Von Willebrand Factor Activity Association With Outcomes After Transcatheter Edge-to-Edge Mitral Valve Repair

Overview

Journal JACC Adv

Specialty Cardiology & Vascular Diseases

Date 2024 Sep 23

PMID 39309664

Authors

Sandra Hadjadj

Philippe Pibarot

Caroline Gravel

Marie-Annick Clavel

Ons Marsit

Dounia Rouabhia

Benoit M Labbe

Kim OConnor

Mathieu Bernier

Erwan Salaun

Julio Farjat

Jorge Nuche Berenguer

Josep Rodes-Cabau

Jean-Michel Paradis

Jonathan Beaudoin

Affiliations

Soon will be listed here.

Abstract

Background: Residual mitral regurgitation (MR) is associated with worse outcomes after transcatheter edge-to-edge mitral valve repair (TEER). Shear stress induced by MR leads to altered von Willebrand factor activity (vWF:Act) and increased closure time with adenosine diphosphate (CT-ADP).

Objectives: The purpose of this study was to investigate the use of CT-ADP to monitor MR during TEER and the association between the vWF, residual MR, and clinical events post-TEER.

Methods: Sixty-five patients undergoing TEER were enrolled. CT-ADP was measured at baseline, after each clip deployment, 1 hour and 24 hours post-TEER. CT-ADP values were related to vWF:Act/vWF antigen (vWF:Ag) ratio at the same time points, and MR severity was assessed by echocardiography at 1 month. Combined events of all-cause mortality and heart failure hospitalizations were evaluated at 1 year.

Results: At 1 month, 32 (49%) patients had residual MR > mild (of those, 14% had MR > moderate). There was no significant change in CT-ADP values during the procedure. However, CT-ADP significantly decreased 1-hour post-TEER ( < 0.001). Patients with corrected MR demonstrated an increase in vWF:Act/vWF:Ag ratio 1-hour post-TEER. Elevated baseline vWF:Act/vWF:Ag ratio and the periprocedural percentage changes of the vWF:Act/vWF:Ag ratio (1 hour post-TEER - baseline values) were associated with the combined clinical outcome.

Conclusions: CT-ADP evolution in time was not quick enough to provide real-time monitoring of MR severity during TEER. However, vWF:Act/vWF:Ag ratio at baseline and its variations following the procedure were associated with clinical outcomes. Those findings will need external validation.

References

Atiq F, Meijer K, Eikenboom J, Fijnvandraat K, Mauser-Bunschoten E, van Galen K . Comorbidities associated with higher von Willebrand factor (VWF) levels may explain the age-related increase of VWF in von Willebrand disease. Br J Haematol. 2018; 182(1):93-105. PMC: 6032952. DOI: 10.1111/bjh.15277. View

Meindl C, Paulus M, Koller T, Rogalski D, Hamerle M, Schach C . Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair. Clin Cardiol. 2020; 44(2):261-266. PMC: 7852171. DOI: 10.1002/clc.23538. View

Nickenig G, Estevez-Loureiro R, Franzen O, Tamburino C, Vanderheyden M, Luscher T . Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011-2012 Pilot European Sentinel Registry. J Am Coll Cardiol. 2014; 64(9):875-84. DOI: 10.1016/j.jacc.2014.06.1166. View

Mack M, Carroll J, Thourani V, Vemulapalli S, Squiers J, Manandhar P . Transcatheter Mitral Valve Therapy in the United States: A Report from the STS/ACC TVT Registry. Ann Thorac Surg. 2021; 113(1):337-365. DOI: 10.1016/j.athoracsur.2021.07.030. View

Folsom A, Wu K, Shahar E, Davis C . Association of hemostatic variables with prevalent cardiovascular disease and asymptomatic carotid artery atherosclerosis. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Arterioscler Thromb. 1993; 13(12):1829-36. DOI: 10.1161/01.atv.13.12.1829. View

Blackshear J, Kusumoto H, Safford R, Wysokinska E, Thomas C, Waldo O . Usefulness of Von Willebrand Factor Activity Indexes to Predict Therapeutic Response in Hypertrophic Cardiomyopathy. Am J Cardiol. 2015; 117(3):436-42. DOI: 10.1016/j.amjcard.2015.11.016. View

Zoghbi W, Asch F, Bruce C, Gillam L, Grayburn P, Hahn R . Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and.... J Am Soc Echocardiogr. 2019; 32(4):431-475. DOI: 10.1016/j.echo.2019.01.003. View

Blackshear J, Wysokinska E, Safford R, Thomas C, Stark M, Shapiro B . Indexes of von Willebrand factor as biomarkers of aortic stenosis severity (from the Biomarkers of Aortic Stenosis Severity [BASS] study). Am J Cardiol. 2012; 111(3):374-81. PMC: 3932487. DOI: 10.1016/j.amjcard.2012.10.015. View

Stockschlaeder M, Schneppenheim R, Budde U . Update on von Willebrand factor multimers: focus on high-molecular-weight multimers and their role in hemostasis. Blood Coagul Fibrinolysis. 2014; 25(3):206-16. PMC: 3969155. DOI: 10.1097/MBC.0000000000000065. View

10.

Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P . Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371. DOI: 10.1016/j.echo.2017.01.007. View

11.

Loscalzo J . From clinical observation to mechanism--Heyde's syndrome. N Engl J Med. 2012; 367(20):1954-6. DOI: 10.1056/NEJMcibr1205363. View

12.

Gragnano F, Crisci M, Cappelli Bigazzi M, Bianchi R, Sperlongano S, Natale F . Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement. Angiology. 2017; 69(2):103-112. DOI: 10.1177/0003319717708070. View

13.

Lancellotti P, Tribouilloy C, Hagendorff A, Popescu B, Edvardsen T, Pierard L . Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013; 14(7):611-44. DOI: 10.1093/ehjci/jet105. View

14.

Van Belle E, Rauch A, Vincentelli A, Jeanpierre E, Legendre P, Juthier F . Von Willebrand factor as a biological sensor of blood flow to monitor percutaneous aortic valve interventions. Circ Res. 2015; 116(7):1193-201. DOI: 10.1161/CIRCRESAHA.116.305046. View

15.

Kar S, Mack M, Lindenfeld J, Abraham W, Asch F, Weissman N . Relationship Between Residual Mitral Regurgitation and Clinical and Quality-of-Life Outcomes After Transcatheter and Medical Treatments in Heart Failure: COAPT Trial. Circulation. 2021; 144(6):426-437. DOI: 10.1161/CIRCULATIONAHA.120.053061. View

16.

Blackshear J, Wysokinska E, Safford R, Thomas C, Shapiro B, Ung S . Shear stress-associated acquired von Willebrand syndrome in patients with mitral regurgitation. J Thromb Haemost. 2014; 12(12):1966-74. DOI: 10.1111/jth.12734. View

17.

Sugiura A, Kavsur R, Spieker M, Iliadis C, Goto T, Ozturk C . Recurrent Mitral Regurgitation After MitraClip: Predictive Factors, Morphology, and Clinical Implication. Circ Cardiovasc Interv. 2022; 15(3):e010895. DOI: 10.1161/CIRCINTERVENTIONS.121.010895. View

18.

Stone G, Lindenfeld J, Abraham W, Kar S, Lim D, Mishell J . Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018; 379(24):2307-2318. DOI: 10.1056/NEJMoa1806640. View

19.

Thompson S, Kienast J, Pyke S, Haverkate F, van de Loo J . Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med. 1995; 332(10):635-41. DOI: 10.1056/NEJM199503093321003. View

20.

Prakash R, Horsfall M, Markwick A, Pumar M, Lee L, Sinhal A . Prognostic impact of moderate or severe mitral regurgitation (MR) irrespective of concomitant comorbidities: a retrospective matched cohort study. BMJ Open. 2014; 4(7):e004984. PMC: 4120438. DOI: 10.1136/bmjopen-2014-004984. View