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Ozkan U, Ozcelik F, Yildiz M, Budak M. Lipoprotein(a) Gene Polymorphism Increases a Risk Factor for Aortic Valve Calcification. J Cardiovasc Dev Dis 2019; 6:jcdd6030031. [PMID: 31455005 PMCID: PMC6787733 DOI: 10.3390/jcdd6030031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/24/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is a multifactorial condition. Both environmental and genetic factors play an important role in its etiology. CAVD exhibits a broad spectrum, varying from mild valve thickening to severe valve calcification and stenosis. Progression of the disease consists of chronic inflammation, lipoprotein deposition, and active leaflet calcification. It is a process similar to coronary artery disease. In this study, we investigated Lp(a) levels and gene polymorphisms associated with calcific aortic stenosis from blood samples after echocardiography in the evaluation of 75 patients diagnosed with CAVD and 77 controls. Blood tests were run in our laboratory to rule out certain risk factors before echocardiography examination. A significant association among smoking, elevated LDL level and creatinine, low albumin levels, Lp(a) level, rs10455872, and rs3798220 polymorphisms may be considered genetic risk factors for the development of calcific aortic stenosis.
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Affiliation(s)
- Ugur Ozkan
- Department of Cardiology, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
- Department of Cardiology, Edirne Sultan 1. Murat State Hospital, 22030 Edirne, Turkey
| | - Fatih Ozcelik
- Department of Cardiology, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
| | - Mustafa Yildiz
- Department of Biophysics, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Metin Budak
- Department of Biophysics, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
- Molecular Research Lab, Prof. Mirko Tos Ear and Hearing Research Center, Trakya University,22030 Edirne, Turkey
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2
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Akin I, Nienaber CA. Is there evidence for statins in the treatment of aortic valve stenosis? World J Cardiol 2017; 9:667-672. [PMID: 28932355 PMCID: PMC5583539 DOI: 10.4330/wjc.v9.i8.667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/21/2017] [Accepted: 06/06/2017] [Indexed: 02/06/2023] Open
Abstract
Research revealed that the pathogenesis of aortic stenosis (AS) not merely comprises of a mechanical wear and tear process yet that active biological processes, similar to those of coronary artery disease are involved, a promising role for statins in disease-modifying therapy was suggested. However, recently, many prospective studies could not observe decreased progression nor regression of the disease. Here, we review the current knowledge on the pathomechanisms of AS and its similarities and differences with atherosclerosis. Moreover, we discuss whether there is still a place for statins in the treatment of particular AS patient subgroups.
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Affiliation(s)
- Ibrahim Akin
- Medical Faculty Mannheim, University Heidelberg, 68167 Mannheim, Germany
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3
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Kaplan S, Aronow WS, Lai H, Dilmanian H, Deluca AJ, Weiss MB, Belkin RN. Patients with echocardiographic aortic valve calcium or mitral annular calcium have an increased prevalence of moderate or severe coronary artery calcium diagnosed by cardiac computed tomography. Int J Angiol 2012; 16:45-6. [PMID: 22477269 DOI: 10.1055/s-0031-1278245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The association between aortic valve calcium (AVC) and mitral annular calcium (MAC), as diagnosed by two-dimensional echocardiography, was investigated in 138 patients (76 women and 62 men, mean age 64±8 years) seen in a private cardiology practice at the New York Medical College. Coronary artery calcium (CAC) scores were diagnosed by 64-multislice computed tomography. AVC was present in 25 of 57 patients (44%) with moderate or severe CAC (a CAC score of more than 100) and in 15 of 81 patients (19%) with no or mild CAC (a CAC score of 0 to 100), P<0.001. Moderate or severe AVC was present in nine of 57 patients (16%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.005. MAC was present in 18 of 57 patients (32%) with moderate or severe CAC, and in seven of 81 patients (9%) with no or mild CAC, P<0.001. Moderate or severe MAC was present in eight of 57 patients (14%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.001.
