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Heidari Moghadam R, Babajani F, Karami A, Elieh-Ali-Komi D, Hoseini F, Salehi N, Elahirad S, Mohammadi-Noori E, Mohammadi H, Kiani A. Association of Matrix Metalloproteinase-2 (MMP-2) and MMP-9 Promoter Variants, Their Serum Levels, and Activities with Aortic Valve Calcification (AVC) in a Population from Western Iran. Genet Test Mol Biomarkers 2024; 28:223-232. [PMID: 38708584 DOI: 10.1089/gtmb.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Background: Matrix metalloproteinase (MMP) enzyme gene polymorphisms MMP-2-1575G/A and MMP-9-1562C/T promoter polymorphism, their serum levels, and activity are associated with aortic valve calcification (AVC). Materials and Methods: The synergistic link between the risk of AVC and the alleles T and A of MMP-9 and MMP-2 was investigated, respectively. Ninety-two cases with AVC and 92 healthy individuals from the west of Iran were included, and MMP- 2-1575G/A and MMP-9-1562C/T promoter polymorphisms were detected using PCR-RFLP. The serum levels and activity of MMP-2 and -9 were assessed using ELISA and gelatin zymography methods, respectively. In addition, serum biochemical markers, including FBS, urea and creatinine, cholesterol, triglyceride, HDL, LDL, calcium, phosphorus, and blood pressure: systolic blood pressure and diastolic blood pressure were measured. Results: Heart valve calcification disease was associated with a comparatively higher frequency of the A allele of the MMP2-1575 variation (p = 0.002). In addition, the frequency of T allele of the MMP9-1562 variant was higher than the control group (p = 0.007). Conclusion: MMP-2 and MMP-9 serum levels and activities were observed to be considerably higher in the experimental group than in the control group (p < 0.001). Patients are more susceptible to cardiovascular disease than the control group due to elevated serum levels and activity of MMP-2 and MMP-9.
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Affiliation(s)
- Reza Heidari Moghadam
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Babajani
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afshin Karami
- Regenerative Medicine Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Daniel Elieh-Ali-Komi
- Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Faeghe Hoseini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeed Elahirad
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Mohammadi-Noori
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Mohammadi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Kiani
- Regenerative Medicine Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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2
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Wachtell K. Understanding the driving mechanisms of bioprosthetic valve degeneration. Heart 2024; 110:223-224. [PMID: 37788891 DOI: 10.1136/heartjnl-2023-323210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Kristian Wachtell
- Department of Cardiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
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3
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Wang Z, Li M, Liu N. The nonlinear correlation between lipoprotein (a) and the prevalence of aortic valve calcification in patients with new-onset acute myocardial infarction. Acta Cardiol 2022; 77:950-959. [PMID: 36326187 DOI: 10.1080/00015385.2022.2129183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Growing studies show that lipoprotein (a) [Lp(a)] is related to calcified aortic valve diseases in general population, while the relationship between Lp(a) and aortic valve calcification (AVC) in patients with new-onset acute myocardial infarction (AMI) remains unclear. Therefore, this study was to evaluate the correlation between Lp(a) and AVC in patients with new-onset AMI. METHODS This cross-sectional study included 410 patients with new-onset AMI who were hospitalised in Zhongda Hospital affiliated to Southeast University from January 1, 2020 to December 31, 2021. Multivariable logistic regression, subgroup analysis, generalised additive model, threshold and saturation effect and receiver operator characteristic (ROC) curve were used to explore the association between Lp(a) and AVC. RESULTS Patients with AVC had higher levels of Lp(a) than those without AVC. Multivariable logistic regression analysis showed that higher Lp(a) was still associated with higher risk of AVC after adjusting for confounding factors, and this correlation was robust in most subgroups and sensitivity analyses (p < 0.05). Additionally, the generalised additive model showed that there was a nonlinear correlation between Lp(a) and AVC (P for nonlinearity = 0.037). Threshold and saturation effect analysis indicated that when Lp(a) < 840 mg/L, it was positively correlated with the prevalence of AVC (p < 0.05), but when Lp(a) ≥ 840 mg/L, this correlation no longer existed. Besides, ROC curve analysis demonstrated that Lp(a) had a good diagnostic performance for AVC. CONCLUSION Lp(a) was independently associated with the prevalence of AVC in patients with new-onset AMI.
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Affiliation(s)
- Zhenwei Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Min Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Naifeng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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4
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Dutta P, Kodigepalli KM, LaHaye S, Thompson JW, Rains S, Nagel C, Thatcher K, Hinton RB, Lincoln J. KPT-330 Prevents Aortic Valve Calcification via a Novel C/EBPβ Signaling Pathway. Circ Res 2021; 128:1300-1316. [PMID: 33601919 PMCID: PMC8085092 DOI: 10.1161/circresaha.120.318503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Punashi Dutta
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Pediatric Cardiology, The Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
| | - Karthik M. Kodigepalli
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Pediatric Cardiology, The Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
| | - Stephanie LaHaye
- The Institute for Genomic Medicine at Nationwide Children’s Hospital, Columbus, OH, USA
| | - J. Will Thompson
- Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
| | - Sarah Rains
- Pharmacology and Cancer Biology, Duke University, Durham, NC, USA
- Duke Proteomics and Metabolomics Shared Resource, Durham, NC, USA
| | - Casey Nagel
- Ocean Ridge Biosciences, Deerfield Beach, Florida, USA
| | - Kaitlyn Thatcher
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Pediatric Cardiology, The Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
| | - Robert B. Hinton
- Division of Molecular Cardiovascular Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Joy Lincoln
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Pediatric Cardiology, The Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, USA
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5
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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6
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Iop L. Toward the Effective Bioengineering of a Pathological Tissue for Cardiovascular Disease Modeling: Old Strategies and New Frontiers for Prevention, Diagnosis, and Therapy. Front Cardiovasc Med 2021; 7:591583. [PMID: 33748193 PMCID: PMC7969521 DOI: 10.3389/fcvm.2020.591583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular diseases (CVDs) still represent the primary cause of mortality worldwide. Preclinical modeling by recapitulating human pathophysiology is fundamental to advance the comprehension of these diseases and propose effective strategies for their prevention, diagnosis, and treatment. In silico, in vivo, and in vitro models have been applied to dissect many cardiovascular pathologies. Computational and bioinformatic simulations allow developing algorithmic disease models considering all known variables and severity degrees of disease. In vivo studies based on small or large animals have a long tradition and largely contribute to the current treatment and management of CVDs. In vitro investigation with two-dimensional cell culture demonstrates its suitability to analyze the behavior of single, diseased cellular types. The introduction of induced pluripotent stem cell technology and the application of bioengineering principles raised the bar toward in vitro three-dimensional modeling by enabling the development of pathological tissue equivalents. This review article intends to describe the advantages and disadvantages of past and present modeling approaches applied to provide insights on some of the most relevant congenital and acquired CVDs, such as rhythm disturbances, bicuspid aortic valve, cardiac infections and autoimmunity, cardiovascular fibrosis, atherosclerosis, and calcific aortic valve stenosis.
