Abstract 14402: Elevated Plasma Von Willebrand Factor (vWF) Level Predicts Left Atrial Appendage Dysfunction in Patients With Cardioembolic Stroke
It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. As shown in the Virchow's triad, low blood flow, hypercoagulable state, and endothelial dysfunction, are important factors for thrombus formation. von Willebrand factor (vWF) is an established marker of endothelial damage and dysfunction. It was reported that increased plasma vWF level predicts presence of LAA thrombus in non-valvular atrial fibrillation. However, it remains determined whether increased vWF level is associated with LAA thrombus and LAA dysfunction in patients with acute ischemic stroke. We hypothesized that increased vWF level is a sensitive predictor for LAA dysfunction and LAA thrombus formation. Transthoracic and transesophageal echocardiography were performed and plasma vWF levels were measured in 204 consecutive patients (age 70 ± 13 years) within 7 days after the onset of acute ischemic stroke. Plasma vWF levels were significantly correlated with LAA emptying flow velocity (LAA eV), left atrial volume index (LAVI), and left atrial ejection fraction (LAEF) (LAA eV, r=0.62, p<0.01; LAVI, r=0.76, p<0.01; LAEF, r=0.37, p<0.01). Plasma vWF levels were increased with advancing CHADS2 score. Plasma vWF levels were higher in patients with cardioembolic stroke compared with those without (230% ± 66 vs. 189% ± 74, p<0.05). Among patients with cardioembolic stroke, plasma vWF levels were significantly higher in patients with cardioembolic stroke caused by LAA thrombus (cardiogenic stroke group) than in those without it (cryptogenic stroke group) (237% ± 68 vs. 140% ± 52, p<0.01). Multivariate logistic regression analysis showed that plasma vWF >183 % was an independent predictor of cardiogenic stroke (odds ratio 4.73, 95% confidence interval 1.09-25.7; p<0.05). Elevated plasma vWF levels may be a reliable surrogate marker for LAA dysfunction and cardiogenic stroke.
- © 2011 by American Heart Association, Inc.