1
|
Shahini N, Ueland T, Auensen A, Michelsen AE, Ludviksen JK, Hussain AI, Pettersen KI, Aakhus S, Espeland T, Lunde IG, Kirschfink M, Nilsson PH, Mollnes TE, Gullestad L, Aukrust P, Yndestad A, Louwe MC. Increased Complement Factor B and Bb Levels Are Associated with Mortality in Patients with Severe Aortic Stenosis. THE JOURNAL OF IMMUNOLOGY 2019; 203:1973-1980. [PMID: 31492744 DOI: 10.4049/jimmunol.1801244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
Inflammation is involved in initiation and progression of aortic stenosis (AS). However, the role of the complement system, a crucial component of innate immunity in AS, is unclear. We hypothesized that circulating levels of complement factor B (FB), an important component of the alternative pathway, are upregulated and could predict outcome in patients with severe symptomatic AS. Therefore, plasma levels of FB, Bb, and terminal complement complex were analyzed in three cohorts of patients with severe symptomatic AS and mild-to-moderate or severe asymptomatic AS (population 1, n = 123; population 2, n = 436; population 3, n = 61) and in healthy controls by enzyme immunoassays. Compared with controls, symptomatic AS patients had significantly elevated levels of FB (2.9- and 2.8-fold increase in population 1 and 2, respectively). FB levels in symptomatic and asymptomatic AS patients were comparable (population 2 and 3), and in asymptomatic patients FB correlated inversely with valve area. FB levels in population 1 and 2 correlated with terminal complement complex levels and measures of systemic inflammation (i.e., CRP), cardiac function (i.e., NT-proBNP), and cardiac necrosis (i.e., Troponin T). High FB levels were significantly associated with mortality also after adjusting for clinical and biochemical covariates (hazard ratio 1.37; p = 0.028, population 2). Plasma levels of the Bb fragment showed a similar pattern in relation to mortality. We concluded that elevated levels of FB and Bb are associated with adverse outcome in patients with symptomatic AS. Increased levels of FB in asymptomatic patients suggest the involvement of FB from the early phase of the disease.
Collapse
Affiliation(s)
- Negar Shahini
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway
| | - Andreas Auensen
- Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Annika E Michelsen
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway
| | | | - Amjad I Hussain
- Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Kjell I Pettersen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Svend Aakhus
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Torvald Espeland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Ida G Lunde
- Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, 0450 Oslo, Norway
| | - Michael Kirschfink
- Institute of Immunology, University of Heidelberg; 69120 Heidelberg, Germany
| | - Per H Nilsson
- K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway.,Department of Immunology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,Linnaeus Center for Biomaterials Chemistry, Linnaeus University, 45027 Kalmar, Sweden
| | - Tom Eirik Mollnes
- Research Laboratory, Nordland Hospital, 8005 Bodø, Norway.,Department of Immunology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, 9037 Tromsø, Norway.,Center of Molecular Inflammation Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Lars Gullestad
- Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, University of Oslo, 0424 Oslo, Norway; and
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway; .,Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway
| | - Mieke C Louwe
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway; .,Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Center for Heart Failure Research, University of Oslo, 0407 Oslo, Norway.,K.G. Jebsen Inflammation Research Center, University of Oslo, 0372 Oslo, Norway
| |
Collapse
|
2
|
Gillis K, Bala G, Roosens B, Hernot S, Remory I, Scheirlynck E, Geers J, Droogmans S, Cosyns B. Clinical validation of an ultrasound quantification score for aortic valve calcifications. Int J Cardiol 2018; 252:68-71. [PMID: 29249440 DOI: 10.1016/j.ijcard.2017.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Kris Gillis
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium.
