{"id":"ab50bd624def","type":"article","url":"https://hartvaat.nl/2026/10/15/vwf-biomarkers-als-aanvulling-op-beeldvorming-bij-prostetische-klepdisfunctie/","title":"VWF-biomarkers als aanvulling op beeldvorming bij prostetische klepdisfunctie","title_en":"Von Willebrand Factor Biomarkers in Prosthetic Valve Dysfunction: An Adjunct to Imaging and Hemodynamic Assessment.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Cardiology in review","doi":"10.1097/CRD.0000000000001496","source_url":"https://doi.org/10.1097/CRD.0000000000001496","authors":["Sameed Arshad","Sabir Khan","Muhammad Zahid"],"significance":5,"published":"2026-10-22","source_date":"2026-10-15","image":"https://hartvaat.nl/global/img/6e2cc0469790.webp","kennis":["https://hartvaat.nl/kennis/kleplijden/kleplijden-en-zwangerschap/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This narrative review evaluates von Willebrand factor (VWF) biomarkers as an adjunct to imaging for assessing prosthetic valve dysfunction, particularly paravalvular regurgitation after TAVR or mitral repair. High shear stress triggers VWF unfolding and proteolysis, measurable via multimer analysis and the VWF activity-to-antigen ratio, which correlate with residual leak and bleeding risk in observational cohorts. However, evidence remains limited to small, single-center studies without independent threshold validation or outcome-driven trials. Consequently, VWF testing is best reserved as an investigational tool when imaging and clinical findings are discordant, rather than for routine surveillance or guideline-directed management.","created":"2026-10-16T01:05:12Z","updated":"2026-10-16T01:05:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narrative review bespreekt de potentiële rol van von Willebrandfactor (VWF)-biomarkers als aanvulling op beeldvorming bij het monitoren van prostetische hartklepdisfunctie. Bij hoge schuifspanningen, zoals bij paravalkleppend regurgitatie na TAVR of mitraliskleprepair, wordt VWF afgebroken, wat meetbaar is via multimeranalyse en de VWF-activiteit/antigeen-ratio Hoewel prospectieve studies aantonen dat deze biomarkers correleren met residuele lekkage en bloedingen, blijft het bewijs observatiegebonden en ontbreekt validatie voor routinematig gebruik. VWF-testen worden daarom gepositioneerd als een onderzoeksinstrument bij discordante beeldvorming of onverklaarde bloedingen, niet als vervanger voor richtlijnconforme echocardiografie.","abstract_original":"Imaging remains the foundation of prosthetic valve surveillance because it identifies valve morphology, lesion mechanism, and hemodynamic severity. However, acoustic shadowing, eccentric or multiple regurgitant jets, loading conditions, and reader variability can complicate assessment, particularly for paravalvular regurgitation after transcatheter aortic valve replacement. High shear stress unfolds von Willebrand factor (VWF), promotes proteolysis of its high-molecular-weight multimers, and produces a measurable defect in primary hemostasis. Multimer analysis, closure time with adenosine diphosphate (CT-ADP), and the VWF activity-to-antigen ratio therefore provide a biologic signal of abnormal flow rather than an anatomic image. Prospective studies show that VWF abnormalities track residual paravalvular regurgitation during transcatheter aortic valve replacement, occur with dysfunctional prostheses, change after mitral paravalvular-leak repair, and are associated with bleeding. The evidence nevertheless remains observational; most diagnostic cohorts are small and single-center, thresholds lack independent validation, assays are vulnerable to hematologic and preanalytic confounding, and no completed randomized trial has shown that VWF-guided management improves outcomes. VWF testing is best viewed as an investigational adjunct when imaging and the clinical picture are discordant or when prosthetic dysfunction coexists with otherwise unexplained bleeding. It should not replace guideline-directed echocardiography or be used for routine surveillance outside research protocols."}