Department of Internal Medicine II, University Medical Center, Regensburg, Germany.
Department of Clinical Chemistry and Laboratory Medicine, University Medical Center, Regensburg, Germany.
Clin Res Cardiol. 2022 Dec;111(12):1348-1357. doi: 10.1007/s00392-022-02047-6. Epub 2022 Jul 15.
Aortic stenosis (AS) can cause acquired von Willebrand syndrome (AVWS) and valve replacement has been shown to lead to von Willebrand factor (vWF) recovery. The aim of the current study was to investigate the prevalence of AVWS in different severe AS phenotypes and its course after transcatheter aortic valve implantation (TAVI).
143 patients with severe AS undergoing TAVI were included in the study. vWF function was assessed at baseline, 6 and 24 h after TAVI. AVWS was defined as a reduced vWF:Ac/Ag ratio ≤ 0.7. Phenotypes were classified by tricuspid (TAV) and bicuspid (BAV) valve morphology, mean transvalvular gradient (P), stroke volume index (SVI), ejection fraction (EF) and indexed effective orifice area (iEOA).
AVWS was present in 36 (25.2%) patients before TAVI. vWF:Ac/Ag ratio was significantly lower in high gradient compared to low-gradient severe AS [0.78 (IQR 0.67-0.86) vs. 0.83 (IQR 0.74-0.93), p < 0.05] and in patients with BAV compared to TAV [0.70 (IQR 0.63-0.78) vs. 0.81 (IQR 0.71-0.89), p < 0.05]. Normalization of vWF:Ac/Ag ratio was achieved in 61% patients 24 h after TAVI. As in the overall study cohort, vWF:Ac/Ag ratio increased significantly in all severe AS subgroups 6 h after TAVI (each p < 0.05). Regarding binary logistic regression analysis, BAV was the only significant predictor for AVWS.
BAV morphology is a strong predictor for AVWS in severe AS. TAVI restores vWF function in most patients with severe AS independently of AS phenotype and valve morphology.
主动脉瓣狭窄（AS）可导致获得性血管性血友病（AVWS），瓣膜置换已被证明可导致血管性血友病因子（vWF）恢复。本研究旨在探讨不同严重 AS 表型中 AVWS 的患病率及其经导管主动脉瓣植入（TAVI）后的病程。
研究纳入 143 例接受 TAVI 的严重 AS 患者。在 TAVI 前、后 6 和 24 小时评估 vWF 功能。AVWS 的定义为 vWF：Ag 比值降低至≤0.7。根据三尖瓣（TAV）和二叶瓣（BAV）瓣膜形态、平均跨瓣梯度（P）、每搏输出量指数（SVI）、射血分数（EF）和有效瓣口面积指数（iEOA）对表型进行分类。
TAVI 前 36 例（25.2%）患者存在 AVWS。高梯度组的 vWF：Ag 比值明显低于低梯度严重 AS 组[0.78（IQR 0.67-0.86）比 0.83（IQR 0.74-0.93），p<0.05]，且 BAV 组明显低于 TAV 组[0.70（IQR 0.63-0.78）比 0.81（IQR 0.71-0.89），p<0.05]。TAVI 后 24 小时 61%的患者 vWF：Ag 比值恢复正常。与整个研究队列一样，TAVI 后 6 小时所有严重 AS 亚组的 vWF：Ag 比值均显著增加（p 均<0.05）。关于二项逻辑回归分析，BAV 是 AVWS 的唯一显著预测因子。
BAV 形态是严重 AS 中 AVWS 的强烈预测因子。TAVI 可恢复大多数严重 AS 患者的 vWF 功能，与 AS 表型和瓣膜形态无关。
