title: Prognostic role of plasma von Willebrand factor and soluble E-selectin levels for future cardiovascular events in a 'real-world' community cohort of patients with atrial fibrillation.
abstract: BACKGROUND
  Endothelial damage/dysfunction may contribute to a prothrombotic state in patients with atrial fibrillation (AF) and the increased risk of thromboembolism and cardiovascular events. Raised plasma von Willebrand factor (vWf), an established marker of endothelial damage/dysfunction, has been associated with stroke and vascular events, at least in a clinical trial population. Soluble E-selectin (sE-sel) is another biomarker of endothelial activation/dysfunction, with more limited data on prognostic outcomes in AF.
  
  
  OBJECTIVE
  To assess the relationship between the levels of vWf, sE-sel and clinical adverse outcomes (including stroke, MI and all-cause mortality) in a 'real-world' community cohort of patients with AF.
  
  
  METHODS
  We studied 423 patients (mean age 72·7 ± 8·4 years, 55·6% male) with nonvalvular AF, with a median follow-up of 19 (9-31) months. Plasma vWf and sE-sel levels were measured using enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  There were 94 clinical adverse events (22·2%) observed during a median follow-up of 19 months. Patients with clinical events had significantly higher vWf (P < 0·001) and sE-sel levels at baseline (P < 0·001) compared with those who were event free. Kaplan-Meir analyses demonstrated that more clinical adverse events occurred in the upper tertile of vWf [upper vs. lowest tertile, RR 3·8, 95% CI (2·63-5·57), P < 0·001; upper vs. middle tertile, RR 10·5, 95% CI (5·33-20·60), P < 0·001]. Similarly, the highest tertile of sE-sel was associated with more adverse events [upper vs. lowest tertile, RR 3·7, 95% CI (2·51-5·31), P < 0·001; upper vs. middle tertile, RR 6·5, 95% CI (3·56-11·91), P < 0·001].
  
  
  CONCLUSIONS
  High plasma vWf and soluble E-selectin levels are associated with an increased risk of clinical adverse events (acute myocardial infarction, ischaemic stroke and all-cause mortality) in 'real-world' patients with AF. These soluble biomarkers may potentially aid clinical risk stratification in this common arrhythmia.
authors: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors: Suresh
authors: S
authors: Krishnamoorthy
authors: Chee Wah
authors: CW
authors: Khoo
authors: Hoong S
authors: HS
authors: Lim
authors: Deirdre A
authors: DA
authors: Lane
authors: Pasquale
authors: P
authors: Pignatelli
authors: Stefania
authors: S
authors: Basili
authors: Francesco
authors: F
authors: Violi
authors: Gregory Y H
authors: GY
authors: Lip
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000401:mortality; D019040:E-Selectin / Q000378:metabolism*; D004730:Endothelium, Vascular / Q000502:physiology*; D004797:Enzyme-Linked Immunosorbent Assay; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D020521:Stroke / Q000209:etiology / Q000401:mortality; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D019040:E-Selectin; D014841:von Willebrand Factor
keywords: Atrial fibrillation; endothelial dysfunction; von Willebrand factor