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuka Eura
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koichi Kokame
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaki Hayakawa
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Noriyuki Okubo
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shingo Sugawara
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin-ichi Fujimaki
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yasunori Kawate
- Medical Affairs 2, Medical & Scientific Affairs, Sysmex Corporation, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hisanori Horiuchi
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
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2
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Favaloro EJ. The Role of the von Willebrand Factor Collagen-Binding Assay (VWF:CB) in the Diagnosis and Treatment of von Willebrand Disease (VWD) and Way Beyond: A Comprehensive 36-Year History. Semin Thromb Hemost 2024; 50:43-80. [PMID: 36807283 DOI: 10.1055/s-0043-1763259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The von Willebrand factor (VWF) collagen binding (VWF:CB) assay was first reported for use in von Willebrand diagnostics in 1986, by Brown and Bosak. Since then, the VWF:CB has continued to be used to help diagnose von Willebrand disease (VWD) (correctly) and also to help assign the correct subtype, as well as to assist in the monitoring of VWD therapy, especially desmopressin (DDAVP). However, it is important to recognize that the specific value of any VWF:CB is predicated on the use of an optimized VWF:CB, and that not all VWF:CB assays are so optimized. There are some good commercial assays available, but there are also some "not-so-good" commercial assays available, and these may continue to give the VWF:CB "a bad reputation." In addition to VWD diagnosis and management, the VWF:CB found purpose in a variety of other applications, from assessing ADAMTS13 activity, to investigation into acquired von Willebrand syndrome (especially as associated with use of mechanical circulatory support or cardiac assist devices), to assessment of VWF activity in disease states in where an excess of high-molecular-weight VWF may accumulate, and lead to increased (micro)thrombosis risk (e.g., coronavirus disease 2019, thrombotic thrombocytopenic purpura). The VWF:CB turns 37 in 2023. This review is a celebration of the utility of the VWF:CB over this nearly 40-year history.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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Yang X, Zhang J, Lai Y, Yan X, Guo X, Han J, Liu J, Wang J, Zhu H. Acquired von Willebrand Syndrome Secondary to Normally Functioning Mechanical Aortic Valve and High-Output Cardiac State. J Cardiovasc Dev Dis 2022; 9:jcdd9120454. [PMID: 36547451 PMCID: PMC9786303 DOI: 10.3390/jcdd9120454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Acquired von Willebrand syndrome (AVWS) is caused by an acquired deficiency of von Willebrand factor (VWF), a multimeric protein required for primary hemostasis. For patients with heart valve diseases, high gradient across the malfunctioning valves could cause elevated shear stress and damage the most effective large VWF, eventually resulting in AVWS. However, AVWS has not been reported in association with normally functioning mechanical valves. Herein, we reported a 74-year-old female who suffered from recurrent gastrointestinal bleeding with a history of mechanical aortic and mitral valve replacement. This patient's function/antigen ratio of VWF was decreased and gel electrophoresis revealed the loss of large VWF, which confirmed the diagnosis of AVWS. Echocardiogram showed that the function of the prostheses was normal. However, the gradient across aortic valve was increased due to a high cardiac state which is secondary to chronic anemia, resulting in the disruption of large VWF multimers and exacerbation of gastrointestinal (GI) bleeding. After managing the patient's anemia with transfusion, the gradient across the aortic valve had improved, with the resolution of GI bleeding. This is the first case report of AVWS that is associated with a normally functioning mechanical valve. AVWS should be considered one of the differential diagnoses if patients present with unexplained GI bleeding on the background of having prosthetic heart valves. The management of the underlying condition is essential.
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Affiliation(s)
- Xinglin Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jinghong Zhang
- Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Yamin Lai
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xuemin Yan
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jianhua Han
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jihai Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jiangshan Wang
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Correspondence:
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Van Belle E, Vincent F, Rauch A, Casari C, Jeanpierre E, Loobuyck V, Rosa M, Delhaye C, Spillemaeker H, Paris C, Debry N, Verdier B, Vincentelli A, Dupont A, Lenting PJ, Susen S. von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:1078-1088. [PMID: 30846101 DOI: 10.1016/j.jacc.2018.12.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 10/27/2022]
Abstract
For decades, numerous observations have shown an intimate relationship between von Willebrand factor (VWF) multimer profile and heart valve diseases (HVD). The current knowledge of the unique biophysical properties of VWF helps us to understand the longstanding observations concerning the bleeding complications in patients with severe HVD. Not only does the analysis of the VWF multimer profile provide an excellent evaluation of HVD severity, it is also a strong predictor of clinical events. Also of importance, VWF responds within minutes to any significant change in hemodynamic valve status, making it an accurate marker of the quality of surgical and transcatheter therapeutic interventions. The authors provide in this review a practical, comprehensive, and evidence-based framework of the concept of VWF as a biomarker in HVD, advocating for its implementation into the clinical decision-making process besides usual clinical and imaging evaluation. They also delineate critical knowledge gaps and research priorities to definitely validate this concept.