| | - Gezim Bala
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Bram Roosens
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Sophie Hernot
- In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Isabel Remory
- In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Esther Scheirlynck
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Jolien Geers
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Steven Droogmans
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Bernard Cosyns
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| |
Collapse
|
3
|
Finsen AV, Ueland T, Sjaastad I, Ranheim T, Ahmed MS, Dahl CP, Askevold ET, Aakhus S, Husberg C, Fiane AE, Lipp M, Gullestad L, Christensen G, Aukrust P, Yndestad A. The homeostatic chemokine CCL21 predicts mortality in aortic stenosis patients and modulates left ventricular remodeling. PLoS One 2014; 9:e112172. [PMID: 25398010 PMCID: PMC4232360 DOI: 10.1371/journal.pone.0112172] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/13/2014] [Indexed: 01/25/2023] Open
Abstract
Background CCL21 acting through CCR7, is termed a homeostatic chemokine. Based on its role in concerting immunological responses and its proposed involvement in tissue remodeling, we hypothesized that this chemokine could play a role in myocardial remodeling during left ventricular (LV) pressure overload. Methods and Results Our main findings were: (i) Serum levels of CCL21 were markedly raised in patients with symptomatic aortic stenosis (AS, n = 136) as compared with healthy controls (n = 20). (ii) A CCL21 level in the highest tertile was independently associated with all-cause mortality in these patients. (iii) Immunostaining suggested the presence of CCR7 on macrophages, endothelial cells and fibroblasts within calcified human aortic valves. (iv). Mice exposed to LV pressure overload showed enhanced myocardial expression of CCL21 and CCR7 mRNA, and increased CCL21 protein levels. (v) CCR7−/− mice subjected to three weeks of LV pressure overload had similar heart weights compared to wild type mice, but increased LV dilatation and reduced wall thickness. Conclusions Our studies, combining experiments in clinical and experimental LV pressure overload, suggest that CCL21/CCR7 interactions might be involved in the response to pressure overload secondary to AS.
Collapse
Affiliation(s)
- Alexandra Vanessa Finsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- * E-mail:
| | - Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- K.G.Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- K.G.Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Trine Ranheim
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mohammed S. Ahmed
- Institute for Surgical Research, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Christen P. Dahl
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Erik T. Askevold
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Cathrine Husberg
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Arnt E. Fiane
- Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Martin Lipp
- Department of Molecular Tumor Genetics and Immunogenetics, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- K.G.Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- K.G.Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- K.G.Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- K.G.Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Coffey S, Cox B, Williams MJA. The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis. J Am Coll Cardiol 2014; 63:2852-61. [PMID: 24814496 DOI: 10.1016/j.jacc.2014.04.018] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/06/2014] [Accepted: 04/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to comprehensively review the epidemiology of aortic sclerosis (ASc) and its association with cardiovascular events. BACKGROUND ASc, which is defined as thickening or calcification of the aortic valve without significant obstruction of blood flow, is a common finding on cardiac imaging. METHODS We searched MEDLINE and EMBASE from inception to April 2013 for studies describing the epidemiology of ASc and performed a meta-analysis of the risk of adverse events using a random effects model. RESULTS Twenty-two studies were identified from the systematic review. The prevalence of ASc increased in proportion to the average age of study participants, ranging from 9% in a study in which the mean age was 54 years to 42% in a study in which the mean age was 81 years. In total, 1.8% to 1.9% of participants with ASc had progression to clinical aortic stenosis per year. There was a 68% increased risk of coronary events in subjects with ASc (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.31 to 2.15), a 27% increased risk of stroke (HR: 1.27; 95% CI: 1.01 to 1.60), a 69% increased risk of cardiovascular mortality (HR: 1.69; 95% CI: 1.32 to 2.15), and a 36% increased risk of all-cause mortality (HR: 1.36; 95% CI: 1.17 to 1.59). CONCLUSIONS ASc is a common finding that is more prevalent with older age. Despite low rates of progression to ASc, there is an independent increase in morbidity and mortality associated with the condition.
Collapse
Affiliation(s)
- Sean Coffey
- Department of Cardiology, Oxford University Hospitals, Oxford, United Kingdom; Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Brian Cox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
5
|
Gillis K, Bala G, Roosens B, Remory I, De Raeve H, Tierens S, Hernot S, Van Camp G, Droogmans S, Cosyns B. Echocardiographic integrated backscatter for the differentiation between aortic valve calcification and valvular myxoid degeneration in rats. Eur Heart J Cardiovasc Imaging 2014; 15:1042-7. [PMID: 24787702 DOI: 10.1093/ehjci/jeu067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Calcification is an independent predictor of mortality in aortic valve (AV) stenosis. Echocardiographic calibrated integrated backscatter (cIB) is a promising parameter for quantifying AV calcification. However, the ability of cIB to differentiate between calcification and valvular thickening has been questioned. Therefore, we aimed to use cIB to study AV calcification compared with non-calcified AV thickening in rats, with histology as reference. METHODS AND RESULTS Twenty male Wistar rats were studied. Group 1 (N = 6) received subcutaneous (SC) serotonin injections (60 mg/kg/day) for 12 weeks to induce myxoid non-calcified AV thickening. Group 2 (N = 7) received vitamin D3 (25,000 UI/kg/day) SC to induce AV calcification, and Group 3 (N = 7) received only vehicle SC for 10 weeks. cIB of the AV was calculated at the end of the study, followed by measurement of the percentage of the histological AV calcification. At the end of the study, cIB values and calcification percentages were significantly higher in vitamin D3-injected rats compared with serotonin-injected rats and controls. There was no significant difference in cIB values between serotonin-injected rats and controls (vitamin D3: 21.5 ± 3.0 dB*; serotonin: 11.8 ± 3.1 dB; control: 10.3 ± 3.4 dB; *P < 0.05). The percentage of histological calcification was significantly higher in the vitamin D3 group compared with the other groups. Serotonin-injected rats developed significant AV thickening. CONCLUSION Increased cIB values of the AV are related to increased calcification at histology and not to myxoid non-calcified valvular thickening. Therefore, cIB may be considered as a sensitive technique to quantify calcification of AV rather than for detecting non-calcified valvular thickening.
