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Kim M, Kim JJ, Lee ST, Shim Y, Lee H, Bae S, Son NH, Shin S, Jung IH. Association Between Aortic Valve Sclerosis and Clonal Hematopoiesis of Indeterminate Potential. Ann Lab Med 2024; 44:279-288. [PMID: 38205526 PMCID: PMC10813825 DOI: 10.3343/alm.2023.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Background The mechanism and medical treatment target for degenerative aortic valve disease, including aortic stenosis, is not well studied. In this study, we investigated the effect of clonal hematopoiesis of indeterminate potential (CHIP) on the development of aortic valve sclerosis (AVS), a calcified aortic valve without significant stenosis. Methods Participants with AVS (valves ≥2 mm thick, high echogenicity, and a peak transaortic velocity of <2.5 m/sec) and an age- and sex-matched control group were enrolled. Twenty-four CHIP genes with common variants in cardiovascular disease were used to generate a next-generation sequencing panel. The primary endpoint was the CHIP detection rate between the AVS and control groups. Inverse-probability treatment weighting (IPTW) analysis was performed to adjust for differences in baseline characteristics. Results From April 2020 to April 2022, 187 participants (125 with AVS and 62 controls) were enrolled; the mean age was 72.6±8.5 yrs, and 54.5% were male. An average of 1.3 CHIP variants was observed. CHIP detection, defined by a variant allele frequency (VAF) of ≥0.5%, was similar between the groups. However, the AVS group had larger CHIP clones: 49 (39.2%) participants had a VAF of ≥1% (vs. 13 [21.0%] in the control group; P=0.020), and 25 (20.0%) had a VAF of ≥2% (vs. 4 [6.5%]; P=0.028). AVS is independently associated with a VAF of ≥1% (adjusted odds ratio: 2.44, 95% confidence interval: 1.11-5.36; P=0.027). This trend was concordant and clearer in the IPTW cohort. Conclusions Participants with AVS more commonly had larger CHIP clones than age- and sex-matched controls. Further studies are warranted to identify causality between AVS and CHIP.
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Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Korea
| | - Jin Ju Kim
- Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeeun Shim
- Department of Laboratory Medicine, Graduate School of Medical Sciences, Brain Korea 21 PLUS Project, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeonah Lee
- Department of Laboratory Medicine, Graduate School of Medical Sciences, Brain Korea 21 PLUS Project, Yonsei University College of Medicine, Seoul, Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Korea
| | - Saeam Shin
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine and Cardiovascular Center, Yongin, Korea
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Lin B, Shen Y, Zhang P, Shen Y, Gu Y, He X, Li J, Yang K, Shen W, Zhang Q, Xin Y, Liu Y. Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis. ESC Heart Fail 2023. [PMID: 37308095 PMCID: PMC10375160 DOI: 10.1002/ehf2.14420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS We sought to investigate the relationship between circulating tissue plasminogen activator (t-PA) level and long-term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). METHODS AND RESULTS Serum levels of t-PA were determined in 347 consecutive stable angina patients with (n = 183) or without (n = 164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6 months up to 7 years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all-cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t-PA was significantly higher in AVSc than in non-AVSc patients (2131.22 pg/mL vs. 1495.85 pg/mL, P < 0.001). For patients with AVSc, those with t-PA level above the median (>1840.68 pg/mL) were more likely to meet the primary and secondary endpoints (all P < 0.001). After adjusting for potential confounding factors, serum t-PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t-PA was good, with an AUC-ROC of 0.753 (P < 0.001). The combination of t-PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P < 0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t-PA levels. CONCLUSIONS Elevated circulating t-PA confers an increased risk for poor long-term clinical outcomes in stable coronary artery disease patients with AVSc.
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Affiliation(s)
- Bowen Lin
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Ying Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Pengfei Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yunli Shen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yuying Gu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan He
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Jimin Li
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Ke Yang
- Institute of Cardiovascular Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weifeng Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yuanfeng Xin
- Department of Cardiovascular Surgery, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yehong Liu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
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Barasch E, Gottdiener JS, Tressel W, Bartz TM, Buzkova P, Massera D, deFilippi C, Biggs ML, Psaty BM, Kizer JR, Owens D. The Associations of Aortic Valve Sclerosis, Aortic Annular Increased Reflectivity, and Mitral Annular Calcification with Subsequent Aortic Stenosis in Older Individuals: Findings from the Cardiovascular Health Study. J Am Soc Echocardiogr 2023; 36:41-49.e1. [PMID: 36096340 PMCID: PMC9822849 DOI: 10.1016/j.echo.2022.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although aortic valve sclerosis (AVS) is well described as preceding aortic stenosis (AS), the associations of AS with antecedent mitral annular calcification (MAC) and aortic annular increased reflectivity (AAIR) have not been characterized. In a population-based prospective study, the authors evaluated whether MAC, AAIR, and AVS are associated with the risk for incident AS. METHODS Among participants of the Cardiovascular Health Study free of AS at the 1994-1995 visit, the presence of MAC, AAIR, AVS, and the combination of all three was evaluated in 3,041 participants. Cox proportional-hazards regression was used to assess the association between the presence of calcification and the incidence of moderate or severe AS in three nested models adjusting for factors associated with atherosclerosis and inflammation both relevant to the pathogenesis of AS. RESULTS Over a median follow-up period of 11.5 years (interquartile range, 6.7-17.0 years), 110 cases of incident moderate or severe AS were ascertained. Strong positive associations with incident moderate or severe AS were found for all calcification sites after adjustment for the main model covariates: AAIR (hazard ratio [HR], 2.90; 95% CI, 1.95-4.32; P < .0005), AVS (HR, 2.20; 95% CI, 1.44-3.37; P < .0005), MAC (HR, 1.67; 95% CI, 1.14-2.45; P = .008), and the combination of all three (HR, 2.50; 95% CI, 1.65-3.78; P < .0005). In a secondary analysis, the risk for AS increased with the number of sites at which calcification was present. CONCLUSIONS In a large cohort of community-dwelling elderly individuals, there were strong associations between each of AAIR, AVS, MAC, and the combination of the three and incident moderate or severe AS. The novel finding that AAIR had a particularly strong association with incident AS, even after adjusting for other calcification sites, suggests its value in identifying individuals at risk for AS and potential inclusion in routine assessment by transthoracic echocardiography.
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Affiliation(s)
- Eddy Barasch
- Department of Research and Education, St. Francis Hospital/SUNY at Stony Brook, Roslyn, New York.
| | - John S Gottdiener
- Department of Medicine (Cardiology), University of Maryland School of Medicine, Baltimore, Maryland
| | - William Tressel
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Daniele Massera
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | | | - Mary L Biggs
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System and Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, California
| | - David Owens
- Division of Cardiology, University of Washington, Seattle, Washington
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Kumar P, Aedma S, Varadarajan P, Pai RG. Novel Insights Into Identifying Patients at Risk for Developing Calcific Aortic Stenosis: Clinical Implications. J Am Soc Echocardiogr 2023; 36:50-2. [PMID: 36402636 DOI: 10.1016/j.echo.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
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Dogdus M, Dindas F, Cekici Y, Yildirim A, Kucukosmanoglu M, Koyunsever NY, Abacioglu OO, Kilic S. Association between Circulating Omentin-1 Levels and Aortic Valve Sclerosis. Acta Cardiol Sin 2022; 38:584-590. [PMID: 36176363 PMCID: PMC9479047 DOI: 10.6515/acs.202209_38(5).20220314a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/14/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Aortic valve sclerosis (AVS) is characterized by thickening of the valve leaflets accompanied by increased echogenicity and calcification without significant limitations in valve movements. Omentin-1 is a glycoprotein of the adiponectin family released from visceral adipose tissue, and it can be used as a biomarker of atherosclerosis, obesity, and metabolic syndrome. No studies have demonstrated any relationship between AVS and omentin-1 in the literature. We aimed to explore the association of serum omentin-1 levels with AVS. METHODS Eighty-six patients with AVS and 92 age- and sex-matched controls were enrolled into the study. The baseline clinical characteristics of the patients were recorded. Conventional 2-dimensional echocardiography was performed. Omentin-1 levels were measured. RESULTS The mean omentin-1 level was significantly lower in the AVS (+) group compared to the control group (78.16 ± 44.95 vs. 163.57 ± 59.84 ng/mL, p < 0.001). Omentin-1 [odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.88-5.39, p < 0.001,] and LDL-C (OR = 1.82, 95% CI = 1.33-2.16, p = 0.015) were found to be independent predictors of AVS in multivariate logistic regression analysis. An omentin-1 level of < 92.45 ng/mL had 90.5% sensitivity and 71.4% specificity for the prediction of AVS (area under curve: 0.697, p < 0.001). CONCLUSIONS Our results indicated that a lower omentin-1 level was associated with an increased risk of AVS. We suggest that omentin-1 could be used as a treatment target as well as to predict AVS.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Usak University, Training and Research Hospital, 64100, Usak