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Affiliation(s)
- Laura Iop
- Department of Cardiac Thoracic Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
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Abstract
Familial hypercholesterolemia (FH) is a rare autosomal gene deficiency disease with increased low-density lipoprotein cholesterol, xanthoma, and premature coronary heart disease. Calcified aortic valve disease (CAVD) is prevalent in FH patients, resulting in adverse events and heavy health care burden. Aortic valve calcification is currently considered an active biological process, which shares several common risk factors with atherosclerosis, including aging, hypertension, dyslipidemia, and so on. Unfortunately, the pathogenesis and therapy of CAVD in FH are still controversial. There is no pharmacological intervention recommended to delay the development of CAVD in FH, and the only effective treatment for severe CAVD is aortic valve replacement. In this review, we summarize the detailed description of the pathophysiology, molecular mechanism, risk factors, and treatment of CAVD in FH patients.
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8
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Fauvel C, Capoulade R, Durand E, Béziau DM, Schott JJ, Le Tourneau T, Eltchaninoff H. Durability of transcatheter aortic valve implantation: A translational review. Arch Cardiovasc Dis 2020; 113:209-221. [PMID: 32113816 DOI: 10.1016/j.acvd.2019.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines has widened the indication to include intermediate-risk patients, based on two recently published trials (PARTNER 2 and SURTAVI). Moreover, two other recent trials (PARTNER 3 and EVOLUT LOW RISK) have demonstrated similar results with transcatheter aortic valve implantation in low-risk patients. Thus, extension of transcatheter aortic valve implantation to younger patients, who are currently treated by surgical aortic valve replacement, raises the crucial question of bioprosthesis durability. In this translational review, we propose to produce a state-of-the-art overview of the durability of transcatheter aortic valve implantation by integrating knowledge of the basic science of bioprosthesis degeneration (pathophysiology and biomarkers). After summarising the new definition of structural valve deterioration, we will present what is known about the pathophysiology of aortic stenosis and bioprosthesis degeneration. Next, we will consider how to identify a population at risk of early degeneration, and how basic science with the help of biomarkers could identify and predict structural valve deterioration. Finally, we will present data on the differences in durability of transcatheter aortic valve implantation compared with surgical aortic valve replacement.
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Affiliation(s)
- Charles Fauvel
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France
| | - Romain Capoulade
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Eric Durand
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France
| | - Delphine M Béziau
- Normandie Université, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, 76000 Rouen, France
| | - Jean-Jacques Schott
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Thierry Le Tourneau
- L'institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France; Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France.
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9
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Kolovou G, Diakoumakou O, Kolovou V, Fountas E, Stratakis S, Zacharis E, Liberopoulos EN, Matsouka F, Tsoutsinos A, Mastorakou I, Katsikas T, Mavrogeni S, Hatzigeorgiou G. Microsomal triglyceride transfer protein inhibitor (lomitapide) efficacy in the treatment of patients with homozygous familial hypercholesterolaemia. Eur J Prev Cardiol 2019; 27:157-165. [DOI: 10.1177/2047487319870007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AimsThe aim of this study was to evaluate the effect of microsomal triglyceride transfer protein inhibitor (lomitapide) in patients with homozygous familial hypercholesterolaemia.Methods and resultsIn 12 homozygous familial hypercholesterolaemia patients treated with lipid-lowering drugs ± biweekly lipoprotein apheresis sessions (nine patients), daily lomitapide was added. The lipid profile (total cholesterol, low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein cholesterol) before and after lomitapide treatment was evaluated. The follow-up period with lomitapide treatment was 3–24 months (13.8 ± 7.9). The median baseline low-density lipoprotein cholesterol level was 900 mg/dl (348–1070), after lipid-lowering drugs therapy was 383.5 mg/dl (214–866) and after lipid-lowering drugs + time-averaged level was 288 mg/dl (183.7–716.6). The addition of lomitapide lowered low-density lipoprotein cholesterol levels further by 56.8% compared to lipid-lowering drugs alone (mean reduction 262, 95% confidence interval (105.5–418.7), p = 0.005) and by 54% (mean reduction 182.9, 95% confidence interval (−342 – −23), p = 0.031) comparing to lipid-lowering drugs + lipoprotein apheresis (time-averaged level). The time-averaged level of low-density lipoprotein cholesterol in lipid-lowering drugs + lipoprotein apheresis patients compared with lipid-lowering drugs + lomitapide was 54% in favour of lomitapide ( p = 0.031).ConclusionsTreatment with lomitapide in homozygous familial hypercholesterolaemia patients has a beneficial effect with a constant decrease of low-density lipoprotein cholesterol by 57% compared with classical lipid-lowering therapy and by 54% compared with classical lipid-lowering therapy and time-averaged level of low-density lipoprotein cholesterol.
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Affiliation(s)
- Genovefa Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Greece
| | - Olga Diakoumakou
- Department of Cardiology, Onassis Cardiac Surgery Center, Greece
| | - Vana Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Greece
- Molecular Immunology Laboratory, Onassis Cardiac Surgery Center, Greece
| | | | | | | | | | - Fedra Matsouka
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Greece
| | | | - Irene Mastorakou
- Department of Rentgenology, Onassis Cardiac Surgery Center, Greece
| | | | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Greece
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Shuvy M, Abedat S, Eliaz R, Abu-Rmeileh I, Abu-Snieneh A, Ben-Dov IZ, Meir K, Pereg D, Beeri R, Lotan C. Hyperphosphatemia is required for initiation but not propagation of kidney failure-induced calcific aortic valve disease. Am J Physiol Heart Circ Physiol 2019; 317:H695-H704. [PMID: 31398059 DOI: 10.1152/ajpheart.00765.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
High serum levels of phosphate are associated with uremia-induced calcific aortic valve disease (CAVD). However, it is not clear whether hyperphosphatemia is required in all phases of the process. Our aim was to determine the effects of phosphate and phosphate depletion at different phases of valve disease. The experimental design consisted of administering a uremia-inducing diet, with or without phosphate enrichment, to rats for 7 wk. Forty-two rats were fed with a phosphate-enriched uremic regimen that caused renal insufficiency and hyperphosphatemia. Another 42 rats were fed with a phosphate-depleted uremic regimen, which induces similar severity of renal insufficiency, but without its related mineral disorder. Aortic valves were evaluated at several points during the time of diet administration. In the second part, additional 54 rats were fed a phosphate-enriched diet for various time periods and were then switched to a phosphate-depleted diet to complete 7 wk of uremic diet. Osteoblast-like phenotype, inflammation, and eventually valve calcification were observed only in rats that were fed with a phosphate-enriched regimen. Significant valve calcification was observed only in rats that were fed a phosphate-enriched diet for at least 4 wk. Valve calcification was observed only when the switch to a phosphate-depleted regimen occurred after osteoblast markers and activation of Akt and ERK intracellular signaling pathways had already been found in the valve. Phosphate is essential for the initiation of the calcification process. However, when osteoblast markers are already expressed in valve tissue, phosphate depletion will not halt the disease.NEW & NOTEWORTHY High serum levels of phosphate are associated with uremia-induced calcific aortic valve disease. However, it is not clear whether hyperphosphatemia is required in all phases of the process. Our aim was to determine the effects of phosphate and phosphate depletion at different phases of valve disease. Our findings indicated that phosphate is essential for the initiation of the process that includes macrophage accumulation and osteoblast phenotype. Furthermore, hyperphosphatemia is dispensable beyond a certain phase of the process, a point of "no return" after which phosphate depletion does not prevent calcification. This point is relatively early in the course of calcification, when no calcification is apparent, but the inflammation, osteoblast markers, and activation of ERK and Akt pathways have already been identified. Our findings emphasize the complexity of the calcification process and suggest that different mediators might be required during different phases and that the role of phosphate precedes the actual calcification.