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Affiliation(s)
- Eric Van Belle
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Flavien Vincent
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Antoine Rauch
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Caterina Casari
- Inserm, UMR_S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuelle Jeanpierre
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Valentin Loobuyck
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiac Surgery, Lille, France
| | - Mickael Rosa
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Cedric Delhaye
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | | | - Camille Paris
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France
| | - Nicolas Debry
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - Basile Verdier
- CHU Lille, Institut Coeur Poumon, Cardiology, Lille, France
| | - André Vincentelli
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Institut Coeur Poumon, Cardiac Surgery, Lille, France
| | - Annabelle Dupont
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France
| | - Peter J Lenting
- Inserm, UMR_S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Susen
- CHU Lille, Université de Lille, Inserm U1011 - EGID, Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, Lille, France.
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5
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Abstract
Heyde described aortic stenosis and gastrointestinal bleeding in the 1950s. Since then, a link with intestinal angiodysplasia and abnormalities of von Willebrand factor (VWF) has been noted. Loss of the highest-molecular-weight multimers of VWF and bleeding also have been described in subaortic stenosis in hypertrophic cardiomyopathy, in isolated mitral and aortic insufficiency, in endocarditis, in patients with prosthetic valve stenosis or regurgitation, and in patients with left ventricular assist devices (LVADs). Bleeding tends to recur with local treatment of angiodysplasias, whereas cardiac repair or removal of LVAD eliminates VWF dysfunction is curative of bleeding in the majority.
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Matsunaga Y, Ishimura M, Nagata H, Uike K, Kinjo T, Ochiai M, Yamamura K, Takada H, Tanoue Y, Hayakawa M, Matsumoto M, Hara T, Ohga S. Thrombotic microangiopathy in a very young infant with mitral valvuloplasty. Pediatr Neonatol 2018. [PMID: 29523490 DOI: 10.1016/j.pedneo.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by systemic or intrarenal platelet aggregation, thrombocytopenia, and red cell fragmentation. Post-operative TMA mostly occurs in adult patients with cardiovascular surgery, with the distinct pathophysiology from classical thrombotic thrombocytopenic purpura (TTP) although the exact pathophysiology remains unclear. CASE PRESENTATION A one-month-old infant developed TMA after the initial surgery of double outlet right ventricle. ADAM metallopeptidase with thrombospondin type 1 motif 13 (ADAMTS13) activity was sustained (64%) with the undetectable inhibitor. Von Willebrand factor (VWF) multimer analyses showed absent high-molecular weight multimers. Echocardiography disclosed severe mitral regurgitation. The mitral valve repair 32 days after the initial valvuloplasty led to prompt resolution of TMA. These suggested that TMA occurred in association with valvulopathy-triggered turbulent shear flow, mechanical hemolysis and endothelial damage. The consumption of large VWF multimers might account for the vascular high shear stress shown in Heyde syndrome. CONCLUSION The youngest case of post-operative TMA underscores the critical coagulopathy after the first surgical intervention for congenital heart disease.
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Affiliation(s)
- Yuka Matsunaga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masataka Ishimura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kiyoshi Uike
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tadamune Kinjo
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masayuki Ochiai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan; Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masaki Hayakawa
- Department of Blood Transfusion Medicine, Nara Medical University, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Japan
| | | | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Japan
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7
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Blackshear JL. Gastrointestinal Bleeding in Native and Prosthetic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:6. [PMID: 29397472 DOI: 10.1007/s11936-018-0595-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastrointestinal bleeding with severe aortic stenosis was originally described in the 1950s by Heyde, although for years, the association was debated. Further discovery of mechanisms and the ubiquity and severity of acquired von Willebrand syndrome in the left ventricular assist device therapy have removed any doubts. At this time, gastrointestinal bleeding from intestinal angiodysplasia in patients with turbulence-related proteolysis of the highest molecular weight multimers of von Willebrand factor is now known to occur in patients with aortic stenosis, and also subaortic obstruction and associated mitral insufficiency in hypertrophic cardiomyopathy, isolated mitral and aortic insufficiency, endocarditis, and in patients with prosthetic valve dysfunction, either from stenosis or insufficiency. The degree of loss of high molecular weight multimers correlates with lesion severity, and tests of von Willebrand factor function have been proposed as important biomarkers of the severity of valve dysfunction, including in-lab testing for paravalvular leak during transcatheter aortic valve replacement. Bleeding tends to recur after endoscopic or surgical therapy, but cardiac repair is curative in the great majority.