Collapse
Affiliation(s)
- Kris Gillis
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Gezim Bala
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Bram Roosens
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Isabel Remory
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | | | - Simon Tierens
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Sophie Hernot
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Guy Van Camp
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Steven Droogmans
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| |
Collapse
|
6
|
Rossi A, Faggiano P, Amado AE, Cicoira M, Bonapace S, Franceschini L, Dini FL, Ghio S, Agricola E, Temporelli PL, Vassanelli C. Mitral and aortic valve sclerosis/calcification and carotid atherosclerosis: results from 1065 patients. Heart Vessels 2013; 29:776-83. [PMID: 24196525 DOI: 10.1007/s00380-013-0433-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/18/2013] [Indexed: 01/20/2023]
Abstract
This study assesses whether aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are associated with carotid artery atherosclerosis, independently of traditional cardiovascular risk factors. A total of 1065 patients underwent both echocardiography and carotid artery ultrasound scanning. AVS and MAC were defined as focal areas of increased echogenicity and thickening of the aortic leaflets or mitral valve annulus. Carotid artery atherosclerosis was defined as presence/absence of any atherosclerotic plaque or presence/absence of plaque >50 %. Of 1065 patients (65 ± 9 years; 38 % female) who comprised the study population, 642 (60 %) had at least one atherosclerotic plaque. AVS, but not mitral valve sclerosis; was associated with the presence of carotid atherosclerosis (odds ratio (OR) 1.9, 95 % confidence interval (CI) 1.2-3.9; P = 0.005) and the degree of carotid atherosclerosis (OR 2.1, 95 % CI 1.2-3.9; P = 0.01) in a multivariate model including age, gender, previous ischemic heart disease, hypertension, dyslipidemia, smoking, diabetes, family cardiovascular history, left ventricular size, mass, and ejection fraction, and left atrial size. AVS is a significant predictor of carotid atherosclerosis, independently of other cardiovascular clinical and echocardiographic risk factors.
Collapse
Affiliation(s)
- Andrea Rossi
- Dipartimento di Medicina, Sezione di Cardiologia, University of Verona, Verona, Italy,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Delvenne P, Caveliers V, Lahoutte T, Van Camp G, Cosyns B. Echocardiographic integrated backscatter for assessing reduction of aortic valve calcifications by R-568 in a rat model of chronic kidney disease. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:2075-2083. [PMID: 23932280 DOI: 10.1016/j.ultrasmedbio.2013.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 05/09/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
Abstract
Chronic kidney disease (CKD) and secondary hyper-parathyroidism are associated with calcific aortic valve disease (CAVD). Innovative modalities for imaging CAVD are warranted. Our aim was to use echocardiographic calibrated integrated backscatter (cIB) to quantitatively determine the preventive effect of the calcimimetic R-568 on CAVD in a CKD rat model, and to compare the results with those of micro-computed tomography and histology. Thirty-six male Wistar rats were followed for 7 wk. Rats were divided into four groups with respect to treatment: (1) adenine 0.5% to induce CKD + vehicle; (2) adenine + R-568 (30 mg/kg/d); (3) control, normal diet + vehicle; (4) controls, normal diet + R-568. At week 7, cIB values of the aortic valve were significantly lower in R-568-treated group 2 than in vehicle-treated group 1. This was confirmed by the significantly lower calcified volume observed on micro-computed tomography and the calcified area observed on histology. There were no significant differences in fractional area change and aortic valve area between groups. In conclusion, echocardiographic cIB was able to quantitatively assess a reduction in CAVD by R-568 in a rat model of CKD.