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Affiliation(s)
- Sarah Kaplan
- Department of Medicine, Cardiology Division, New York Medical College, Valhalla, New York, USA
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4
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de Lorgeri M, Salen P. Recent cholesterol-lowering drug trials: New data, new questions. ACTA ACUST UNITED AC 2010. [DOI: 10.4010/jln.19.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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5
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Sá MPBDO, Gomes RAF, Calado Filho I, Medeiros A, Gonçalves A. Estenose aórtica severa em idosos: avaliação clínica, eletrocardiográfica, ecocardiográfica e angiográfica. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2009. [DOI: 10.1590/1809-9823.200912015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivos: Analisar o perfil clínico e laboratorial de idosos portadores de estenose aórtica severa e possíveis diferenças entre os sexos. Método: Foram estudados 30 pacientes (18 homens e 12 mulheres), com média de idade de 70,7±5,3 anos, portadores de estenose aórtica acentuada, sendo avaliados quanto a sintomas clínicos, presença de fatores de risco, padrões eletrocardiográficos, ecocardiográficos e associação com doença arterial coronariana, pela realização de angiografia coronariana. Resultados: Dispnéia foi o sintoma mais frequente (40%). Mulheres tinham mais angina que os homens. Apenas dois pacientes tinham fração de ejeção baixa. Homens apresentaram menores frações de ejeção que mulheres (p<0,05). Houve alta prevalência (53,3%) de doença arterial coronariana associada através de coronariografia. Conclusões: Os achados de dispnéia como sintoma mais frequente no grupo total, diferença da frequência de sintomas entre os sexos e fração de ejeção menor nos homens sugeriram que os mecanismos de adaptação ventricular à estenose aórtica possam ser diferentes entre os sexos. Existe forte associação entre estenose aórtica senil calcificada e doença arterial coronariana em idosos.
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6
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Geist V, Sherif MA, Khattab AA. Successful percutaneous coronary intervention after implantation of a CoreValve percutaneous aortic valve. Catheter Cardiovasc Interv 2009; 73:61-7. [PMID: 19089940 DOI: 10.1002/ccd.21744] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The association between aortic valve disease and coronary atherosclerosis is common. In the recent era of percutaneous aortic valve replacement (PAVR), there is little experience with coronary artery intervention after valve implantation. CASE REPORT To our knowledge, this is the first case of successful percutaneous coronary intervention after implantation of a CoreValve percutaneous aortic valve. We report a case of a 79-year-old female patient who underwent successful coronary artery intervention few months after a CoreValve's percutaneous implantation for severe aortic valve stenosis. Verifying the position of the used wires (crossing from inside the self expanding frame) is of utmost importance before proceeding to coronary intervention. In this case, crossing the aortic valve, coronary angiography, and multivessel stenting were successfully performed. CONCLUSION Percutaneous coronary intervention in patients with previous CoreValve is feasible and safe.
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Affiliation(s)
- Volker Geist
- Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, The Academic Teaching Hospital for the University of Kiel, Bad Segeberg, Germany
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7
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Chui MC, Newby DE, Panarelli M, Bloomfield P, Boon NA. Association between calcific aortic stenosis and hypercholesterolemia: is there a need for a randomized controlled trial of cholesterol-lowering therapy? Clin Cardiol 2009; 24:52-5. [PMID: 11195607 PMCID: PMC6655077 DOI: 10.1002/clc.4960240109] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Calcific aortic stenosis may have common etiological factors with atherosclerosis. HYPOTHESIS In this retrospective, case-control study, we aimed to determine whether there is an association between hypercholesterolemia and calcific aortic valve stenosis. METHODS Consecutive patients undergoing single aortic or mitral valve replacement in a regional cardiothoracic surgical center were reviewed and preoperative patient characteristics were recorded: demographics, comorbidity (including coronary artery disease and associated risk factors), serum total cholesterol, lipid-lowering therapy, and serum creatinine. RESULTS Serum total cholesterol concentrations were significantly higher in patients with calcific aortic stenosis than in controls (6.2+/-1.1 vs. 5.3+/-1.1 mmol/l; p < 0.001). The significant difference in serum cholesterol concentrations remained following correction for gender and body mass index (p = 0.02) and when patients with coronary artery disease were excluded (6.3+/-1.1 vs. 5.3+/-1.4 mmol/l; p<0.001). Subgroup analysis demonstrated that the association between elevated serum cholesterol concentrations and calcific aortic stenosis was particularly strong in patients with tricuspid aortic valves (6.4+/-1.2 vs. 5.3+/-1.1 mmol/l; p < 0.001) compared with those with bicuspid valves (5.9+/-1.1 vs. 5.3+/-1.1 mmol/l; p = 0.06). CONCLUSIONS We conclude that hypercholesterolemia is associated with calcific aortic stenosis and may be implicated in its pathogenesis and progression. We believe that there is now a need for a randomized, controlled trial of cholesterol-lowering therapy in patients with calcific aortic stenosis.