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Affiliation(s)
- Mony Shuvy
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Suzan Abedat
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ran Eliaz
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Israa Abu-Rmeileh
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Asmahan Abu-Snieneh
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karen Meir
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Pereg
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Ronen Beeri
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Chaim Lotan
- Heart Institute, Cardiovascular Research Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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11
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Bicuspid aortic valve, atherosclerosis and changes of lipid metabolism: Are there pathological molecular links? J Mol Cell Cardiol 2019; 129:231-235. [DOI: 10.1016/j.yjmcc.2019.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 12/19/2022]
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12
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Degenerative Aortic Stenosis, Dyslipidemia and Possibilities of Medical Treatment. ACTA ACUST UNITED AC 2018; 54:medicina54020024. [PMID: 30344255 PMCID: PMC6037252 DOI: 10.3390/medicina54020024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022]
Abstract
Degenerative aortic stenosis (DAS) is the most frequently diagnosed heart valve disease in Europe and North America. DAS is a chronic progressive disease which resembles development of atherosclerosis. Endothelial dysfunction, lipid infiltration, calcification and ossification are evidenced in both diseases. The same risk factors such as older age, male sex, smoking, and elevated levels of lipids are identified. The effect of smoking, visceral obesity, metabolic syndrome, hypercholesterolemia, low-density lipoprotein, high-density lipoprotein, lipoprotein(a), adiponectin and apolipoprotein(a) on development of DAS are being studied. The search for genetic ties between disorders of lipid metabolism and DAS has been started. DAS is characterized by a long symptom-free period which can last for several decades. Aortic valve replacement surgery is necessary when the symptoms occur. The lipid-lowering therapy effect on stopping or at least slowing down the progression of DAS was studied. However, the results of the conducted clinical trials are controversial. In addition, calcium homeostasis, bone metabolism and calcinosis-reducing medication are being studied. Although prospective randomized clinical trials have not demonstrated any positive effect of statins used for slowing progression of the disease, statins are still recommended for patients with dyslipidemia. Recent study has suggested that a specific modification of treatment, based on severity of disease, may have a beneficial effect in patients with aortic sclerosis and mild DAS. New clinical studies analyzing new treatment possibilities which could correct the natural course of the disease and reduce the need for aortic valve replacement by surgery or transcatheter treatment interventions are needed.
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13
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Abstract
PURPOSE OF REVIEW This review aims to highlight the past and more current literature related to the multifaceted pathogenic programs that contribute to calcific aortic valve disease (CAVD) with a focus on the contribution of developmental programs. RECENT FINDINGS Calcification of the aortic valve is an active process characterized by calcific nodule formation on the aortic surface leading to a less supple and more stiffened cusp, thereby limiting movement and causing clinical stenosis. The mechanisms underlying these pathogenic changes are largely unknown, but emerging studies have suggested that signaling pathways common to valvulogenesis and bone development play significant roles and include Transforming Growth Factor-β (TGF-β), bone morphogenetic protein (BMP), Wnt, Notch, and Sox9. This comprehensive review of the literature highlights the complex nature of CAVD but concurrently identifies key regulators that can be targeted in the development of mechanistic-based therapies beyond surgical intervention to improve patient outcome.
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14
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Rajamannan NM. Osteocardiology: Defining the Go/No-Go Time Point for Therapy. Cardiology 2018; 139:175-183. [DOI: 10.1159/000485074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
Abstract
Recent epidemiological studies have revealed that the risk factors associated with coronary artery calcification (CAC), including male gender, smoking, hypertension, and elevated serum cholesterol, are similar to the risk factors associated with the development of calcific aortic valve disease (CAVD). The results of the experimental and clinical studies demonstrate that traditional risk factors initiate early atherosclerosis which over time differentiates to form bone in the heart causing clinical CAC and CAVD. Understanding the cellular mechanisms of cardiovascular calcification, the end-stage process of the atherosclerosis will help define the specific time point to modify this cellular process of bone formation in the heart termed osteocardiology. This time point between subclinical atherosclerosis and clinical calcification is the go/no-go time point, or the point of no return with severe clinical calcification in the heart. This review will summarize the development of bone formation in the heart termed osteocardiology, to define the go/no-go time point for therapy initiation to slow the progression of cardiovascular calcification.
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15
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Foulquier S, Daskalopoulos EP, Lluri G, Hermans KCM, Deb A, Blankesteijn WM. WNT Signaling in Cardiac and Vascular Disease. Pharmacol Rev 2018; 70:68-141. [PMID: 29247129 PMCID: PMC6040091 DOI: 10.1124/pr.117.013896] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
WNT signaling is an elaborate and complex collection of signal transduction pathways mediated by multiple signaling molecules. WNT signaling is critically important for developmental processes, including cell proliferation, differentiation and tissue patterning. Little WNT signaling activity is present in the cardiovascular system of healthy adults, but reactivation of the pathway is observed in many pathologies of heart and blood vessels. The high prevalence of these pathologies and their significant contribution to human disease burden has raised interest in WNT signaling as a potential target for therapeutic intervention. In this review, we first will focus on the constituents of the pathway and their regulation and the different signaling routes. Subsequently, the role of WNT signaling in cardiovascular development is addressed, followed by a detailed discussion of its involvement in vascular and cardiac disease. After highlighting the crosstalk between WNT, transforming growth factor-β and angiotensin II signaling, and the emerging role of WNT signaling in the regulation of stem cells, we provide an overview of drugs targeting the pathway at different levels. From the combined studies we conclude that, despite the sometimes conflicting experimental data, a general picture is emerging that excessive stimulation of WNT signaling adversely affects cardiovascular pathology. The rapidly increasing collection of drugs interfering at different levels of WNT signaling will allow the evaluation of therapeutic interventions in the pathway in relevant animal models of cardiovascular diseases and eventually in patients in the near future, translating the outcomes of the many preclinical studies into a clinically relevant context.
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Affiliation(s)
- Sébastien Foulquier
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
| | - Evangelos P Daskalopoulos
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
| | - Gentian Lluri
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
| | - Kevin C M Hermans
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
| | - Arjun Deb
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
| | - W Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands (S.F., K.C.M.H., W.M.B.); Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium (E.P.D.); Department of Medicine, Division of Cardiology, David Geffen School of Medicine (G.L., A.D.); and Department of Molecular Cell and Developmental Biology, University of California at Los Angeles, Los Angeles, California (A.D.)
