Oral Presentation No. 41 High plasma von Willebrand factor concentration is associated with the development of bleeding complications in patients with polyvascular disease receiving multicomponent antithrombotic therapy

Background

von Willebrand factor (VWF) is well known biochemical marker of endothelial dysfunction that increased may be associated with the development of thrombotic complications in patients with polyvascular disease (PD). We aimed to asses the relation of VWF to the development of bleeding outcomes in patients with PD receiving multicomponent antithrombotic therapy (MAT).

Material and methods

The data were obtained during the prospective register REGATA-1, NCT04347200. 95 patients (70 males), median age 67 [IQR 61; 72] with PD (coronary artery disease and peripheral atherosclerosis of at least one vascular territory ≥ 50%) were enrolled. 61% of patients received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid, other (39%)with clopidogrel. Median follow-up was 10 months [IQR 8.0; 12.0]. The safety end point was major and clinically relevant bleedings (type 2–5) according to the BARC classification. Plasma samples for VWF were taken at the inclusion and analyzed using ELISA.

Results

Frequency of BARC 2–5 bleedings was 20%. The most frequent (79%) was gastrointestinal bleedings. Median VWF plasma concentration was 154% [116; 196]. According to the quartile analysis, VWF values in the top three quartiles distribution (cut-off value > 122%) were associated with a higher frequency of bleeding events: 3.7% versus 36.7%, OR 8.8; CI 1,11-69,9, ? = 0.0392. Bleeding-free survival in groups formed depending on the VFW plasma concentration (122 > and ≤ 122%) was 96.2% vs. 73.9%, respectively, Log-Rank P = 0.0488.

Conclusions

Increase of VWF plasma concentration (> 122%) is associated with the development of major and clinically relevant bleedings in patients with PD receiving MAT.

Oral Presentation No. 03 Growth differentiation factor-15 and bleeding complication risk in patients with coronary artery disease, receiving combined antithrombotic therapy

Introduction

Recent studies are aimed to find laboratory predictors of bleeding complications in patients receiving various regimens of antithrombotic therapy. One of these biomarkers is GDF-15.

Purpose

To study the significance of GDF-15 in relation to the development of bleeding outcomes in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy.

Methods

The data was obtained from the prospective registry REGATA-1 (NCT04347200). 122 patients (90 males), median age 69 [IQR 64; 76] yrs) with CAD and peripheral atherosclerosis of at least one vascular territory (≥ 50%), were enrolled. Half of the patients (47.5%) with sinus rhythm received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid. Other patients (52.5%) with concomitant atrial fibrillation received direct oral anticoagulants in combination with antiplatelet therapy after elective PCI. Median follow-up was 10 months [IQR 7.0;12.0]. The safety end point was BARC 2–5 bleedings. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA.

Results

Frequency of BARC 2–5 bleedings was 14%. Median GDF-15 level was 1248.5 pg/ml [947.8; 1791.0]. According to the quartile analysis, GDF-15 values in the top three quartiles of the distribution (cut-off value > 948 pg/ml) were associated with higher frequency of bleeding events: 3.1% versus 17.8%, P = 0.0411. Bleeding-free survival in groups, formed depending on the level of GDF-15 (948 > and ≤ 948 pg/ml), was 96.7% vs. 82.2%, respectively, Log-Rank P = 0.0408.

Conclusions

Increase in GDF-15 level (> 948 pg/ml) is associated with the development of BARC 2-5 bleedings in CAD patients with multifocal atherosclerosis, receiving combined antithrombotic therapy.

The monomeric C-reactive protein level is associated with the increase in carotid plaque number in patients with subclinical carotid atherosclerosis