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Affiliation(s)
- M C Chui
- Department of Cardiology, Royal Infirmary, Edinburgh, Scotland, UK
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8
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Imai K, Okura H, Kume T, Yamada R, Miyamoto Y, Kawamoto T, Watanabe N, Neishi Y, Toyota E, Yoshida K. C-Reactive protein predicts severity, progression, and prognosis of asymptomatic aortic valve stenosis. Am Heart J 2008; 156:713-8. [PMID: 18926152 DOI: 10.1016/j.ahj.2008.04.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 04/14/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND C-Reactive protein (CRP) has been shown to play a pivotal role in the pathogenesis of atherosclerosis progression. The aim of this study was to assess whether CRP predicts severity, progression, and prognosis of aortic valve stenosis (AS). METHODS One hundred and thirty-five patients with asymptomatic AS were studied. Patients were diagnosed as mild (n = 18, aortic valve area [AVA] > or =1.5 cm(2)), moderate (n = 57, AVA 1.0-1.49 cm(2)), or severe AS (n = 60, AVA <1.0 cm(2)) by Doppler echocardiography. Patients with serial (baseline and at 1 year) echocardiographic examination (n = 47) were grouped as either slow (n = 22, DeltaAVA <-0.15 cm(2)/y) or rapid progression group (n = 25, DeltaAVA > or =-0.15 cm(2)/y). In addition, long-term prognosis was compared between patients with low CRP (n = 68, CRP <0.15 mg/dL) and those with high CRP (n = 67, CRP > or =0.15 mg/dL). RESULTS Baseline CRP was significantly higher in patients with severe AS than in those with mild or moderate AS (mild AS 0.17 +/- 0.43, moderate AS 0.22 +/- 0.28, severe AS 0.53 +/- 0.66 mg/dL, P = .001). By multivariate logistic regression analysis, CRP was an independent predictor of severe AS (odds ratio 3.51, P = .015). Similarly, CRP was significantly higher in the rapid progression group than in the slow progression group (0.56 +/- 0.76 vs 0.19 +/- 0.25 mg/dL, P = .004). Furthermore, long-term survival was significantly lower in the high CRP group than in the low CRP group (log rank: P < .001). CONCLUSION C-Reactive protein predicts severity, progression, and prognosis in patients with asymptomatic AS.
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9
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Roberts WC, Fye WB. William Clifford Roberts, MD: An Interview by W. Bruce Fye, MD. Proc (Bayl Univ Med Cent) 2007; 20:269-92. [PMID: 17637883 PMCID: PMC1906578 DOI: 10.1080/08998280.2007.11928302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Nozue T, Kawashiri MA, Higashikata T, Nohara A, Inazu A, Kobayashi J, Koizumi J, Yamagishi M, Mabuchi H. Cholesterol-years score is associated with development of senile degenerative aortic stenosis in heterozygous familial hypercholesterolemia. J Atheroscler Thromb 2007; 13:323-8. [PMID: 17192697 DOI: 10.5551/jat.13.323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We retrospectively evaluated the frequency and identified the factors associated with the development of aortic stenosis (AS) in 96 patients with heterozygous familial hypercholesterolemia (FH). The frequency of AS was 31% (4/13) and that of critical stenosis was 15% (2/13) in older patients over the age of 70 years. All 4 patients with AS were female aged more than 70 years who were diagnosed with FH when aged more than 60 years. There were no significant differences in conventional coronary risk factors; however, the age at cardiac catheterization, age at diagnosis of FH and the cholesterol-years score (CYS) with AS were significantly higher than those without AS (p=0.006, p=0.017, p=0.021, respectively). In multiple regression analysis, CYS was a significant independent predictor for the development of AS (p=0.037) in 13 older patients over the age of 70 years. These results suggest that physicians should be aware that AS needs attention in older patients with heterozygous FH, especially women who have been diagnosed late in life and those who have been inadequately treated.
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Affiliation(s)
- Tsuyoshi Nozue
- Molecular Genetics of Cardiovascular Disorders, Division of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University, Japan.