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16
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Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries. Int J Cardiol 2017; 248:427-432. [DOI: 10.1016/j.ijcard.2017.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/13/2017] [Accepted: 06/07/2017] [Indexed: 11/20/2022]
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17
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Gillis K, Roosens B, Bala G, Remory I, Hernot S, Delvenne P, Mestrez F, Droogmans S, Cosyns B. Interaction of renal failure and dyslipidaemia in the development of calcific aortic valve disease in rats. Acta Cardiol 2017; 72:537-546. [PMID: 28657494 DOI: 10.1080/00015385.2017.1311138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Calcific aortic valve disease (CAVD) is currently the most common heart valve disease worldwide and is known to be an active process. Both renal failure and dyslipidaemia are considered to be promoting factors for the development of valvular calcifications. The aim of this study is to prospectively evaluate the respective contribution and interaction of renal failure and dyslipidaemia on CAVD in a rat model, using echocardiography and compared with histology. METHODS AND RESULTS Sixty-eight male Wistar rats were prospectively divided in eight groups, each fed a different diet to induce renal failure alone and combined with hyperlipidaemia or hypercholesterolemia. CAVD was detected and quantified by calibrated integrated backscatter of ultrasound (cIB) and compared with the histological calcium score. The study follow-up was 20 weeks. At the end of the study, the cIB value and the calcium score of the aortic valve were significantly increased in the group with isolated renal failure but not with dyslipidaemia. The combination of renal failure with high cholesterol or high-fat diet did not significantly increase calcifications further. CONCLUSIONS Renal failure alone does induce aortic valve calcifications in a rat model of CAVD, whereas dyslipidaemia alone does not. The combination of renal failure with dyslipidaemia does not increase calcification further. These findings suggest that a combination of atherosclerotic and calcifying factors is not required to induce aortic valve calcifications in this model.
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Affiliation(s)
- Kris Gillis
- Centrum voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Jette, Belgium
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Bram Roosens
- Centrum voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Jette, Belgium
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Gezim Bala
- Centrum voor Hart-en Vaatziekten (CHVZ), UZ Brussel, 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
| | - Sophie Hernot
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Philippe Delvenne
- Department of Pathology, University Hospital (CHU) of Liège, Liège, Belgium
| | - Fabienne Mestrez
- Department of Nephrology, University Hospital (CHU) Ambroise Paré, Mons, Belgium
| | - Steven Droogmans
- Centrum voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Jette, Belgium
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
| | - Bernard Cosyns
- Centrum voor Hart-en Vaatziekten (CHVZ), UZ Brussel, Jette, Belgium
- In Vivo Cellular and Molecular Imaging Laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Belgium
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18
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Yu B, Hafiane A, Thanassoulis G, Ott L, Filwood N, Cerruti M, Gourgas O, Shum-Tim D, Al Kindi H, de Varennes B, Alsheikh-Ali A, Genest J, Schwertani A. Lipoprotein(a) Induces Human Aortic Valve Interstitial Cell Calcification. JACC Basic Transl Sci 2017; 2:358-371. [PMID: 30062157 PMCID: PMC6034440 DOI: 10.1016/j.jacbts.2017.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022]
Abstract
Lp(a) significantly increased alkaline phosphatase activity, phosphate and calcium content, and matrix vesicle formation and induced apoptosis and calcification of normal human aortic valve interstitial cells. The type of minerals induced by Lp(a) resembles that seen in calcified human aortic valves as shown by Raman spectroscopy. Lp(a)-induced calcification of human aortic valve interstitial cells is mediated by activation of MAPK38, GSK3β, and Wnt signaling. Inhibition of GSK3β and MAPK38 significantly reduced lipoprotein(a)-induced aortic valve interstitial cell calcification. Lp(a)is abundant in calcified aortic valves, and lipoprotein(a) immunoreactivity colocalized with that of oxidized phospholipids.
Lipoprotein(a), or Lp(a), significantly increased alkaline phosphatase activity, release of phosphate, calcium deposition, hydroxyapatite, cell apoptosis, matrix vesicle formation, and phosphorylation of signal transduction proteins; increased expression of chondro-osteogenic mediators; and decreased SOX9 and matrix Gla protein (p < 0.001). Inhibition of MAPK38 and GSK3β significantly reduced Lp(a)-induced calcification of human aortic valve interstitial cells (p < 0.001). There was abundant presence of Lp(a) and E06 immunoreactivity in diseased human aortic valves. The present study demonstrates a causal effect for Lp(a) in aortic valve calcification and suggests that interfering with the Lp(a)pathway could provide a novel therapeutic approach in the management of this debilitating disease.
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Key Words
- ALP, alkaline phosphatase
- BMP, bone morphogenetic protein
- FWHM, full width half maximum
- HAVIC, human aortic valve interstitial cell
- LDL, low-density lipoprotein
- LOX-1, oxidized LDL receptor 1
- Lp(a), lipoprotein(a)
- MAPK, mitogen-activated protein kinase
- MGP, matrix Gla protein
- OxPL, oxidized phospholipid
- Raman spectroscopy
- apo(a), apolipoprotein(a)
- mRNA, messenger ribonucleic acid
- oxidized phospholipids
- real-time PCR
- stenosis
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Affiliation(s)
- Bin Yu
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Anouar Hafiane
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - George Thanassoulis
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Leah Ott
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Nial Filwood
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Marta Cerruti
- Department of Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Ophélie Gourgas
- Department of Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Dominique Shum-Tim
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Hamood Al Kindi
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Benoit de Varennes
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medical and Health Sciences, Dubai, United Arab Emirates
| | - Jacques Genest
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
| | - Adel Schwertani
- Divisions of Cardiology and Cardiac Surgery, Department of Medicine, Surgery and Pathology, McGill University, Montreal, Quebec, Canada
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19
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Best PJM, Rajamannan NM. OxPL: Elusive Risk Factor in Calcific Aortic Valve Disease or Another Piece of the Puzzle? Arterioscler Thromb Vasc Biol 2017; 37:1425-1427. [PMID: 28747455 DOI: 10.1161/atvbaha.117.309719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Patricia J M Best
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.J.M.B.); Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN (N.M.R.); and Most Sacred Heart of Jesus Cardiology and Valvular Institute, Sheboygan, WI (N.M.R.)
| | - Nalini M Rajamannan
- From the Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (P.J.M.B.); Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN (N.M.R.); and Most Sacred Heart of Jesus Cardiology and Valvular Institute, Sheboygan, WI (N.M.R.).
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20
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Perrucci GL, Zanobini M, Gripari P, Songia P, Alshaikh B, Tremoli E, Poggio P. Pathophysiology of Aortic Stenosis and Mitral Regurgitation. Compr Physiol 2017. [PMID: 28640443 DOI: 10.1002/cphy.c160020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR). AVS is the most commonly encountered valve disease nowadays and affects almost 5% of elderly population. In particular, AVS poses a great challenge due to the multiple comorbidities and frailty of this patient subset. MR is also a common valve pathology and has an estimated prevalence of 3% in the general population, affecting more than 176 million people worldwide. This review will focus on pathophysiological changes in both these valve diseases, starting from the description of the anatomical aspects of normal valve, highlighting all the main cellular and molecular features involved in the pathological progression and cardiac consequences. This review also evaluates the main approaches in clinical management of these valve diseases, taking into account of the main published clinical guidelines. © 2017 American Physiological Society. Compr Physiol 7:799-818, 2017.
