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Usefulness of von Willebrand factor in cardiac allograft vasculopathy: preliminary experience
C I Chamorro1, L Almenar, L Martínez-Dolz
1Cardiac Failure and Transplant Unit, La Fe University Hospital, Valencia, Spain. carlosisra@ono.com
Insights
Cardiac allograft vasculopathy (CAV) is a significant post-transplant complication. Elevated von Willebrand factor (vWf) serum concentrations may aid in early screening for CAV, despite a general trend of decreasing levels over time.
Area of Science:
- Cardiology
- Transplantation immunology
- Vascular biology
Background:
- Cardiac allograft vasculopathy (CAV) significantly impacts long-term survival in heart transplant recipients.
- Intravascular ultrasound (IVUS) is the gold standard for CAV diagnosis.
- von Willebrand factor (vWf) is a potential biomarker for endothelial dysfunction.
Purpose of the Study:
- To investigate the utility of serum von Willebrand factor (vWf) as a diagnostic marker for cardiac allograft vasculopathy (CAV).
- To assess the correlation between vWf levels and the presence and progression of CAV.
Main Methods:
- Prospective analysis of 22 cardiac transplant recipients with serial coronary angiography and IVUS at baseline and follow-up (598 +/- 49 days).
- Regular monitoring of serum vWf levels throughout the follow-up period.
- Statistical analysis using repeated-measures ANOVA and Receiver Operating Characteristic (ROC) curve analysis.
Main Results:
- CAV was diagnosed in 10 (45.5%) of the 22 patients.
- Patients with CAV exhibited significantly higher serum vWf concentrations (298 +/- 139 mg/dL) compared to those without CAV (212 +/- 105 mg/dL; P = .02).
- ROC analysis indicated a sensitivity of 40% and specificity of 83% for vWf at a cutoff of 300 mg/dL.
Conclusions:
- Elevated serum vWf levels are associated with the presence of CAV in cardiac transplant recipients.
- vWf may serve as a valuable early screening marker for CAV, particularly in the initial stages post-transplantation.
- While vWf levels may decrease over time, their elevated concentration in early phases warrants further investigation for clinical application.
Background:
Cardiac allograft vasculopathy (CAV) is a disease that significantly limits the survival of transplant patients intravascular ultrasound (IVUS) is considered the method of choice for its diagnosis. von Willebrand factor (vWf) has been used as a marker of endothelial malfunction. We sought to evaluate the usefulness of vWf as a CAV marker.
Materials And Methods:
We prospectively analyzed 22 cardiac transplant subjects, on whom we performed a first study using coronary angiography and IVUS at 36 +/- 3 days and a second study at 598 +/- 49 days. During the follow-up period, five vWf serum controls were performed per patient. We analyzed the results with the repeated-measures ANOVA test and a ROC curve.
Results:
CAV was detected in 10 (45.5%) of the 22 patients. Although vWf levels tended to diminish progressively during evolution, this trend was not statistically significant (P = .3). However, differences were appreciated based on the presence versus absence of CAV (298 +/- 139 mg/dL versus 212 +/- 105 mg/dL, P = .02). The ROC curve showed a sensitivity of 40%, a specificity of 83%, and a negative predictive value of 82% with a cutoff point of 300 mg/dL.
Conclusions:
Subjects with CAV showed significantly higher vWf serum concentrations, particularly during the preliminary phases of cardiac transplantation decreasing during its evolution. This marker could be useful for early screening of CAV.