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Affiliation(s)
- Joseph L Blackshear
- Department of Cardiovascular Diseases, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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8
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Fidalgo T, Ferreira G, Oliveira AC, Silva Pinto C, Martinho P, Mendes MJ, Duarte M, Salvado R, Ribeiro ML. Acquired von Willebrand syndrome in haematologic malignancies - how the clinical-laboratory correlation improves a challenging diagnosis - a case series. Haemophilia 2017; 23:e361-e365. [PMID: 28497886 DOI: 10.1111/hae.13243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/26/2022]
Affiliation(s)
- T Fidalgo
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - G Ferreira
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - A C Oliveira
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - C Silva Pinto
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - P Martinho
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - M J Mendes
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - M Duarte
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - R Salvado
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
| | - M L Ribeiro
- Serviço de Hematologia Clínica, Centro Hospitalar Universitãrio de Coimbra, Coimbra, Portugal
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Gragnano F, Crisci M, Bigazzi MC, Bianchi R, Sperlongano S, Natale F, Fimiani F, Concilio C, Cesaro A, Pariggiano I, Diana V, Limongelli G, Cirillo P, Russo M, Golia E, Calabrò P. Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement. Angiology 2017; 69:103-112. [PMID: 28481153 DOI: 10.1177/0003319717708070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
von Willebrand Factor (vWF) is a well-known mediator of hemostasis and vascular inflammation. Its dynamic modulation in the bloodstream, according to hemodynamic conditions, makes it an appealing biomarker in patients with valvular heart disease (VHD). Recent studies highlight the close connection between vWF and VHD, with possible implications in the pathogenesis of VHD, promoting valve aging and calcification or favoring the development of infective endocarditis. Moreover, vWF has been recently proposed as a new diagnostic and prognostic tool in patients with valve stenosis or regurgitation, showing a strict correlation with severity of valve disease, outcome, and bleeding (Heyde syndrome). A novel role for vWF is also emerging in patients undergoing percutaneous or surgical valve repair/replacement to select and stratify patients, evaluate periprocedural bleeding risk, and detect procedural complications. We also report our single-center experience, suggesting, for the first time, possible clinical implications for vWF in percutaneous mitral valve repair (MitraClip). This review summarizes recent advances in the role of vWF in VHD with an updated overview going from bench to operating room.
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Affiliation(s)
- Felice Gragnano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Crisci
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Cappelli Bigazzi
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renatomaria Bianchi
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Sperlongano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Natale
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Fimiani
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudia Concilio
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Arturo Cesaro
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ivana Pariggiano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Diana
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Limongelli
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Plinio Cirillo
- 2 Department of Advanced Biological Sciences, Federico II University, Naples, Italy
| | - Mariagiovanna Russo
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrica Golia
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
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Nishigori N, Matsumoto M, Koyama F, Hayakawa M, Hatakeyayama K, Ko S, Fujimura Y, Nakajima Y. von Willebrand Factor-Rich Platelet Thrombi in the Liver Cause Sinusoidal Obstruction Syndrome following Oxaliplatin-Based Chemotherapy. PLoS One 2015; 10:e0143136. [PMID: 26580395 PMCID: PMC4651512 DOI: 10.1371/journal.pone.0143136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/31/2015] [Indexed: 12/24/2022] Open
Abstract
Oxaliplatin-based chemotherapy is widely used to treat advanced colorectal cancer (CRC). Sinusoidal obstruction syndrome (SOS) due to oxaliplatin is a serious type of chemotherapy-associated liver injury (CALI) in CRC patients. SOS is thought to be caused by the sinusoidal endothelial cell damage, which results in the release of unusually-large von Willebrand factor multimers (UL-VWFMs) from endothelial cells. To investigate the pathophysiology of CALI after oxaliplatin-based chemotherapy, we analyzed plasma concentration of von Willebrand factor (VWF) and the distribution of VWFMs in CRC patients. Twenty-three patients with advanced CRC who received oxaliplatin-based chemotherapy with (n = 6) and without (n = 17) bevacizumab were analyzed. CALI (n = 6) and splenomegaly (n = 9) were found only in patients who did not treated with bevacizumab. Plasma VWF antigen (VWF:Ag) and serum aspartate aminotransferase (AST) levels increased after chemotherapy only in patients without bevacizumab. VWFM analysis in patients who did not receive bevacizumab showed the presence of UL-VWFMs and absence of high molecular weight VWFMs during chemotherapy, especially in those with CALI. In addition, plasma VWF:Ag and AST levels increased after chemotherapy in patients with splenomegaly (n = 9), but not in patients without splenomegaly (n = 14). Histological findings in the liver tissue of patients who did not receive bevacizumab included sinusoidal dilatation and microthrombi in the sinusoids. Many microthrombi were positive for both anti-IIb/IIIa and anti-VWF antibodies. Plasma UL-VWFM levels might be increased by damage to endothelial cells as a result of oxaliplatin-based chemotherapy. Bevacizumab could prevent CALI and splenomegaly through inhibition of VWF-rich platelet thrombus formation.