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11
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Messika-Zeitoun D, Bielak LF, Peyser PA, Sheedy PF, Turner ST, Nkomo VT, Breen JF, Maalouf J, Scott C, Tajik AJ, Enriquez-Sarano M. Aortic Valve Calcification. Arterioscler Thromb Vasc Biol 2007; 27:642-8. [PMID: 17185617 DOI: 10.1161/01.atv.0000255952.47980.c2] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Aortic valve calcification (AVC) is considered degenerative. Recent data suggested links to atherosclerosis or coronary disease (CAD).
Methods and Results—
AVC and coronary artery calcifications (CAC) were prospectively assessed by Electron-Beam-Computed-Tomography in 262 population-based research participants ≥60 years. AVC was frequent (27%) with aging (
P
<0.01) and in men (
P
<0.05). AVC was associated with diabetes, hypertension, higher body-mass-index, and serum glucose (all
P
<0.05). AVC was a marker of higher prevalence (
P
<0.01) and severity of CAD (CAC score: 441±802 versus 265±566,
P
<0.05) independently of age. After follow-up of 3.8±0.9 years, AVC score increased (94±271 versus 54±173,
P
<0.01, +11±32 U/year), faster with higher baseline AVC score (
P
<0.01). Compared with participants remaining free of AVC, de novo acquisition of AVC was associated with higher LDL-cholesterol (141±31 versus 121±27 mg/dL,
P
<0.05) and faster CAC progression (+78±87 versus +28±47 U/year,
P
<0.05). In multivariate analysis, LDL-cholesterol independently determined AVC acquisition while higher baseline AVC scores determined faster progression of existing AVC.
Conclusion—
In the population, AVC is frequent with aging and atherosclerotic risk factors. AVC is a marker of subclinical CAD. AVC is progressive, appearing de novo with progressive atherosclerosis whereas established AVC progresses independently of atherosclerotic risk factors and faster with increasing initial AVC loads.
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Affiliation(s)
- David Messika-Zeitoun
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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12
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Li YB, Hu CL, Liu J, Tang QZ, Huang CX. Calcific aortic valve disease should not be considered as a degenerative disease anymore. Med Hypotheses 2007; 68:1233-5. [PMID: 17011715 DOI: 10.1016/j.mehy.2006.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 07/29/2006] [Indexed: 10/24/2022]
Abstract
Calcific aortic valve disease is common among the elderly. Until recently, the concept that calcific aortic valve disease is a degenerative and unmodifiable process basically induced by long-lasting mechanical stress was generally accepted. However calcific aortic valve disease is not merely related to age-associated "wear and tear". The development and progression of calcific aortic valve disease are based on an active process that shares a number of similarities with atherosclerosis. Statins and angiotensin-converting enzyme inhibitors have been shown to slow calcium accumulation in aortic valves. Thus, calcific aortic valve disease should not be considered as a degenerative disease anymore.
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Affiliation(s)
- Yan Bo Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China
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13
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Cowell SJ, Newby DE, Prescott RJ, Bloomfield P, Reid J, Northridge DB, Boon NA. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med 2005; 352:2389-97. [PMID: 15944423 DOI: 10.1056/nejmoa043876] [Citation(s) in RCA: 731] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Calcific aortic stenosis has many characteristics in common with atherosclerosis, including hypercholesterolemia. We hypothesized that intensive lipid-lowering therapy would halt the progression of calcific aortic stenosis or induce its regression. METHODS In this double-blind, placebo-controlled trial, patients with calcific aortic stenosis were randomly assigned to receive either 80 mg of atorvastatin daily or a matched placebo. Aortic-valve stenosis and calcification were assessed with the use of Doppler echocardiography and helical computed tomography, respectively. The primary end points were change in aortic-jet velocity and aortic-valve calcium score. RESULTS Seventy-seven patients were assigned to atorvastatin and 78 to placebo, with a median follow-up of 25 months (range, 7 to 36). Serum low-density lipoprotein cholesterol concentrations remained at 130+/-30 mg per deciliter in the placebo group and fell to 63+/-23 mg per deciliter in the atorvastatin group (P<0.001). Increases in aortic-jet velocity were 0.199+/-0.210 m per second per year in the atorvastatin group and 0.203+/-0.208 m per second per year in the placebo group (P=0.95; adjusted mean difference, 0.002; 95 percent confidence interval, -0.066 to 0.070 m per second per year). Progression in valvular calcification was 22.3+/-21.0 percent per year in the atorvastatin group, and 21.7+/-19.8 percent per year in the placebo group (P=0.93; ratio of post-treatment aortic-valve calcium score, 0.998; 95 percent confidence interval, 0.947 to 1.050). CONCLUSIONS Intensive lipid-lowering therapy does not halt the progression of calcific aortic stenosis or induce its regression. This study cannot exclude a small reduction in the rate of disease progression or a significant reduction in major clinical end points. Long-term, large-scale, randomized, controlled trials are needed to establish the role of statin therapy in patients with calcific aortic stenosis.