Collapse
Affiliation(s)
- Bram Roosens
- Centrum Voor Hart- en Vaatziekten, UZ Brussel, Brussels, Belgium; In Vivo Cellular and Molecular Imaging, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Roosens B, Bala G, Gillis K, Remory I, Droogmans S, Somja J, Delvenne E, De Nayer J, Schiettecatte J, Delvenne P, Lancellotti P, Van Camp G, Cosyns B. Echocardiographic integrated backscatter for detecting progression and regression of aortic valve calcifications in rats. Cardiovasc Ultrasound 2013; 11:4. [PMID: 23351880 PMCID: PMC3598438 DOI: 10.1186/1476-7120-11-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background Calcification is an independent predictor of mortality in calcific aortic valve disease (CAVD). The aim of this study was to evaluate the use of non-invasive, non-ionizing echocardiographic calibrated integrated backscatter (cIB) for monitoring progression and subsequent regression of aortic valvular calcifications in a rat model of reversible renal failure with CAVD, compared to histology. Methods 28 male Wistar rats were prospectively followed during 21 weeks. Group 1 (N=14) was fed with a 0.5% adenine diet for 9 weeks to induce renal failure and CAVD. Group 2 (N=14) received a standard diet. At week 9, six animals of each group were killed. The remaining animals of group 1 (N=8) and group 2 (N=8) were kept on a standard diet for an additional 12 weeks. cIB of the aortic valve was calculated at baseline, 9 and 21 weeks, followed by measurement of the calcified area (Ca Area) on histology. Results At week 9, cIB values and Ca Area of the aortic valve were significantly increased in the adenine-fed rats compared to baseline and controls. After 12 weeks of adenine diet cessation, cIB values and Ca Area of group 1 decreased compared to week 9, while there was no longer a significant difference compared to age-matched controls of group 2. Conclusions cIB is a non-invasive tool allowing quantitative monitoring of CAVD progression and regression in a rat model of reversible renal failure, as validated by comparison with histology. This technique might become useful for assessing CAVD during targeted therapy.
Collapse
Affiliation(s)
- Bram Roosens
- Department of Cardiology, Centrum Voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Askevold ET, Gullestad L, Aakhus S, Ranheim T, Tønnessen T, Solberg OG, Aukrust P, Ueland T. Secreted Wnt modulators in symptomatic aortic stenosis. J Am Heart Assoc 2012; 1:e002261. [PMID: 23316316 PMCID: PMC3540657 DOI: 10.1161/jaha.112.002261] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 10/03/2012] [Indexed: 12/19/2022]
Abstract
Background Valve calcification and inflammation play key roles in the development of aortic stenosis (AS). The Wnt pathways have been linked to inflammation, bone metabolism, angiogenesis, and heart valve formation. We hypothesized that soluble Wnt modulators may be dysregulated in symptomatic AS. Methods and Results We measured circulating levels (n=136) and aortic valve tissue expression (n=16) of the secreted Wnt modulators secreted frizzled related protein-3, dickkopf-1 (DKK-1), and Wnt inhibitory factor-1 (WIF-1) by enzyme immunoassay, immunostaining, and RT-PCR in patients with symptomatic, severe AS and investigated associations with echocardiographic parameters of AS and cardiac function. Finally, we assessed the prognostic value of these Wnt modulators in relation to all-cause mortality (n=35) during long-term follow-up (median 4.6 years; survivors, 4.8 years; nonsurvivors, 1.9 years) in these patients. Our main findings were: (1) serum levels of all Wnt modulators were markedly elevated in patients with symptomatic AS (mean increase 231% to 278%, P<0.001), (2) all Wnt modulators were present in calcified aortic valves but correlated poorly with systemic levels or degree of AS, (3) some modulators (ie, WIF-1) were associated with the degree of myocardial function and valvular calcification, (4) all Wnt modulators, and DKK-1 in particular, predicted long-term mortality in these patients also after adjusting for conventional predictors including NT-proBNP. Conclusions Together, these in vivo data support the involvement of Wnt signaling in the development of AS and suggest that circulating Wnt modulators should be further investigated as risk markers in larger AS populations, including patients with asymptomatic disease.
Collapse
Affiliation(s)
- Erik Tandberg Askevold
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Sverdlov AL, Ngo DT, Chan WP, Chirkov YY, Gersh BJ, McNeil JJ, Horowitz JD. Determinants of aortic sclerosis progression: implications regarding impairment of nitric oxide signalling and potential therapeutics. Eur Heart J 2012; 33:2419-25. [DOI: 10.1093/eurheartj/ehs171] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
11
|
Sverdlov AL, Ngo DT, Horowitz JD. Redefining the natural history of calcific aortic stenosis: lessons from Laennec. J Intern Med 2012; 271:569-72. [PMID: 22324298 DOI: 10.1111/j.1365-2796.2012.02520.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Ueland T, Aukrust P, Dahl CP, Husebye T, Solberg OG, Tønnessen T, Aakhus S, Gullestad L. Osteoprotegerin levels predict mortality in patients with symptomatic aortic stenosis. J Intern Med 2011; 270:452-60. [PMID: 21623962 DOI: 10.1111/j.1365-2796.2011.02393.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the prognostic value of osteoprotegerin (OPG) levels in relation to all-cause mortality in patients with symptomatic severe aortic stenosis (AS). DESIGN We measured plasma OPG levels in 136 patients with symptomatic severe AS and investigated associations with transvalvular gradients, valve area, valve calcification (using ultrasonic backscatter analysis as an estimate) and measures of heart failure. Then, we assessed the prognostic value of elevated plasma OPG in determining all-cause mortality (n = 29) in these patients. RESULTS Elevated OPG was poorly correlated with the degree of AS but was associated with increased backscatter measurements and impaired cardiac function. Furthermore, OPG was associated with all-cause mortality in patients with symptomatic AS, even after adjustment for conventional risk markers. The strongest association was obtained by using a combination of high levels of both OPG and N-terminal pro-brain natriuretic peptide (NT-proBNP), suggesting that these markers may reflect distinct pathways in the development and progression of AS. CONCLUSION The level of circulating OPG is significantly associated with all-cause mortality alone and in combination with NT-proBNP in patients with severe symptomatic AS.
Collapse
Affiliation(s)
- T Ueland
- Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Ngo DT, Stafford I, Sverdlov AL, Qi W, Wuttke RD, Zhang Y, Kelly DJ, Weedon H, Smith MD, Kennedy JA, Horowitz JD. Ramipril retards development of aortic valve stenosis in a rabbit model: mechanistic considerations. Br J Pharmacol 2011; 162:722-32. [PMID: 20958293 DOI: 10.1111/j.1476-5381.2010.01084.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Aortic valve stenosis (AVS) is associated with significant cardiovascular morbidity and mortality. To date, no therapeutic modality has been shown to be effective in retarding AVS progression. We evaluated the effect of angiotensin-converting enzyme inhibition with ramipril on disease progression in a recently developed rabbit model of AVS. EXPERIMENTAL APPROACH The effects of 8 weeks of treatment with either vitamin D₂ at 25,000 IU for 4 days a week alone or in combination with ramipril (0.5 mg·kg⁻¹) on aortic valve structure and function were examined in New Zealand white rabbits. Echocardiographic aortic valve backscatter (AV(BS)) and aortic valve:outflow tract flow velocity ratio were utilized to quantify changes in valve structure and function. KEY RESULTS Treatment with ramipril significantly reduced AV(BS) and improved aortic valve :outflow tract flow velocity ratio. The intravalvular content of the pro-oxidant thioredoxin-interacting protein was decreased significantly with ramipril treatment. Endothelial function, as measured by asymmetric dimethylarginine concentrations and vascular responses to ACh, was improved significantly with ramipril treatment. CONCLUSIONS AND IMPLICATIONS Ramipril retards the development of AVS, reduces valvular thioredoxin-interacting protein accumulation and limits endothelial dysfunction in this animal model. These findings provide important insights into the mechanisms of AVS development and an impetus for future human studies of AVS retardation using an angiotensin-converting enzyme inhibitor.
Collapse
Affiliation(s)
- Doan Tm Ngo
- Department of Medicine, Vascular Disease and Therapeutics Research Group, Basil Hetzel Institute, The Queen Elizabeth Hospital, The University of Adelaide, South Australia, Australia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Roosens B, Droogmans S, Hostens J, Somja J, Delvenne E, Hernot S, Bala G, Degaillier C, Caveliers V, Delvenne P, Lahoutte T, Van Camp G, Cosyns B. Integrated Backscatter for the In Vivo Quantification of Supraphysiological Vitamin D3-Induced Cardiovascular Calcifications in Rats. Cardiovasc Toxicol 2011; 11:244-52. [DOI: 10.1007/s12012-011-9118-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Gharacholou SM, Karon BL, Shub C, Pellikka PA. Aortic valve sclerosis and clinical outcomes: moving toward a definition. Am J Med 2011; 124:103-10. [PMID: 21295189 DOI: 10.1016/j.amjmed.2010.10.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 10/20/2010] [Accepted: 10/25/2010] [Indexed: 10/18/2022]
Abstract
The presence of aortic valve sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality. However, it remains unclear whether aortic valve sclerosis is independently associated with risk or merely a marker of coexistent cardiovascular risk factors. Aortic valve sclerosis is usually diagnosed on transthoracic echocardiography, the most widely used imaging modality in observational and natural history studies of aortic valve disease. Defining aortic valve sclerosis has remained challenging due to the variable and qualitative nature of its description by ultrasound techniques. Importantly, artifacts common to ultrasound imaging and awareness of demographic and clinical history information may bias the diagnosis of aortic valve sclerosis. Because clinicians may alter treatment recommendations or follow-up based on echocardiographic reporting of aortic valve sclerosis, highlighting pitfalls of the subjective nature by which aortic valve sclerosis is identified and establishing diagnostic criteria are necessary. This review describes the diagnostic criteria for aortic valve sclerosis used in outcome studies, summarizes the epidemiological findings reporting the relationship between aortic valve sclerosis and clinical outcome, and proposes a definition of aortic valve sclerosis based on the literature.
Collapse
Affiliation(s)
- S Michael Gharacholou
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
16
|
Quantitative evaluation of coronary artery wall echogenicity by integrated backscatter analysis in Kawasaki disease. J Am Soc Echocardiogr 2010; 23:938-42. [PMID: 20656453 DOI: 10.1016/j.echo.2010.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Coronary artery wall echogenicity increases on echocardiograms during the acute phase of Kawasaki disease (KD). According to this background, echogenicity of the coronary artery wall in patients with KD is quantified by using integrated backscatter (IB) analysis. METHODS IB analysis is a quantitative method for evaluating echogenicity. We examined the value of IB in the wall of the left anterior descending coronary artery and compared it with that in adjacent intracardiac blood as a measure of background. The difference between these values is represented as corrected IB for the coronary artery wall. RESULTS Corrected IB for the coronary artery wall was higher in patients with KD than in controls (KD with pre-immunoglobulin therapy vs. controls: 27.4 +/- 5.3 dB vs. 22.0 +/- 3.5 dB, P < .05) and in patients with coronary enlargement after intravenous immunoglobulin (with vs. without coronary enlargement, 29.2 +/- 5.2 dB vs. 24.1 +/- 5.5 dB, P < .05). CONCLUSION The magnitude of IB from the coronary artery wall reflects the effectiveness of immunoglobulin therapy. Furthermore, this method and its value might be useful to predict the occurrence of coronary enlargement in patients with KD.
Collapse
|
17
|
Lack of association between aortic sclerosis and left ventricular hypertrophy in elderly subjects. Int J Cardiol 2010; 150:33-8. [PMID: 20236713 DOI: 10.1016/j.ijcard.2010.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 11/28/2009] [Accepted: 02/14/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The presence of aortic sclerosis has been associated with increased LV mass, particularly in hypertensive subjects. However, aortic sclerosis has also been associated with endothelial dysfunction, which may provide stimuli for development of left ventricular hypertrophy independent of afterload. Thus, we have sought to determine whether aortic sclerosis is a determinant of increased left ventricular mass in a non-hypertensive cohort of aging subjects. METHODS 79 subjects, mean age 68 ± 6 years, without existing cardiovascular disease or previous antihypertensive therapy were studied. LV volumes were calculated from the short axis stack of cardiac MRI and LV mass was indexed to height(2.7). The presence of aortic sclerosis was assessed with echocardiography using backscatter from the aortic valve (AV(BS)) and visual scoring. Plasma asymmetric dimethylarginine levels and vascular responses to salbutamol were used to assess endothelial function. ANCOVA was used to test the relationship between LV mass index and afterload. Univariate and multivariate analyses were performed to find determinants of increased LV mass. RESULTS 15 (19%) of subjects had aortic sclerosis on the basis of AV(BS); none had aortic valve areas <1.5 cm(2). There was no significant difference in LV mass between subjects with and without aortic sclerosis. While LV mass was directly related to systolic blood pressure, this relationship was independent of the presence/absence of aortic sclerosis. On multivariate analysis, significant correlates of increased LV mass were male gender, systolic blood pressure and increased BMI, but not presence of aortic sclerosis. CONCLUSIONS In this aging normotensive population free of established cardiovascular disease, aortic sclerosis is not associated with left ventricular hypertrophy.
