Djuric Predrag, Mladenovic Zorica, Jovic Zoran, Vukotic Snjezana, Spasic Marijan, Mijuskovic Mirjana, Terzic Brankica, Radojicic Zoran, Radisavljevic Nina, Djuric Marko, Djuric Dragan
Clinic for Cardiology, Military Medical Academy, 11040 Belgrade, Serbia.
Clinic for Urgent Internal Medicine, Military Medical Academy, 11040 Belgrade, Serbia.
Biomedicines. 2025 Sep 17;13(9):2284. doi: 10.3390/biomedicines13092284.
Factor VIII (FVIII) and the von Willebrand factor (vWF) are key components of hemostatic balance. Disruption of the vWF-ADAMTS13 axis, characterized by elevated vWF and reduced ADAMTS13 activity has been implicated in thrombotic disorders, including COVID-19-asscoiated coagulopathy, where this imbalance correlates with disease severity and mortality. This study evaluated the relationship between plasma FVIII and vWF levels and the severity of coronary artery disease (CAD), as assessed by the SYNTAX score. We enrolled 82 patients with chronic coronary syndrome (CCS) and a positive treadmill test who underwent elective coronary angiography. Based on the SYNTAX score, patients were divided into three groups: Group I (≤22), Group II (23-32), and Group III (≥33). FVIII levels varied significantly (Group I: 2.25 ± 0.75; Group III: 2.97 ± 0.95; = 0.007), with an OR of 3.632 (95% CI: 1.116-11.826; = 0.03). vWF levels differed significantly across SYNTAX groups (Group I: 1.16 ± 0.59; Group II: 1.52 ± 0.62; Group III: 1.49 ± 0.80; = 0.040). vWF > 1.75 was more frequent in Groups II and III, with an odds ratio (OR) of 4.909 (95% CI: 1.429-16.864; = 0.01) for Group III vs. Group I. Fibrinogen and C-reactive protein (CRP) were elevated in patients with SYNTAX scores ≥33. In multinomial logistic regression analysis, FVIII emerged as the sole independent predictor of CAD complexity ( = 0.004), while the vWF showed significance in pairwise comparison (Group II vs. Group I; OR = 3.433, = 0.049). This study demonstrated significant differences in hemostatic and inflammatory biomarkers across SYNTAX score categories reflecting CAD severity in CCS patients. FVIII emerged as an independent predictor of CAD complexity, while the vWF demonstrated significant associations in specific subgroup comparisons. The observed vWF-ADAMTS13 axis dysregulation supports the rationale for investigating vWF-targeted therapeutics, including agents such as caplacizumab, in cardiovascular disease management. These findings require validation in larger studies.
凝血因子VIII（FVIII）和血管性血友病因子（vWF）是止血平衡的关键组成部分。以vWF升高和ADAMTS13活性降低为特征的vWF-ADAMTS13轴破坏与血栓形成性疾病有关，包括与COVID-19相关的凝血病，这种失衡与疾病严重程度和死亡率相关。本研究评估了血浆FVIII和vWF水平与冠状动脉疾病（CAD）严重程度之间的关系，CAD严重程度通过SYNTAX评分进行评估。我们纳入了82例慢性冠状动脉综合征（CCS）且平板运动试验阳性并接受选择性冠状动脉造影的患者。根据SYNTAX评分，患者分为三组：I组（≤22分）、II组（23 - 32分）和III组（≥33分）。FVIII水平差异显著（I组：2.25±0.75；III组：2.97±0.95；P = 0.007），比值比为3.632（95%置信区间：1.116 - 11.826；P = 0.03）。vWF水平在不同SYNTAX组间存在显著差异（I组：1.16±0.59；II组：1.52±0.62；III组：1.49±0.80；P = 0.040）。II组和III组中vWF>1.75更为常见，III组与I组相比比值比（OR）为4.909（95%置信区间：1.429 - 16.864；P = 0.01）。SYNTAX评分≥33的患者纤维蛋白原和C反应蛋白（CRP）升高。在多项逻辑回归分析中，FVIII成为CAD复杂性的唯一独立预测因子（P = 0.004），而vWF在两两比较中具有显著性（II组与I组比较；OR = 3.433，P = 0.049）。本研究表明，在反映CCS患者CAD严重程度的不同SYNTAX评分类别中，止血和炎症生物标志物存在显著差异。FVIII成为CAD复杂性的独立预测因子，而vWF在特定亚组比较中显示出显著关联。观察到的vWF-ADAMTS13轴失调支持了在心血管疾病管理中研究以vWF为靶点的治疗方法的理论依据，包括诸如卡帕单抗等药物。这些发现需要在更大规模的研究中进行验证。