The high-sensitivity C-reactive protein (hsCRP) assay measures the level of the pentameric form of CRP in blood. Currently, there are no available assays measuring the level of the monomeric form of CRP (mCRP), produced at sites of local inflammation. We developed an assay measuring the mCRP level in blood plasma with functional beads for flow cytometry. The assay was used to measure the mCRP level in 80 middle-aged individuals with initially moderate cardiovascular SCORE risk. By the time of the mCRP measurement, the patients have been followed up for subclinical carotid atherosclerosis progression for 7 years. Ultrasound markers of subclinical atherosclerosis, which included plaque number (PN) and total plaque height (PH), were measured at baseline and at the 7th-year follow-up survey. Inflammatory biomarkers, including mCRP, hsCRP, inteleukin-6 (IL-6) and von Willebrand factor (VWF) level, were measured at the 7th-year follow-up survey. The median level of mCRP was 5.2 (3.3; 7.1) μg/L, hsCRP 1.05 (0.7; 2.1) mg/L, IL-6 0.0 (0.0; 2.8) pg/mL, VWF 106 (77; 151) IU/dL. In the patients with the mCRP level below median vs. the patients with the median mCRP level or higher, change from baseline in PN was 0.0 (0.0; 1.0) vs. 1.0 (1.0; 2.0) and PH 0.22 (−0.24; 1.91) mm vs. 1.97 (1.14; 3.14) mm, respectively (p < 0.05). The adjusted odds ratio for the formation of new carotid atherosclerotic plaques was 4.7 (95% CI 1.7; 13.2) for the patients with the median mCRP level or higher. The higher mCRP level is associated with the more pronounced increase in PN and PH in patients with normal level of traditional inflammatory biomarkers and initially moderate cardiovascular SCORE risk.

POS0520 ASSOCIATIONS BETWEEN THE NEOVASCULARIZATION OF CAROTID ATHEROSCLEROTIC PLAQUES, LIPID PARAMETERS AND IMMUNOLOGICAL DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Development of carotid atherosclerotic plaques (CAP) in patients (pts) with rheumatoid arthritis (RA) is associated with accumulation of traditional risk factors and immunological disorders. CAP neovascularization is associated with its’ inflammation and increasing vulnerability. Therefore, early detection of CAP neovascularization is important for prevention of potential cardiovascular complications, preferably using a non-invasive technique, such as contrast-enhanced ultrasound (CEUS) of the carotid arteries.

Objectives:

to identify the relationship between the severity of CAP neovascularization, lipid parameters and RA-related parameters.

Methods:

Evaluation of 23 RA pts, 8 males and 15 females, mean age 61 [58; 65] years, with a longstanding disease (7 [3;12] years), seropositivity for IgM rheumatoid factor (RF) (76%) and anti-cyclic citrullinated peptide (ACCP) (62%) and moderate clinical disease activity (DAS 28 3,9 [3,2;4,8]). Nineteen RA pts (83%) received Methotrexate, 35% - biological agents, 35% - low-dose glucocorticoids. All patients underwent bilateral CEUS of the carotid arteries using a PHILIPS IU22 ultrasound system with 3-9 MHz linear array transducer and i/v administration of SonoVue contrast agent. The severity of carotid intraplaque neovascularization (IPN) was visually assessed on a scale from 0 to 3 (Shah et al. 2007): 0 - no neovascularization, 1 (mild) - limited to moderate neovascularization, 2 (severe) - extensive appearance of neovascularization, 3 - in the presence of a pulsating vessel in the plaque image.

Results:

Carotid IPN was found in all RA pts. Grade 1 of neovascularization was established in 39% pts (group I) and Grade 2 - in 61% pts (group II). Groups were comparable in terms of age, sex, body mass index, smoking, disease duration and activity RA (DAS 28 score). The degree of carotid IPN positively correlated with the LDL-C level (R = 0,46, p=0,04), and the TG level (R=0,56, p=0,01) and negatively correlated with the HDL-C level (R= -0,52, p=0,02) in all pts. The degree of neovascularization was also associated with RA duration (R=0,52, p<0,05) and ACCP-positivity (R=0,57, p=0,007). Aforementioned correlations were significant for both groups of RA pts. No association was found between the severity of IPN and the levels of RF, DAS28. Association between the degree of carotid stenosis and CRP concentrations (R=-0,73, p<0,05) was found in pts of group II.

Conclusion:

CEUS of carotid arteries demonstrated the presence of a predominantly extensive carotid IPN in RA pts. Cases of more severe carotid IPN were associated with lipid parameters (positively with the LDL-C, TG levels and negatively with the HDL-C level), RA duration and ACCP-positivity. The relationship between the degree of carotid artery stenosis and CRP requires additional studies to determine the role of immunological disorders in the development of carotid intraplaque neovascularization in RA pts.

References:

[1]Shah F., Balan P., Weinberg M., Reddy V., Neems R., Feinstein M., Dainauskas J., Meyer P., Goldin M., Feinstein S.B. Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis? Vasc Med. 2007;12(4):291-7. https://doi.org/10.1177/1358863x07083363

Disclosure of Interests:

None declared

Modern medical treatment with or without carotid endarterectomy for severe asymptomatic carotid atherosclerosis

OBJECTIVE

This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis.

METHODS

We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up.

RESULTS

The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P = .008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P = .0048).

CONCLUSIONS

CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT.