Elevated circulating levels of von Willebrand factor and D-dimer in patients with heart failure and mechanical prosthesis

Increased soluble platelet/endothelial cellular adhesion molecule-1 and osteonectin levels in patients with severe congestive heart failure. Independence of disease etiology, and antecedent aspirin therapy

BACKGROUND

Platelet-endothelial interactions modulated by adhesion molecules, may play an important role in the pathogenesis of congestive heart failure (CHF). Soluble levels of these molecules and platelet-derived substances are reportedly elevated in patients with CHF. However, no data are available on the plasma levels of Platelet/Endothelial Cell Adhesion Molecule-1 (PECAM-1), and platelet-derived osteonectin in this growing population.

METHODS AND RESULTS

Soluble levels by ELISA were prospectively determined in patients with severe CHF (n = 37) and correlated to etiology and antecedent aspirin use, and compared with 14 healthy control subjects. Left ventricular dysfunction was attributed to idiopathic dilated cardiomyopathy in 18 and coronary artery disease in 19 patients. Twenty-one patients were aspirin-free and 16 patients were using aspirin (81-500 mg daily). Elevated soluble PECAM-1 (51.31+/-2.44 ng/ml, P = 0.0001), and osteonectin (826.27+/-22.37 ng/ml, P = 0.0001) were observed in patients with CHF, as compared to healthy controls (32.56+/-1.21 ng/ml, and 478.02+/-31.32 ng/ml, respectively). Neither etiology of CHF, nor antecedent aspirin therapy significantly affects the levels of PECAM-1 or osteonectin.

CONCLUSIONS

Despite long-term aspirin therapy and independently of the etiology of the disease, soluble PECAM-1 and osteonectin were elevated in the majority of patients with severe CHF, suggesting platelet-endothelial activation. The present data provide additional evidence that more potent anti-platelet and endothelial preservation regimens deserve further study in the heart failure population.

Usefulness of soluble and surface-bound P-selectin in detecting heightened platelet activity in patients with congestive heart failure

P-selectin is an important marker of platelet activation and may be up-regulated in patients with congestive heart failure (CHF). We sought to prospectively compare simultaneously determined platelet and soluble P-selectin in patients with CHF and in healthy controls. Matched soluble levels by enzyme-linked immmunosorbent assay, and platelet-bound expression by whole blood flow cytometry of P-selectin were measured in 22 patients with CHF and compared with 14 healthy controls. Twelve patients were aspirin free and 10 patients were taking aspirin (81 to 500 mg/day). Patients with CHF had significantly elevated soluble P-selectin (186.6 +/- 82.7 ng/ml, p = 0.017) and more than twofold increased expression of platelet-bound P-selectin (9.58 +/- 7.16% of positive platelets, p = 0.021) compared with the P-selectin profile (102.6 +/- 29.0 ng/ml of plasma, and 4.06 +/- 1.21% of positive platelets, respectively) in controls. Aspirin therapy did not affect the P-selectin profile in patients with CHF. Despite antecedent aspirin therapy and interindividual variability of the P-selectin profile, soluble and platelet P-selectin were elevated in most patients with severe CHF, suggesting persistent platelet activation.