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Affiliation(s)
- Gianluca L Perrucci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Paola Songia
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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21
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Masjedi S, Lei Y, Patel J, Ferdous Z. Sex-related differences in matrix remodeling and early osteogenic markers in aortic valvular interstitial cells. Heart Vessels 2016; 32:217-228. [PMID: 27761653 DOI: 10.1007/s00380-016-0909-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/14/2016] [Indexed: 01/03/2023]
Abstract
Calcific aortic valve disease (CAVD) is a major cardiovascular disorder in the developed countries. Male is a known risk factor in this disease; unfortunately, how sex contributes to CAVD is mostly unknown. The objective of this study is to determine whether valvular interstitial cells (VICs) isolated from male versus female aortic valves demonstrate difference in osteogenic differentiation and/or extracellular matrix (ECM) remodeling. VICs were isolated from male and female rat or porcine aortic valves and cultured in osteogenic media for 10, 15 and 20 days. The proliferation among male and female VICs was assessed by a cell growth assay. The matrix remodeling of the VIC samples was quantified using glycosaminoglycan (GAG), collagen type I and gelatin zymography assays. Early osteogenic marker expression was assessed using alkaline phosphatase (ALP) staining and enzyme activity assay and Alizarin Red S staining. Our result showed that proliferation of VICs was significantly greater in female than male after 12 days of culture in regular media. Additionally, male VICs showed elevated amounts of normalized GAG, collagen I, and activated matrix metallopreoteniase-2 expression compared to female. Similarly, ALP content was greater in male VICs than female at all time points. In addition, male VICs formed calcific nodules with greater size, % area and integrated density than females. The results from this research suggest that there is a sex-related difference in the events associated with osteogenic differentiation of the aortic VICs, where male VICs are more prone to calcification.
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Affiliation(s)
- Shirin Masjedi
- The Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, 312 Perkins Hall, Knoxville, TN, 37996, USA
| | - Ying Lei
- The Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, 312 Perkins Hall, Knoxville, TN, 37996, USA
| | - Jenny Patel
- The Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, 312 Perkins Hall, Knoxville, TN, 37996, USA
| | - Zannatul Ferdous
- The Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, 312 Perkins Hall, Knoxville, TN, 37996, USA.
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22
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Rajamannan NM. Calcific Aortic Valve Disease in Familial Hypercholesterolemia: The LDL-Density-Gene Effect. J Am Coll Cardiol 2015; 66:2696-2698. [PMID: 26700831 DOI: 10.1016/j.jacc.2015.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Nalini M Rajamannan
- Most Sacred Heart of Jesus Cardiology and Valvular Institute, Sheboygan, Wisconsin; Department of Molecular Biology and Biochemistry, Mayo Clinic School of Medicine, Rochester, Minnesota.
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23
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Rajamannan NM, Greve AM, Moura LM, Best P, Wachtell K. SALTIRE-RAAVE: targeting calcific aortic valve disease LDL-density-radius theory. Expert Rev Cardiovasc Ther 2015; 13:355-67. [PMID: 25797901 DOI: 10.1586/14779072.2015.1025058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SALTIRE and RAAVE were the first two studies to evaluate the use of statin therapy for impeding calcific aortic valve disease (CAVD). This review presents the findings of low-density lipoprotein (LDL)-density-radius theory as tested using the combined results from the SALTIRE and RAAVE studies. Patients who received statin therapy had a greater degree of LDL cholesterol lowering, seen as the % change in LDL (47 vs 2%, p = 0.012), which in itself was significantly associated with a lesser change in aortic valve area (AVA; p < 0.001 and R(2) = 0.27). The percent change in the AVA for the treated patients was 5% and 15% for the nontreated patients (p = 0.579 and R(2) = 0.03). In summary, these published findings suggest that when applying the LDL-density-radius theory, which combines the cellular biology and the hemodynamics as defined by the continuity equation for AVA, there may be a role for lipid-lowering therapy in contemporary patients with calcific aortic valve disease (CAVD).
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Affiliation(s)
- Nalini M Rajamannan
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
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24
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ten Kate GJR, Bos S, Dedic A, Neefjes LA, Kurata A, Langendonk JG, Liem A, Moelker A, Krestin GP, de Feyter PJ, Roeters van Lennep JE, Nieman K, Sijbrands EJ. Increased Aortic Valve Calcification in Familial Hypercholesterolemia. J Am Coll Cardiol 2015; 66:2687-2695. [DOI: 10.1016/j.jacc.2015.09.087] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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25
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Vascular diseases investigated ex vivo by using Raman, FT-IR and complementary methods. Pharmacol Rep 2015; 67:744-50. [DOI: 10.1016/j.pharep.2015.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 11/20/2022]
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26
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Vongpromek R, Bos S, Ten Kate GJR, Yahya R, Verhoeven AJM, de Feyter PJ, Kronenberg F, Roeters van Lennep JE, Sijbrands EJG, Mulder MT. Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia. J Intern Med 2015; 278:166-73. [PMID: 25487646 DOI: 10.1111/joim.12335] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Lipoprotein(a) [Lp(a)] is an independent risk factor for aortic valve stenosis and aortic valve calcification (AVC) in the general population. In this study, we determined the association between AVC and both plasma Lp(a) levels and apolipoprotein(a) [apo(a)] kringle IV repeat polymorphisms in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH). METHODS A total of 129 asymptomatic heterozygous FH patients (age 40-69 years) were included in this study. AVC was detected using computed tomography scanning. Lp(a) concentration and apo(a) kringle IV repeat number were measured using immunoturbidimetry and immunoblotting, respectively. Univariate and multivariate logistic regression were used to assess the association between Lp(a) concentration and the presence of AVC. RESULTS Aortic valve calcification was present in 38.2% of patients, including three with extensive AVC (>400 Agatston units). Lp(a) concentration was significantly correlated with gender, number of apo(a) kringle IV repeats and the presence and severity of AVC, but not with coronary artery calcification (CAC). AVC was significantly associated with plasma Lp(a) level, age, body mass index, blood pressure, duration of statin use, cholesterol-year score and CAC score. After adjustment for all significant covariables, plasma Lp(a) concentration remained a significant predictor of AVC, with an odds ratio per 10-mg dL(-1) increase in Lp(a) concentration of 1.11 (95% confidence interval 1.01-1.20, P = 0.03). CONCLUSION In asymptomatic statin-treated FH patients, plasma Lp(a) concentration is an independent risk indicator for AVC.
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Affiliation(s)
- R Vongpromek
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - S Bos
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - G-J R Ten Kate
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Yahya
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - A J M Verhoeven
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - P J de Feyter
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F Kronenberg
- Division of Genetic Epidemiology, Department of Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | - J E Roeters van Lennep
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - E J G Sijbrands
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
| | - M T Mulder
- Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands
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27
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Parisi V, Leosco D, Ferro G, Bevilacqua A, Pagano G, de Lucia C, Perrone Filardi P, Caruso A, Rengo G, Ferrara N. The lipid theory in the pathogenesis of calcific aortic stenosis. Nutr Metab Cardiovasc Dis 2015; 25:519-525. [PMID: 25816732 DOI: 10.1016/j.numecd.2015.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/27/2015] [Accepted: 02/02/2015] [Indexed: 01/04/2023]
Abstract
AIMS Biologically active phenomena, triggered by atherogenesis and inflammation, lead to aortic valve (AV) calcification. Lipids play an important role in activating the cell signaling leading to AV bone deposition. This review, based on evidence from animal and human studies, mainly focused on the involvement of lipids and atherogenic phenomena in the pathogenesis of calcific aortic stenosis (AS). DATA SYNTHESIS The role of elevated low density lipoproteins for the risk of both vascular atherosclerosis and AS has been elucidated. Lipid disorders act synergistically with other risk factors to increase prevalence of calcific AS. Atherosclerosis is also involved in the pathogenesis of bone demineralization, a typical hallmark of aging, which is associated with ectopic calcification at vascular and valvular levels. Animal studies have recently contributed to demonstrate that lipids play an important role in AS pathogenesis through the activation of molecular cell signalings, such as Wnt/Lrp5 and RANK/RANKL/Osteprotegerin, which induce the transition of valvular myofibroblasts toward an osteogenic phenotype with consequent valvular bone deposition. Although all these evidence strongly support the lipid theory in AS pathogenesis, lipids lowering therapies failed to demonstrate in controlled trials a significant efficacy to slow AS progression. Encouraging results from animal studies indicate that physical activity may counteract the biological processes inducing AV degeneration. CONCLUSIONS This review indicates a robust interplay between lipids, inflammation, and calcific AS. This new pathophysiological scenario of such an emerging valvular disease paves the way to the next challenge of cardiovascular research: "prevent and care aortic valve stenosis".
