Von Willebrand Factor Improves Risk Prediction in Addition to N-Terminal Pro-B-type Natriuretic Peptide in Patients Referred to Coronary Angiography and Signs and Symptoms of Heart Failure and Preserved Ejection Fraction.

Kleber, Marcus E; Koller, Lorenz; Goliasch, Georg; Sulzgruber, Patrick; Scharnagl, Hubert; Silbernagel, Günther; Grammer, Tanja B; Delgado, Graciela; Tomaschitz, Andreas; Pilz, Stefan; März, Winfried; Niessner, Alexander (2015). Von Willebrand Factor Improves Risk Prediction in Addition to N-Terminal Pro-B-type Natriuretic Peptide in Patients Referred to Coronary Angiography and Signs and Symptoms of Heart Failure and Preserved Ejection Fraction. Circulation - heart failure, 8(1), pp. 25-32. Lippincott Williams & Wilkins 10.1161/CIRCHEARTFAILURE.114.001478

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BACKGROUND Heart failure with preserved ejection fraction (HFpEF) represents a growing health burden associated with substantial mortality and morbidity. Consequently, risk prediction is of highest importance. Endothelial dysfunction has been recently shown to play an important role in the complex pathophysiology of HFpEF. We therefore aimed to assess von Willebrand factor (vWF), a marker of endothelial damage, as potential biomarker for risk assessment in patients with HFpEF. METHODS AND RESULTS Concentrations of vWF were assessed in 457 patients with HFpEF enrolled as part of the LUdwigshafen Risk and Cardiovascular Health (LURIC) study. All-cause mortality was observed in 40% of patients during a median follow-up time of 9.7 years. vWF significantly predicted mortality with a hazard ratio (HR) per increase of 1 SD of 1.45 (95% confidence interval, 1.26-1.68; P<0.001) and remained a significant predictor after adjustment for age, sex, body mass index, N-terminal pro-B-type natriuretic peptide (NT-proBNP), renal function, and frequent HFpEF-related comorbidities (adjusted HR per 1 SD, 1.22; 95% confidence interval, 1.05-1.42; P=0.001). Most notably, vWF showed additional prognostic value beyond that achievable with NT-proBNP indicated by improvements in C-Statistic (vWF×NT-proBNP: 0.65 versus NT-proBNP: 0.63; P for comparison, 0.004) and category-free net reclassification index (37.6%; P<0.001). CONCLUSIONS vWF is an independent predictor of long-term outcome in patients with HFpEF, which is in line with endothelial dysfunction as potential mediator in the pathophysiology of HFpEF. In particular, combined assessment of vWF and NT-proBNP improved risk prediction in this vulnerable group of patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Silbernagel, Günther

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1941-3289

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Catherine Gut

Date Deposited:

26 Feb 2015 11:12

Last Modified:

30 Oct 2015 07:54

Publisher DOI:

10.1161/CIRCHEARTFAILURE.114.001478

PubMed ID:

25342739

Uncontrolled Keywords:

diastolic heart failure, prognosis, von Willebrand factor

BORIS DOI:

10.7892/boris.63364

URI:

https://boris.unibe.ch/id/eprint/63364

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