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Affiliation(s)
- S Joanna Cowell
- Department of Cardiology, Royal Infirmary, Edinburgh, United Kingdom
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14
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Varma R, Aronow WS, McClung JA, Garrick R, Vistainer PF, Weiss MB, Belkin RN. Prevalence of valve calcium and association of valve calcium with coronary artery disease, atherosclerotic vascular disease, and all-cause mortality in 137 patients undergoing hemodialysis for chronic renal failure. Am J Cardiol 2005; 95:742-3. [PMID: 15757600 DOI: 10.1016/j.amjcard.2004.11.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 10/25/2022]
Abstract
Of 137 patients (mean age 63 years) who underwent hemodialysis for chronic renal failure, 65 (47%) had mitral valve calcium, mitral annular calcium, or aortic valve calcium. Thirty-eight of 65 patients (59%) who had valve calcium died at 3.5-year follow-up versus 21 of 72 patients (29%) who did not have valve calcium and who died at 4.3-year follow-up (p = 0.0005).
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Affiliation(s)
- Raja Varma
- Department of Medicine, Cardiology and Renal Divisions, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA
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15
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Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation 2005; 111:920-5. [PMID: 15710758 DOI: 10.1161/01.cir.0000155623.48408.c5] [Citation(s) in RCA: 612] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aortic valve stenosis (with or without aortic regurgitation and without associated mitral stenosis) in adults in the Western world has been considered in recent years to most commonly be the result of degenerative or atherosclerotic disease. METHODS AND RESULTS We examined operatively excised, stenotic aortic valves from 932 patients aged 26 to 91 years (mean+/-SD, 70+/-12), and none had associated mitral valve replacement or evidence of mitral stenosis: A total of 504 (54%) had congenitally malformed valves (unicuspid in 46 [unicommissural in 42; acommissural in 4] and bicuspid in 458); 417 (45%) had tricuspid valves (either absent or minimal commissural fusion); and 11 (1%) had valves of undetermined type. It is likely that the latter 11 valves also had been congenitally malformed. Of the 584 men, 343 (59%) had either a unicuspid or a bicuspid valve; of the 348 women, 161 (46%) had either a unicuspid or a bicuspid aortic valve. CONCLUSIONS The data from this large study of adults having isolated aortic valve replacement for aortic stenosis (with or without associated aortic regurgitation) and without associated mitral stenosis or mitral valve replacement strongly suggest that an underlying congenitally malformed valve, at least in men, is more common than a tricuspid aortic valve.
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Affiliation(s)
- William C Roberts
- Baylor Heart and Vascular Institute and the Department of Pathology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246, USA.
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16
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Pérez Cabeza AI, Gómez Doblas JJ, Morcillo Hidalgo L, Cabrera Bueno F, Jiménez Navarro MF, López Salguero R, Rodríguez Bailón I, de Teresa Galván E. Disfunción ventricular sistólica, un nuevo marcador de enfermedad coronaria en pacientes con estenosis aórtica sin infarto de miocardio previo. Rev Esp Cardiol 2005. [DOI: 10.1157/13071896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Yilmaz MB, Guray U, Guray Y, Cihan G, Caldir V, Cay S, Kisacik HL, Korkmaz S. Lipid profile of patients with aortic stenosis might be predictive of rate of progression. Am Heart J 2004; 147:915-8. [PMID: 15131551 DOI: 10.1016/j.ahj.2003.11.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile. METHODS AND RESULTS The annual rates of progression in the peak and mean aortic gradients were 8.5 +/- 3.2 and 6.7 +/- 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with <10 mm Hg ("slow progressors") and group 2 with > or =10 mm Hg annual rate of progression ("fast progressors"). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 +/- 2 mm Hg and 6.4 +/- 1.6 mm Hg; 9 +/- 1.3 mm Hg and 5.2 +/- 1.1 mmHg; P <.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 +/- 1.4 vs 5.2 +/- 1.3, P <.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P =.009). Smoking (P =.024, Beta = 0.26), presence of coronary heart disease (P =.011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P =.004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis. CONCLUSION In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.