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Affiliation(s)
- V Parisi
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy
| | - D Leosco
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy.
| | - G Ferro
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy
| | - A Bevilacqua
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy
| | - G Pagano
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy
| | - C de Lucia
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy
| | - P Perrone Filardi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Italy
| | - A Caruso
- Casa di Cura S. Michele, Maddaloni, Italy
| | - G Rengo
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy; Fondazione S. Maugeri, IRCCS, Istituto di Telese Terme, BN, Italy
| | - N Ferrara
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Italy; Fondazione S. Maugeri, IRCCS, Istituto di Telese Terme, BN, Italy
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28
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Rajamannan NM. Atorvastatin Attenuates Bone Loss and Aortic Valve Atheroma in LDLR-/- Mice. Cardiology 2015; 132:11-5. [DOI: 10.1159/000381703] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 03/16/2015] [Indexed: 11/19/2022]
Abstract
Atherosclerosis and osteoporosis are the leading causes of mortality and morbidity. The objective of this study was to test this hypothesis in experimental hypercholesterolemia to determine whether statins play a protective role in this process. LDLR-/- mice (n = 60) were allocated to the following groups: group I (n = 20), normal diet; group II (n = 20), 0.25% (w/w) cholesterol diet (w/w), and group III (n = 20), 0.25% (w/w) cholesterol diet + atorvastatin for 48 weeks. Examination of aortic valves (AVA) and femurs for atherosclerosis and calcification markers included micro-CT, special stains, and calcein incorporation. The cholesterol diet induced bone formation in calcified AVA and an increase in macrophage infiltration. Hyperlipidemic bones expressed an increase in osteoclast cells and a decrease in bone formation. Atorvastatin reduced atherosclerosis and bone mineralization in AVA and increased mineralization within femur bones (p < 0.05). Atherosclerosis is present in hyperlipidemic bones and valves as characterized by macrophage and osteoclast infiltration, and it is attenuated by atorvastatin, which may have implications for therapy in the future.
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Boudoulas KD, Wolfe B, Ravi Y, Lilly S, Nagaraja HN, Sai-Sudhakar CB. The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy. J Cardiol 2015; 65:377-82. [DOI: 10.1016/j.jjcc.2014.12.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/20/2014] [Accepted: 12/31/2014] [Indexed: 11/25/2022]
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Capoulade R, Mahmut A, Tastet L, Arsenault M, Bédard É, Dumesnil JG, Després JP, Larose É, Arsenault BJ, Bossé Y, Mathieu P, Pibarot P. Impact of Plasma Lp-PLA2 Activity on the Progression of Aortic Stenosis. JACC Cardiovasc Imaging 2015; 8:26-33. [DOI: 10.1016/j.jcmg.2014.09.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/12/2014] [Accepted: 09/22/2014] [Indexed: 02/05/2023]
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Czamara K, Natorska J, Kapusta P, Baranska M, Kaczor A. Raman microspectroscopy of human aortic valves: investigation of the local and global biochemical changes associated with calcification in aortic stenosis. Analyst 2015; 140:2164-70. [DOI: 10.1039/c4an01856g] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Raman microspectroscopy was applied to characterize the local and global biochemical changes associated with calcification in human stenotic aortic valves.
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Affiliation(s)
- Krzysztof Czamara
- Faculty of Chemistry
- Jagiellonian University
- 30-060 Krakow
- Poland
- Jagiellonian Centre for Experimental Therapeutics (JCET)
| | - Joanna Natorska
- Institute of Cardiology
- Jagiellonian University
- 31-202 Krakow
- Poland
| | | | - Malgorzata Baranska
- Faculty of Chemistry
- Jagiellonian University
- 30-060 Krakow
- Poland
- Jagiellonian Centre for Experimental Therapeutics (JCET)
| | - Agnieszka Kaczor
- Faculty of Chemistry
- Jagiellonian University
- 30-060 Krakow
- Poland
- Jagiellonian Centre for Experimental Therapeutics (JCET)
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The degeneration of biological cardiovascular prostheses under pro-calcific metabolic conditions in a small animal model. Biomaterials 2014; 35:7416-28. [DOI: 10.1016/j.biomaterials.2014.05.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/14/2014] [Indexed: 01/23/2023]
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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.
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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
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Lazaros G, Toutouzas K, Drakopoulou M, Boudoulas H, Stefanadis C, Rajamannan N. Aortic sclerosis and mitral annulus calcification: a window to vascular atherosclerosis? Expert Rev Cardiovasc Ther 2014; 11:863-77. [DOI: 10.1586/14779072.2013.811978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Defining the role of fluid shear stress in the expression of early signaling markers for calcific aortic valve disease. PLoS One 2013; 8:e84433. [PMID: 24376809 PMCID: PMC3871675 DOI: 10.1371/journal.pone.0084433] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/22/2013] [Indexed: 12/14/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is an active process presumably triggered by interplays between cardiovascular risk factors, molecular signaling networks and hemodynamic cues. While earlier studies demonstrated that alterations in fluid shear stress (FSS) on the fibrosa could trigger inflammation, the mechanisms of CAVD pathogenesis secondary to side-specific FSS abnormalities are poorly understood. This knowledge could be critical to the elucidation of key CAVD risk factors such as congenital valve defects, aging and hypertension, which are known to generate FSS disturbances. The objective of this study was to characterize ex vivo the contribution of isolated and combined abnormalities in FSS magnitude and frequency to early valvular pathogenesis. The ventricularis and fibrosa of porcine aortic valve leaflets were exposed simultaneously to different combinations of sub-physiologic/physiologic/supra-physiologic levels of FSS magnitude and frequency for 24, 48 and 72 hours in a double cone-and-plate device. Endothelial activation and paracrine signaling were investigated by measuring cell-adhesion molecule (ICAM-1, VCAM-1) and cytokine (BMP-4, TGF-β1) expressions, respectively. Extracellular matrix (ECM) degradation was characterized by measuring the expression and activity of the proteases MMP-2, MMP-9, cathepsin L and cathepsin S. The effect of the FSS treatment yielding the most significant pathological response was examined over a 72-hour period to characterize the time-dependence of FSS mechano-transduction. While cytokine expression was stimulated under elevated FSS magnitude at normal frequency, ECM degradation was stimulated under both elevated FSS magnitude at normal frequency and physiologic FSS magnitude at abnormal frequency. In contrast, combined FSS magnitude and frequency abnormalities essentially maintained valvular homeostasis. The pathological response under supra-physiologic FSS magnitude peaked at 48 hours but was then maintained until the 72-hour time point. This study confirms the sensitivity of valve leaflets to both FSS magnitude and frequency and suggests the ability of supra-physiologic FSS levels or abnormal FSS frequencies to initiate CAVD mechanisms.
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Hjortnaes J, New SEP, Aikawa E. Visualizing novel concepts of cardiovascular calcification. Trends Cardiovasc Med 2013; 23:71-9. [PMID: 23290463 DOI: 10.1016/j.tcm.2012.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/29/2012] [Accepted: 08/31/2012] [Indexed: 12/19/2022]
Abstract
Cardiovascular calcification is currently viewed as an active disease process similar to embryonic bone formation. Cardiovascular calcification mainly affects the aortic valve and arteries and is associated with increased mortality risk. Aortic valve and arterial calcification share similar risk factors, including age, gender, diabetes, chronic renal disease, and smoking. However, the exact cellular and molecular mechanism of cardiovascular calcification is unknown. Late-stage cardiovascular calcification can be visualized with conventional imaging modalities such as echocardiography and computed tomography. However, these modalities are limited in their ability to detect the development of early calcification and the progression of calcification until advanced tissue mineralization is apparent. Due to the subsequent late diagnosis of cardiovascular calcification, treatment is usually comprised of invasive interventions such as surgery. The need to understand the process of calcification is therefore warranted and requires new imaging modalities which are able to visualize early cardiovascular calcification. This review focuses on the use of new imaging techniques to visualize novel concepts of cardiovascular calcification.
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Affiliation(s)
- Jesper Hjortnaes
- Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, 77 Avenue Louis Pasteur, NRB741J, Boston, MA 02115, USA
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37
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Fantus D, Awan Z, Seidah NG, Genest J. Aortic calcification: Novel insights from familial hypercholesterolemia and potential role for the low-density lipoprotein receptor. Atherosclerosis 2013; 226:9-15. [DOI: 10.1016/j.atherosclerosis.2012.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/19/2012] [Accepted: 08/20/2012] [Indexed: 12/31/2022]
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38
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Boudoulas KD, Borer JS, Boudoulas H. Etiology of Valvular Heart Disease in the 21st Century. Cardiology 2013; 126:139-52. [DOI: 10.1159/000354221] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/01/2013] [Indexed: 11/19/2022]
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39
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Gil-Dones F, Darde VM, Vivanco F, Barderas MG. A comparative study of immunodepletion and equalization methods for aortic stenosis human plasma. Methods Mol Biol 2013; 1005:245-56. [PMID: 23606263 DOI: 10.1007/978-1-62703-386-2_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Calcified aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening with no obstruction of blood flow, known as aortic sclerosis, to severe calcification with impaired leaflet motion or aortic stenosis. Until now, aortic stenosis (AS) was thought to result from aging and "wear and tear" of the aortic valve, but nowadays, it is known that it presents the same risk factors as atherosclerosis and cardiovascular diseases.A proteomic analysis of plasma could permit to identify the changes in protein expression induced by AS in this biological sample. However, the characterization of human plasma proteome is a very complicated task, due to the wide dynamic range of concentration that separates the most abundant proteins and the less common ones (10-12 orders of magnitude). For this reason, plasma analysis requires pre-fractionation methods, and several such techniques are currently used to deplete albumin and other abundant plasma proteins.In this work we describe two different and optimized protocols to decrease the plasma proteome complexity for proteomic analysis. With this, comprehensive and systematic characterization of the plasma proteome in the healthy and diseased aortic stenosis (AS) state will greatly facilitate the development of "useful" biomarkers for early disease detection, clinical diagnosis, and therapy.
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Affiliation(s)
- Felix Gil-Dones
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
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40
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Affiliation(s)
- Jane A Leopold
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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41
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42
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Orton EC, Lacerda CMR, MacLea HB. Signaling pathways in mitral valve degeneration. J Vet Cardiol 2012; 14:7-17. [PMID: 22364692 DOI: 10.1016/j.jvc.2011.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/08/2011] [Indexed: 01/22/2023]
Abstract
Heart valves exhibit a highly-conserved stratified structure exquisitely designed to counter biomechanical forces delivered over a lifetime. Heart valve structure and competence is maintained by heart valve cells through a process of continuous turnover extracellular matrix (ECM). Degenerative (myxomatous) mitral valve disease (DMVD) is an important disease associated with aging in both dogs and humans. DMVD is increasingly regarded as a disease with identifiable signaling mechanisms that control key genes associated with regulation and dysregulation of ECM homeostasis. Initiating stimuli for these signaling pathways have not been fully elucidated but likely include both mechanical and chemical stimuli. Signaling pathways implicated in DMVD include serotonin, transforming growth factor β (TGFβ), and heart valve developmental pathways. High circulating serotonin (carcinoid syndrome) and serotoninergic drugs are known to cause valvulopathy that shares pathologic features with DMVD. Recent evidence supports a local serotonin signaling mechanism, possibly triggered by high tensile loading on heart valves. Serotonin initiates TGFβ signaling, which in turn has been strongly implicated in canine DMVD. Recent evidence suggests that degenerative aortic and mitral valve disease may involve pathologic processes that mimic osteogenesis and chondrogenesis, respectively. These processes may be mediated by developmental pathways shared by heart valves, bone, and cartilage. These pathways include bone morphogenic protein (BMP) and Wnt signaling. Other signaling pathways implicated in heart valve disease include Notch, nitric oxide, and angiotensin II. Ultimately, increased understanding of signaling mechanisms could point to therapeutic strategies aimed at slowing or halting disease progression.
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Affiliation(s)
- E Christopher Orton
- Department of Clinical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO 80523-1678, USA.
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Alexopoulos A, Kaoukis A, Papadaki H, Pyrgakis V. Pathophysiologic mechanisms of calcific aortic stenosis. Ther Adv Cardiovasc Dis 2012; 6:71-80. [DOI: 10.1177/1753944712439337] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Calcific aortic stenosis (CAS) comprises the leading indication for valve replacement in the Western world. Until recently, progressive calcification was considered to be a passive process. Emerging evidence, however, suggests that degenerative aortic stenosis constitutes an active process involving stimulation of several pathophysiologic pathways such as inflammation and osteogenesis. In addition, CAS and atherosclerosis share common features regarding histopathology of lesions. These novel data raise a new perspective on the prevention and treatment of disease. The current article reviews the most important pathophysiologic mechanisms of senile aortic stenosis.