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Affiliation(s)
- Naoto Nishigori
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
- * E-mail:
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Masaki Hayakawa
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Kinta Hatakeyayama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Saiho Ko
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Yoshihiro Fujimura
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
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Blackshear JL, Wysokinska EM, Safford RE, Thomas CS, Shapiro BP, Ung S, Stark ME, Parikh P, Johns GS, Chen D. Shear stress-associated acquired von Willebrand syndrome in patients with mitral regurgitation. J Thromb Haemost 2014; 12:1966-74. [PMID: 25251907 DOI: 10.1111/jth.12734] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/17/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mitral valve regurgitation is associated with an acquired hemostatic defect. OBJECTIVE We sought to assess the prevalence and severity of acquired von Willebrand syndrome in patients with native valve mitral regurgitation (MR). PATIENTS/METHODS Fifty-three patients were prospectively observed with bleeding questionnaires and laboratory tests when undergoing an echocardiographic assessment of MR. In patients referred for mitral valve surgery, testing was repeated postoperatively. RESULTS Echocardiography identified 13 patients with mild MR, 14 with moderate MR, and 26 with severe MR. Among patients with mild, moderate or severe MR, loss of the highest molecular weight von Willebrand factor (VWF) multimers occurred in 8%, 64%, and 85%, respectively, median platelet function analyzer collagen ADP closure times (PFA-CADPs) were 84 s (interquartile range [IQR] 73-96 s), 156 s (IQR 104-181 s), and 190 s (IQR 157-279 s), respectively, and the ratios of VWF latex activity to antigen were 0.92 (IQR 0.83-0.97), 0.85 (IQR 0.76-0.89), and 0.79 (IQR 0.75-0.82), respectively (all P < 0.001). Nine patients reported clinically significant bleeding, and seven had intestinal angiodysplasia and transfusion-dependent gastrointestinal bleeding (Heyde syndrome), with the median number of transfusions required being 20 (IQR 10-33; range 4-50). In patients who underwent mitral valve repair (n = 13) or replacement (n = 7), all measures of VWF function reported above improved significantly. CONCLUSION The high-shear environment of moderate to severe MR is sufficient to produce prevalent perturbations in VWF activity. Acquired von Willebrand syndrome may occur in this setting, and appears to be reversible with mitral valve surgery.
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Affiliation(s)
- J L Blackshear
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
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Loeffelbein F, Funk D, Nakamura L, Zieger B, Grohmann J, Siepe M, Kroll J, Stiller B. Shear-stress induced acquired von Willebrand syndrome in children with congenital heart disease. Interact Cardiovasc Thorac Surg 2014; 19:926-32. [DOI: 10.1093/icvts/ivu305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wan SH, Liang JJ, Vaidya R, Blackshear JL, Chen D. Acquired Von Willebrand syndrome secondary to mitral and aortic regurgitation. Can J Cardiol 2014; 30:1108.e9-1108.e10. [PMID: 24994586 DOI: 10.1016/j.cjca.2014.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022] Open
Abstract
The association between aortic stenosis and gastrointenstinal bleeding due to acquired von Willebrand syndrome (AVWS) has been well established. We report a patient with AVWS from underlying severe endocarditis-associated aortic regurgitation and pre-existing mitral regurgitation. Cardiovascular disease-related AVWS occurs from a selective loss of the largest multimers of von Willebrand factor from high shear forces, and desmopressin leads to transient clinical improvement.
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Affiliation(s)
- Siu-Hin Wan
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Jackson J Liang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakhee Vaidya
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dong Chen
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
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