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18
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Cowell SJ, Newby DE, Burton J, White A, Northridge DB, Boon NA, Reid J. Aortic valve calcification on computed tomography predicts the severity of aortic stenosis. Clin Radiol 2003; 58:712-6. [PMID: 12943644 DOI: 10.1016/s0009-9260(03)00184-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Incidental aortic valve calcification is often detected during computed tomography. The aim was to compare the severity of valvular stenosis and calcification in patients with aortic stenosis. MATERIALS AND METHODS One hundred and fifty-seven patients aged 68+/-11 years (range: 34-85) with aortic valve stenosis underwent multislice helical computed tomography and Doppler echocardiography performed by independent, blinded observers. The aortic valve calcium score was determined using automated computer software calibrated with a phantom. RESULTS Doppler echocardiography demonstrated a post-valve velocity of 3.45+/-0.66 m/s and a peak gradient of 49+/-11 mmHg. Computed tomography showed excellent reproducibility and the median aortic valve calcium score was 5858 AU (interquartile range, 1555-14,596). The computed tomography aortic valve calcium score positively correlated with the Doppler post-valve velocity and peak gradient (r=0.54, p<0.0001 for both) of the aortic valve. All patients with severe aortic stenosis had a calcium score of >3700 AU. CONCLUSION Calcification of the aortic valve is closely associated with the severity of aortic stenosis, and heavy calcification suggests the presence of severe aortic stenosis that requires urgent cardiological assessment. Patients with lesser degrees of aortic valve calcification should be screened for aortic stenosis and monitored for disease progression.
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Affiliation(s)
- S J Cowell
- Department of Cardiology, Royal Infirmary, Edinburgh, Scotland, UK.
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Nassimiha D, Aronow WS, Ahn C, Goldman ME. Association of coronary risk factors with progression of valvular aortic stenosis in older persons. Am J Cardiol 2001; 87:1313-4. [PMID: 11377366 DOI: 10.1016/s0002-9149(01)01531-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- D Nassimiha
- Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA
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20
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21
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Aronow WS, Ahn C, Kronzon I. Association of mitral annular calcium and of aortic cuspal calcium with coronary artery disease in older patients. Am J Cardiol 1999; 84:1084-5, A9. [PMID: 10569669 DOI: 10.1016/s0002-9149(99)00504-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a prospective study, mitral annular calcium (MAC) was present in 274 of 752 men (36%), mean age 80 years, and in 869 of 1,663 women (52%), mean age 82 years (p <0.0001); aortic cuspal calcium was present in 295 of 752 men (39%) and in 672 of 1,663 women (40%) without aortic cuspal calcium (p = NS). Coronary artery disease was present in 150 of 274 men (55%) with versus 192 of 478 men (40%) without MAC (p = 0.0001) and in 446 of 869 women (51%) with versus 276 of 794 women (35%) without MAC (p <0.0001); coronary artery disease was present in 167 of 295 men (57%) with versus 175 of 457 men (38%) without aortic cuspal calcium (p <0.0001), and in 360 of 672 women (54%) with versus 362 of 991 women (37%) without aortic cuspal calcium (p <0.0001).
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Affiliation(s)
- W S Aronow
- Hebrew Hospital Home, Bronx, New York 10475, USA
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22
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Aronow WS, Ahn C, Shirani J, Kronzon I. Comparison of frequency of new coronary events in older subjects with and without valvular aortic sclerosis. Am J Cardiol 1999; 83:599-600, A8. [PMID: 10073870 DOI: 10.1016/s0002-9149(98)00922-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a prospective study of 1,980 subjects (mean age 81 +/- 8 years) without valvular aortic stenosis, 981 (50%) had valvular aortic sclerosis diagnosed by 2-dimensional and continuous-wave Doppler echocardiography. Independent risk factors for new coronary events were prior coronary artery disease (p = 0.0001, risk ratio 2.8), male gender (p = 0.002, risk ratio 1.3), and valvular aortic sclerosis (p = 0.0001, risk ratio 1.8).
