title: Von Willebrand factor is associated with atrial fibrillation development in ischaemic patients after cardiac surgery.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is associated with an increased morbidity and mortality after cardiac surgery. Von Willebrand factor (vWF) has been proposed as a biomarker of endothelial damage/dysfunction. We hypothesized that vWF levels could be used as valuable biomarker for AF occurrence after cardiac surgery. Moreover, we explored the potential association between vWF and tissue remodelling as possible implication in post-surgical AF.
  
  
  RESULTS
  We prospectively recruited 100 consecutive patients who undergoing programmed cardiac surgery with cardiopulmonary bypass and with no previous history of AF. Plasma vWF levels were determined from citrated plasma samples. Right atrial appendage tissue was obtained during cardiac surgery, and vWF expression as well as interstitial fibrosis was analysed by immunostaining and Masson's trichrome, respectively. We found raised vWF plasma levels in ischaemic vs. valvular patients (200.2 ± 66.3 vs. 157.2 ± 84.3 IU/dL; P = 0.015). Fibrosis degree was associated with plasma vWF levels. Plasma vWF was an independent prognostic marker for AF development in ischaemic patients [odds ratio, OR 6.44 (95% confidence interval, CI 1.40-36.57), P = 0.035].
  
  
  CONCLUSIONS
  Plasma vWF levels are associated with tissue fibrosis in patients undergoing cardiac surgery and with post-surgical AF development in ischaemic patients. These findings suggest an association among vWF levels, atrial remodelling, and AF development. It is supported by higher vWF expression in right atrial tissue in ischaemic patients, who developed post-surgical AF.
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain dianahr@um.es.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Romero
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Lahoz
authors.affiliation: Hematology and Medical Oncology Unit, Hospital Universitario Morales Meseguer, University of Murcia, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldan
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Jover
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Romero-Aniorte
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Martinez
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Jara-Rubio
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Arribas
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Arcadio
authors.initials: A
authors.lastname: Garcia-Alberola
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cánovas
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Department of Cardiology, University Clinic Hospital Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000473:pathology; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D064752:Atrial Remodeling; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis; D006349:Heart Valve Diseases / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014841:von Willebrand Factor
keywords: Aortic valve replacement; Atrial fibrillation; CABG; Coronary artery bypass grafts; Endothelium; Fibrosis