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Von Willebrand Factor Abnormalities in Severe Aortic Stenosis: Associations With Valve Structure, Hemodynamics and Changes After TAVI
Session:
Sessão de Posters 26 - Implantação transcateter da válvula aórtica (TAVI): desfechos, complicações e biomarcadores
Speaker:
Erivaldo Figueiredo Pires Andrade
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Erivaldo Figueiredo; Emanuel Oliveira; Catarina Amaral Marques; Ana Isabel Pinho; Catarina Faria; Isabel Miranda; Francisca Saraiva; Fábio Trindade; Marta Tavares Silva; Adelino Leite Moreira; Rui André Rodrigues; Carla Sousa
Abstract
<p><strong>Background:</strong><br /> Severe aortic stenosis promotes shear-mediated degradation of high–molecular-weight von Willebrand Factor (vWF) multimers, a key mechanism in Heyde’s syndrome. The contribution of anatomical narrowing, Doppler hemodynamics, and aortic valve calcium burden to this disruption remains uncertain. Prior studies report recovery of vWF multimers within 24–72 hours after relief of shear stress. Clarifying determinants of vWF loss and peri-procedural changes after TAVR may refine bleeding risk stratification.</p> <p><strong>Objectives:</strong><br /> To assess the relationship between anatomical severity, Doppler hemodynamics, and aortic valve calcium burden with shear-related vWF abnormalities, and to characterize peri-procedural vWF changes after TAVR.</p> <p><strong>Methods:</strong><br /> We retrospectively analysed prospectively collected data from consecutive patients undergoing TAVI (2022–2024). Total vWF and vWF multimer ratio were measured before and 48 hours after TAVR. Echocardiography provided AVA, indexed AVA, Vmax, and gradients; CT quantified aortic valve calcium by Agatston scoring. Associations were assessed with Spearman correlation. Differences in multimer ratio by AVA category (≤0.8 vs >0.8 cm²) were evaluated with the Mann–Whitney U test, and peri-procedural total vWF changes with the Wilcoxon signed-rank test.</p> <p><strong>Results:</strong><br /> Ninety-eight patients were included (mean age 78.9 ± 17.1 years, 68.2% women). Among 47 with paired samples, total vWF showed no significant peri-procedural change (76.9% vs 75.8%, p = 0.67). Neither baseline vWF nor its variation correlated with AVA, Vmax, gradients, or CT calcium burden (all p ≥ 0.10). Baseline multimer ratio showed no correlation with Doppler severity or calcific load (ρ ≤ 0.18), and AVA as a continuous measure was not associated with multimer ratio (ρ = 0.17, p = 0.12). However, AVA ≤ 0.8 cm² was associated with significantly lower multimer ratios (53.5 vs 58.0, p = 0.007). Doppler-defined severity did not discriminate multimer loss.</p> <p><strong>Conclusion:</strong><br /> In contrast to prior literature describing a strong and consistent association between aortic stenosis severity and shear-related loss of high-molecular-weight vWF multimers, our cohort demonstrated this pattern only in the most critically stenotic anatomies. Total vWF remained stable peri-procedurally, and the multimer ratio showed limited discriminatory value outside extreme disease. These findings suggest that, in contemporary TAVI candidates, shear-mediated vWF depletion may be less tightly aligned with conventional severity markers than previously reported, underscoring the need for larger studies to clarify its reliability as a biomarker of hemostatic vulnerability.</p>
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