Collapse
|
18
|
Ngo DT, Sverdlov AL, Willoughby SR, Nightingale AK, Chirkov YY, McNeil JJ, Horowitz JD. Determinants of Occurrence of Aortic Sclerosis in an Aging Population. JACC Cardiovasc Imaging 2009; 2:919-27. [DOI: 10.1016/j.jcmg.2009.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 03/09/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
|
19
|
Kennedy JA, Hua X, Mishra K, Murphy GA, Rosenkranz AC, Horowitz JD. Inhibition of calcifying nodule formation in cultured porcine aortic valve cells by nitric oxide donors. Eur J Pharmacol 2008; 602:28-35. [PMID: 19056377 DOI: 10.1016/j.ejphar.2008.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 11/12/2008] [Accepted: 11/17/2008] [Indexed: 12/27/2022]
Abstract
Calcific aortic stenosis displays some similarities to atherosclerosis including evidence of endothelial dysfunction. Whether nitric oxide (NO), which is produced by valvular endothelium, has direct protective effects extending to calcification processes in aortic valve cells has not previously been examined. In vitro calcifying nodules in porcine aortic valve interstitial cell cultures, formed in response to transforming growth factor-beta1 (TGF-beta1) 5 ng/ml, were inhibited by NO donors DETA-NONOate 5-100 microM, and sodium nitroprusside (SNP) 3 microM. Raising intracellular cGMP concentrations, via 8-bromo cGMP 1 mM or via brain natiuretic peptide and C-type natiuretic peptide 0.1 microM, inhibited TGF-beta1-induced nodule formation, potentially implicating the cGMP pathway in the NO effect. Stimulation of interstitial cells with substance P or calcium ionophone (A23187) caused NO release and increased intracellular cGMP respectively. However in the presence of TGF-beta1 basal levels of NO production via nitric oxide synthase (NOS) were insufficient to affect nodule formation. Increased dihydroethidium (DHE) fluorescence in response to TGF-beta1, which was inhibited by DETA-NONOate and TEMPOL, suggested a role for intracellular superoxide in TGF-beta1 signalling. Moreover, nodule formation was suppressed by superoxide scavengers TEMPOL, hydralazine and polyethylene glycol-superoxide dismutase (PEG-SOD), but not SOD. In conclusion, NO donors, or agents raising intracellular cGMP levels, may protect aortic valve interstitial cells from early events leading to calcification.
Collapse
Affiliation(s)
- Jennifer A Kennedy
- Cardiology Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
| | | | | | | | | | | |
Collapse
|
20
|
Ngo DTM, Stafford I, Kelly DJ, Sverdlov AL, Wuttke RD, Weedon H, Nightingale AK, Rosenkranz AC, Smith MD, Chirkov YY, Kennedy JA, Horowitz JD. Vitamin D(2) supplementation induces the development of aortic stenosis in rabbits: interactions with endothelial function and thioredoxin-interacting protein. Eur J Pharmacol 2008; 590:290-6. [PMID: 18585377 DOI: 10.1016/j.ejphar.2008.05.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/10/2008] [Accepted: 05/20/2008] [Indexed: 10/22/2022]
Abstract
Understanding of the pathophysiology of aortic valve stenosis (AVS) and finding potentially effective treatments are impeded by the lack of suitable AVS animal models. A previous study demonstrated the development of AVS in rabbits with vitamin D(2) and cholesterol supplementation without any hemodynamic changes in the cholesterol supplemented group alone. The current study aimed to determine whether AVS develops in an animal model with vitamin D(2) supplementation alone, and to explore pathophysiological mechanisms underlying this process. The effects of 8 weeks' treatment with vitamin D(2) alone (n=8) at 25,000 IU/4 days weekly on aortic valve structure and function were examined in male New Zealand white rabbits. Echocardiographic aortic valve backscatter (AV(BS)), transvalvular velocity, and transvalvular pressure gradient were utilized to quantitate changes in valve structure and function. Valvular histology/immunochemistry and function were examined after 8 weeks. Changes in valves were compared with those in endothelial function and in valvular measurement of thioredoxin-interacting protein (TXNIP), a marker/mediator of reactive oxygen species-induced oxidative stress. Vitamin D(2) treated rabbits developed AVS with increased AV(BS) (17.6+/-1.4 dB vs 6.7+/-0.8 dB, P<0.0001), increased transvalvular velocity and transvalvular pressure gradient (both P<0.01 via 2-way ANOVA) compared to the control group. There was associated valve calcification, lipid deposition and macrophage infiltration. Endothelial function was markedly impaired, and intravalvular TXNIP concentration increased. In this model, vitamin D(2) induces the development of AVS with histological features similar to those of early AVS in humans and associated endothelial dysfunction/redox stress. AVS development may result from the loss of nitric oxide suppression of TXNIP expression.