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Affiliation(s)
- W S Aronow
- Hebrew Hospital Home, Bronx, New York 10475, USA
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23
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Gómez Doblas JJ, Jiménez Navarro M, Rodríguez Bailón I, Alonso Briales JH, Hernández García JM, Montiel Trujillo A, Rueda Calle E, Barrera Cordero A, Castillo Castro JL, Alvarez de Cienfuegos Rivera F, de Teresa Galván E. [Preoperative coronarography in heart valve disease patients. A probability analysis of coronary lesion]. Rev Esp Cardiol 1998; 51:756-61. [PMID: 9803802 DOI: 10.1016/s0300-8932(98)74819-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The indication of preoperative coronary angiography is routinely performed for patients who are going to valve replacement surgery. The need of coronary angiography is based on age, gender and previous angina, but it is not usually based on risk factors. The purpose of this study has been to find markers to predict the probability of coronary lesion in this group of patients. PATIENTS AND METHODS We studied retrospectively a population of 541 patients with valvular heart disease who underwent preoperative coronary angiography from 1989 to 1994. Mean age was 61.8 (range 34-82). There were 301 men and 240 women. We analyzed in each patient different variables such as age, gender, previous angina, hypertension, diabetes mellitus, tobacco and familial predisposition. We correlated these variables with the presence of coronary lesion by multivariate analysis. RESULTS There were 73 patients with coronary lesion greater than 50%. The prevalence of significant coronary artery disease was 13.4%. Angina was present in 34.6%. The risk of coronary lesion was defined as odds ratio: previous angina 3.3; tobacco 2.6; diabetes 2.2; hypertension 1.8 and age 1.4. The others variables were not predictor of coronary lesion. The probability of coronary lesion in patients without those variables (angina, tobacco, diabetes, hypertension) was 4%. If we analyzed age, the probability of coronary lesion was 3% in patients under 65 years and 6% above 65 years. CONCLUSIONS The lack of previous angina and at least the three risk factors described as predictors of coronary lesion (hypertension, tobacco and diabetes) can define a group of patients with a very low prevalence of coronary lesion, especially if they are under 65 years. It can allow us to avoid preoperatory coronary angiography in patients who undergo valve replacement.
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Affiliation(s)
- J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga.
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Aronow WS, Ahn C, Shirani J, Kronzon I. Comparison of frequency of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. Am J Cardiol 1998; 81:647-9. [PMID: 9514469 DOI: 10.1016/s0002-9149(97)00966-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Independent risk factors for new coronary events were prior myocardial infarction, valvular aortic stenosis, male gender, and increasing age in patients with aortic stenosis. In older persons with moderate or severe valvular aortic stenosis, congestive heart failure, syncope, or angina pectoris was present in 101 of 114 persons (89%) with new coronary events and in 1 of 22 persons (5%) without new coronary events (p <0.0001).
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Affiliation(s)
- W S Aronow
- Hebrew Hospital Home, Bronx, New York 10475, USA
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25
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Wilmshurst PT, Stevenson RN, Griffiths H, Lord JR. A case-control investigation of the relation between hyperlipidaemia and calcific aortic valve stenosis. Heart 1997; 78:475-9. [PMID: 9415007 PMCID: PMC1892301 DOI: 10.1136/hrt.78.5.475] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the relation of hyperlipidaemia to calcific aortic valve stenosis. DESIGN A case-control study designed to detect a clinically relevant difference in the fasting plasma concentrations of total cholesterol between the groups at the 5% level with a power of 90%. Predefined subgroup analyses were based on presence of significant coronary disease and valve morphology (that is, bicuspid or tricuspid). SETTING A district general hospital. SUBJECTS 20 patients with severe calcific aortic stenosis and 20 controls. RESULTS Mean (SD) fasting plasma total cholesterol in patients with aortic stenosis was 0.79 (1.50) mmol/l greater than in the controls (p = 0.029). The magnitude of differences between patients with aortic stenosis and controls was similar whether the patients had coronary artery disease (0.78 (1.73) mmol/l) or not (0.80 (1.37) mmol/l). The presence of a stenosed tricuspid aortic valve was associated with a significant increase in plasma cholesterol (1.70 (0.87) mmol/l, p = 0.012). For bicuspid valves the degree of elevation of plasma cholesterol was less and not statistically significant. CONCLUSIONS Calcific aortic stenosis is associated with hypercholesterolaemia, especially when the valve is tricuspid. Further studies are necessary to confirm that the relation is causal. This finding may have implications for measures to prevent the most common cause of cardiac valve replacement in the developed world.
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Affiliation(s)
- P T Wilmshurst
- Department of Cardiology, Royal Infirmary, Huddersfield, UK
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