Key result
Continuous-flow ventricular assist device implantation was associated with a 50% decrease in plasma vWF (P<0.01) and a 64% increase in ANGPT-2 (P<0.05) at 30 days post-implant.
Why the study?
Nonsurgical bleeding frequently occurs in patients with continuous-flow ventricular assist devices and is associated with nonphysiologic flow and diminished pulsatility.
Does diminished pulsatility from CF-VAD implantation alter levels of vWF and ANGPT-2?
Observational (n=15)
Does diminished pulsatility from CF-VAD implantation alter levels of vWF and ANGPT-2?
Effect estimate: 50% decrease
Absolute Event Rate: 22.49% vs 45.59%
p-value: p=<0.01
vWF and ANGPT-2 are sensitive biomarkers of diminished pulsatility in CF-VAD patients, which may help identify patients at high risk of nonsurgical bleeding.
Supports vWF and ANGPT-2 as pulsatility biomarkers in CF-VAD; leaves open human validation for bleeding risk prediction.
Nonsurgical bleeding occurs in a significant proportion of patients implanted with continuous-flow ventricular assist devices (CF-VADs) and is associated with nonphysiologic flow with diminished pulsatility. An in vitro vascular pulse perfusion model seeded with adult human aortic endothelial cells (HAECs) was used to identify biomarkers sensitive to changes in pulsatility. Diminished pulsatility resulted in an ~45% decrease in von Willebrand factor (vWF) levels from 9.80 to 5.32 ng/ml (n = 5, p < 0.05) and a threefold increase in angiopoietin-2 (ANGPT-2) levels from 775.29 to 2471.93 pg/ml (n = 5, p < 0.05) in cultured HAECs. These changes are in agreement with evaluation of patient blood samples obtained pre-CF-VAD implant and 30-day postimplant: a decrease in plasma vWF level by 50% from ~45.59 to ~22.49 μg/ml (n = 15, p < 0.01) and a 64% increase in plasma ANGPT-2 level from 7,073 to 11,615 pg/ml (n = 8, p < 0.05). This study identified vWF and ANGPT-2 as highly sensitive to changes in pulsatility, in addition to interleukin-6 (IL-6), IL-8, and tumor necrosis-α (TNF-α). These biomarkers may help determine the optimal level of pulsatility and help identify patients at high risk of nonsurgical bleeding.
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Nguyen et al. (2023) conducted an observational in Continuous-flow ventricular assist device (CF-VAD) implantation (n=15). Continuous-flow ventricular assist device (CF-VAD) implantation vs. Pre-CF-VAD implant was evaluated on Plasma von Willebrand factor (vWF) level (μg/ml) (50% decrease, p=<0.01). Continuous-flow ventricular assist device implantation was associated with a 50% decrease in plasma vWF (P<0.01) and a 64% increase in ANGPT-2 (P<0.05) at 30 days post-implant.
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