Collapse
Affiliation(s)
- Doan T M Ngo
- Cardiology Unit, The Queen Elizabeth Hospital, Department of Medicine, The University of Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Strowitzki M, Brand S, Ketter R, Steudel WI, Jenderka KV. Ultrasonic radio-frequency spectrum analysis differentiates normal and edematous brain tissue from meningioma intraoperatively. J Neuroimaging 2008; 18:73-80. [PMID: 18190500 DOI: 10.1111/j.1552-6569.2007.00173.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intraoperative ultrasound imaging of the brain is used for tumor localization and resection control. The aim of the present study was to prove whether spectral analysis of radio-frequency (rf) signals is able to improve its diagnostic capabilities by adding quantitative acoustical parameters to pure visual analysis. Meningioma was chosen as a first model because of its distinct borders during surgery as well as in ultrasound imaging. Rf signals were captured intraoperatively. Spectral analysis of rf signals was performed off-line in areas of normal brain, edematous tissue, and meningioma within the bandwidth of the transducer. At 5.0 MHz, attenuation allowed significant differentiation for normal brain versus edema (P= .00002), normal brain versus meningioma (P= .000004), and edema versus meningioma (P= .002). The slope of attenuation reached significant levels among the three groups, too. Backscatter analysis consisted of determination of the power spectral density with a significant difference for edema versus meningioma at 5 MHz (P= .02). The same was true for a relative integrated backscatter coefficient (P= .01). Frequency-dependent backscatter coefficients were estimated using a standard phantom with edema showing the highest values followed by parenchyma and meningioma. Spectral analysis of rf signals has the potential of differentiating intracranial tissues as could be shown exemplarily with meningioma in this study. If this is also true for infiltrating tumors, the method might serve as a tool to better define tumor borders, thus improving the extent of resection.
Collapse
Affiliation(s)
- Martin Strowitzki
- Department of Neurosurgery, Saarland University Medical School, Homburg-Saar, Germany.
| | | | | | | | | |
Collapse
|
22
|
Ngo DTM, Heresztyn T, Mishra K, Marwick TH, Horowitz JD. Aortic stenosis is associated with elevated plasma levels of asymmetric dimethylarginine (ADMA). Nitric Oxide 2006; 16:197-201. [PMID: 17126043 DOI: 10.1016/j.niox.2006.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 07/15/2006] [Accepted: 10/06/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We tested the hypothesis that the presence of aortic stenosis (AS) is associated with elevation of plasma levels of asymmetric dimethylarginine (ADMA), a physiological inhibitor of nitric oxide synthase, a mediator and marker of endothelial dysfunction and an indicator of incremental cardiovascular risk. BACKGROUND The presence of aortic sclerosis (ASC), the precursor of AS is independently associated both with endothelial dysfunction, and with incremental coronary event risk. It remains uncertain whether elevations of ADMA levels might mediate endothelial dysfunction in these conditions. METHODS Forty two consecutive patients referred for echocardiography for evaluation of AS, who had calculated aortic valve areas of <1.4 cm(2) (AS group) were evaluated together with 42 consecutive age-matched referred patients (non-AS group). Plasma ADMA levels were measured by high-performance liquid chromatography (HPLC). Determinants of elevation of plasma ADMA levels were identified via stepwise multiple linear regression analysis. RESULTS Plasma ADMA levels were not statistically different between the AS and non-AS group (median 0.59 vs 0.54 micromol/L, p=0.13, Mann-Whitney test) on univariate analysis. However, in backward stepwise multiple linear regression, the presence of AS was a significant predictor of elevated ADMA levels (p=0.04, 95% CI=0.001, 0.072). In addition, elevated plasma ADMA levels were also associated with history of atrial fibrillation (p=0.009, 95% CI=0.015, 0.100), and negatively associated with creatinine clearance (p=0.01, 95% CI=-0.002, 0.000), and the use of statin therapy (p=0.01, 95% CI=-0.081, -0.011). CONCLUSIONS AS is independently associated with elevation of ADMA levels, beyond that implied by "conventional" risk factors for endothelial dysfunction. The clinical status of AS as an incremental marker of cardiovascular risk may reflect ADMA-mediated endothelial dysfunction.
Collapse
Affiliation(s)
- Doan T M Ngo
- Cardiology Unit, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Rd, Woodville South, SA 5011, Australia
| | | | | | | | | |
Collapse
|
23
|
Nightingale AK, Horowitz JD. Aortic sclerosis: not an innocent murmur but a marker of increased cardiovascular risk. Heart 2005; 91:1389-93. [PMID: 15797932 PMCID: PMC1769170 DOI: 10.1136/hrt.2004.057117] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or minor disruption of the aortic valve with associated turbulence but minimal obstruction. Aortic sclerosis has two important clinical implications. Firstly, aortic sclerosis is an antecedent to clinically significant aortic valve obstruction and, secondly, it acts as a marker of increased risk of cardiovascular events. This article reviews the evidence that aortic sclerosis is a useful adjunctive tool in cardiovascular risk stratification and that its progression to haemodynamically significant aortic stenosis is a potential focus for individual monitoring and for interventional studies.
Collapse
Affiliation(s)
- A K Nightingale
- Department of Cardiology, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia.
| | | |
Collapse
|