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Affiliation(s)
- Alexandros Alexopoulos
- Department of Cardiology, Athens General Hospital, Mesogeion Avenue, 154, 15669 Athens, Greece
| | - Andreas Kaoukis
- Department of Cardiology, General Hospital of Athens ‘G. Gennimatas’, Greece, Athens, Greece
| | - Helen Papadaki
- Department of Anatomy, School of Medicine, University of Patras, Greece, Rio, Patras, Greece
| | - Vlassios Pyrgakis
- Department of Cardiology, General Hospital of Athens ‘G. Gennimatas’, Greece, Athens, Greece
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Fisher CI, Chen J, Merryman WD. Calcific nodule morphogenesis by heart valve interstitial cells is strain dependent. Biomech Model Mechanobiol 2012; 12:5-17. [PMID: 22307683 DOI: 10.1007/s10237-012-0377-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 01/18/2012] [Indexed: 01/26/2023]
Abstract
Calcific aortic valve disease (CAVD) results in impaired function through the inability of valves to fully open and close, but the causes of this pathology are unknown. Stiffening of the aorta is associated with CAVD and results in exposing the aortic valves to greater mechanical strain. Transforming growth factor β1 (TGF-β1) is enriched in diseased valves and has been shown to combine with strain to synergistically alter aortic valve interstitial cell (AVIC) phenotypes. Therefore, we investigated the role of strain and TGF-β1 on the calcification of AVICs. Following TGF-β1 pretreatment, strain induced intact monolayers to aggregate and calcify. Using a wound assay, we confirmed that TGF-β1 increases tension in the monolayer in parallel with α-smooth muscle actin (αSMA) expression. Continual exposure to strain accelerates aggregates to calcify into mature nodules that contain a necrotic core surrounded by an apoptotic ring. This phenotype appears to be mediated by strain inhibition of AVIC migration after the initial formation of aggregates. To better interpret the extent to which externally applied strain physically impacts this process, we modified the classical Lamé solution, derived using principles from linear elasticity, to reveal strain magnification as a novel feature occurring in a mechanical environment that supports nodule formation. These results indicate that strain can impact multiple points of nodule formation: by modifying tension in the monolayer, remodeling cell contacts, migration, apoptosis, and mineralization. Therefore, strain-induced nodule formation provides new directions for developing strategies to address CAVD.
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Affiliation(s)
- Charles I Fisher
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232-0493, USA
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Rajamannan NM, Evans FJ, Aikawa E, Grande-Allen KJ, Demer LL, Heistad DD, Simmons CA, Masters KS, Mathieu P, O'Brien KD, Schoen FJ, Towler DA, Yoganathan AP, Otto CM. Calcific aortic valve disease: not simply a degenerative process: A review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: Calcific aortic valve disease-2011 update. Circulation 2012; 124:1783-91. [PMID: 22007101 DOI: 10.1161/circulationaha.110.006767] [Citation(s) in RCA: 561] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nalini M Rajamannan
- Division of Cardiology and Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Gil-Dones F, Darde VM, Alonso-Orgaz S, Lopez-Almodovar LF, Mourino-Alvarez L, Padial LR, Vivanco F, Barderas MG. Inside human aortic stenosis: a proteomic analysis of plasma. J Proteomics 2011; 75:1639-53. [PMID: 22178735 DOI: 10.1016/j.jprot.2011.11.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 11/20/2022]
Abstract
Valvular aortic stenosis (AS) produces a slowly progressive obstruction in left ventricular outflow track. For this reason, aortic valve replacement is warranted when the valvular stenosis is hemodinamically significant, becoming the most common worldwide cause of aortic valve surgery. Recent epidemiologic studies have revealed an association between degenerative AS and cardiovascular risk factors for atherosclerosis, althought reducing the exposure to such factors and statin therapies both fail to delay or reverse the pathology. Hence, a deeper understanding of the pathophysiology of this disease is required to identify appropriate preventive measures. A proteomic analysis of plasma will permit to know and identify the changes in protein expression induced by AS in this tissue. Using two-dimensional difference gel electrophoresis (2D-DIGE) followed by mass spectrometry (MS), we compared the crude (not pre-fractioned) and pre-fractioned plasma from AS patients and control subjects. We sought to identify plasma proteins whose expression is modified in AS. In addition we investigated if crude plasma presented some alterations in the more abundant proteins since to date, has never been studied before. We also further investigated the link between this disease and atherosclerosis with a view to identifying new potential markers and therapeutic targets.
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Affiliation(s)
- Félix Gil-Dones
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
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Serum phosphate concentrations: a novel pre-clinical biomarker for cardiovascular calcification. J Am Coll Cardiol 2011; 58:298-9. [PMID: 21737023 DOI: 10.1016/j.jacc.2011.01.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 01/05/2011] [Accepted: 01/11/2011] [Indexed: 11/21/2022]
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van der Linde D, Yap SC, van Dijk APJ, Budts W, Pieper PG, van der Burgh PH, Mulder BJM, Witsenburg M, Cuypers JAAE, Lindemans J, Takkenberg JJM, Roos-Hesselink JW. Effects of rosuvastatin on progression of stenosis in adult patients with congenital aortic stenosis (PROCAS Trial). Am J Cardiol 2011; 108:265-71. [PMID: 21565321 DOI: 10.1016/j.amjcard.2011.03.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 01/31/2023]
Abstract
Recent trials have failed to show that statin therapy halts the progression of calcific aortic stenosis (AS). We hypothesized that statin therapy in younger patients with congenital AS would be more beneficial, because the valve is less calcified. In the present double-blind, placebo-controlled trial, 63 patients with congenital AS (age 18 to 45 years) were randomly assigned to receive either 10 mg of rosuvastatin daily (n = 30) or matched placebo (n = 33). The primary end point was the progression of peak aortic valve velocity. The secondary end points were temporal changes in the left ventricular mass, ascending aortic diameter, and N-terminal pro-brain natriuretic peptide (NT-proBNP). The median follow-up was 2.4 years (interquartile range 1.9 to 3.0). The mean increase in peak velocity was 0.05 ± 0.21 m/s annually in the rosuvastatin group and 0.09 ± 0.24 m/s annually in the placebo group (p = 0.435). The annualized change in the ascending aorta diameter (0.4 ± 1.7 mm with rosuvastatin vs 0.5 ± 1.6 mm with placebo; p = 0.826) and left ventricular mass (1.1 ± 15.8 g with rosuvastatin vs -3.7 ± 30.9 g with placebo; p = 0.476) were not significantly different between the 2 groups. Within the statin group, the NT-proBNP level was 50 pg/ml (range 19 to 98) at baseline and 21 pg/ml (interquartile range 12 to 65) at follow-up (p = 0.638). NT-proBNP increased from 40 pg/ml (interquartile range 20 to 92) to 56 pg/ml (range 26 to 130) within the placebo group (p = 0.008). In conclusion, lipid-lowering therapy with rosuvastatin 10 mg did not reduce the progression of congenital AS in asymptomatic young adult patients. Interestingly, statins halted the increase in NT-proBNP, suggesting a potential positive effect of statins on cardiac function in young patients with congenital AS.
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Abstract
PURPOSE OF REVIEW Aortic stenosis is a common disorder affecting increasing numbers of elderly patients, which is associated with markedly increased cardiovascular morbidity and mortality. Both histological and epidemiological studies have suggested that the process of valve degeneration may resemble atherosclerosis. This review investigates the potential role of lipid-lowering therapy in its management. RECENT FINDINGS The current treatment methods are surgical or endovascular intervention but it has been hoped that antiatherosclerotic therapies might result in a reduction in progression and need for intervention. There have been a number of retrospective studies of lipid-lowering therapy, which suggested that statins might be effective in reducing progression of aortic stenosis. Lately a series of trials of aggressive statin therapy on surrogate markers of progression have shown no benefit from these measures. The controversial Simvastatin-Ezetimibe and Aortic Stenosis (SEAS) endpoint trial did not show any benefit on a combined endpoint of valve-related and ischaemic events but hinted at a reduction in cardiovascular events in this high cardiovascular risk group. SUMMARY The data clearly shows statins have little effect in well established stenotic disease with calcification, but their effects earlier in the disease process (aortic valve sclerosis) remain to be determined.
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