| | - Ferhat Dindas
- Department of Cardiology, Usak University, Training and Research Hospital, 64100, Usak
| | - Yusuf Cekici
- Department of Cardiology, Mehmet Akif Inan Research and Training Hospital, 63040, Sanliurfa
| | - Arafat Yildirim
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, 01060, Adana, Turkey
| | - Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, 01060, Adana, Turkey
| | - Nermin Yildiz Koyunsever
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, 01060, Adana, Turkey
| | - Ozge Ozcan Abacioglu
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, 01060, Adana, Turkey
| | - Salih Kilic
- Department of Cardiology, University of Health Sciences, Adana Training and Research Hospital, 01060, Adana, Turkey
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Dogdus M, Yildirim A, Kucukosmanoglu M, Kilic S, Yavuzgil O, Nalbantgil S. Are there any subclinical myocardial dysfunctions in subjects with aortic valve sclerosis? A 3D-speckle tracking echocardiography study. Int J Cardiovasc Imaging 2021; 37:207-13. [PMID: 32888107 DOI: 10.1007/s10554-020-01977-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Aortic valve sclerosis (AVS) is defined as calcified and thickened aortic leaflets without restriction of leaflet motion. We have not found any studies that previously assessed the effect of AVS on myocardial functions with three dimensional-speckle tracking echocardiography (3D-STE). Therefore, we aimed to identify any early changes in left atrial (LA) myocardial dynamics and/or left ventricular (LV) systolic functions in patients with AVS using 3D-STE. Seventy-five patients with AVS and 80 age- and gender-matched controls were enrolled into the study. The baseline clinical characteristics of the study patients were recorded. Conventional 2D echocardiographic and 3D-STE analyses were performed. The LV-global longitudinal strain (LV-GLS) and LV-global circumferential strain (LV-GCS) were significantly decreased in the AVS (+) group than in the control group (p < 0.001 and p = 0.013, respectively). In multivariate logistic regression analysis; LV-GLS (p < 0.001, odds ratio (OR) = 3.16, 95% confidence interval (CI) 1.42-5.63) and Triglyceride (TG) (p = 0.033, OR = 1.29, 95% CI 1.11-1.72) were found to be independent predictors of AVS. ROC analysis was performed to find out the ideal LV-GLS cut-off value for predicting the AVS. A LV-GLS value of > - 18 has 85.8% sensitivity, 67.5% specificity for the prediction of the AVS. Our results support that subjects with AVS may have subclinical LV deformation abnormalities even though they have not LV pressure overload. According to our findings, patients with AVS should be investigated in terms of atherosclerotic risk factors, their dysmetabolic status should be evaluated and closely followed up for their progression to calcific aortic stenosis.
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Kim M, Kim HL, Park KT, Kim YN, Lim JS, Lim WH, Seo JB, Kim SH, Kim MA, Zo JH. Echocardiographic parameters determining cardiovascular outcomes in patients after acute ischemic stroke. Int J Cardiovasc Imaging 2020; 36:1445-54. [PMID: 32297100 DOI: 10.1007/s10554-020-01841-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Abstract
Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic markers in patients with acute ischemic stroke (AIS). A total of 900 patients with AIS who underwent transthoracic echocardiography (72.6 ± 12.0 years and 60% males) were retrospectively reviewed. Composite clinical events, including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization, were assessed during clinical follow-ups. During a median follow-up of 3.3 years (interquartile range 0.6-5.1 years), there were 151 (16.8%) composite events. In the multivariable analyses after controlling for potential confounders, left ventricular ejection fraction (LVEF) < 62% (hazard ratio [HR] 1.62; 95% confidence interval [CI] 1.14-2.30; p = 0.007) and AV sclerosis (AVs) (HR 1.56; 95% CI 1.10-2.21; p = 0.013) were independent prognostic factors associated with composite events. Multivariable analyses showed that HR for composite events gradually increased according to LVEF and AVs: HR was 2.6-fold higher in the highest-risk group than in the lowest group (p < 0.001). Compared with a clinical model (global chi-square = 69.6), LVEF, AVs, and both of them were significantly improved outcome prediction in sequential Cox model analysis (global chi-square = 75.6, 75.7, and 78.8, respectively; p < 0.05 for each) for each. In patients with AIS, LVEF < 62%, and the presence of AV sclerosis can predict future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention.
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Dursun I, Kul S, Bayraktar A, Erkan H, Turan T, Sayin MR, Korkmaz L. Association of Aortic Valve Sclerosis and Clinical Factors in Patients With Acute Myocardial Infarction. Am J Med Sci 2019; 357:474-482. [PMID: 31000422 DOI: 10.1016/j.amjms.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Since aortic valve sclerosis (AVS) and coronary artery disease (CAD) share similar cardiovascular risk factors, we hypothesized that the clinical profile of patients with acute myocardial infarction (AMI) would be worse in the presence of AVS. The aim of this study was to investigate the association between AVS and clinical factors in patients with AMI. METHODS Three hundred and fifteen patients with AMI were consecutively enrolled in the study. Echocardiography was used to assess the aortic valve morphology and left ventricular function. The extent and severity of CAD were assessed by Gensini score and the number of obstructed vessels. The patients were divided into 2 groups according to presence or absence of AVS. RESULTS The overall number of patients with AVS was 132 (41.9%). Patients with AVS were older (69.5 ± 11 vs. 59.5 ± 12 years, P < 0.00001). They also had a higher prevalence of hypertension (61% vs. 45%, P = 0.006), prior CAD (33% vs. 23%, P = 0.041), prior AMI (20% vs. 11%, P = 0.019) and a higher percentage were female (32% vs. 19%, P = 0.007) compared with AMI patients without AVS. There was no significant difference between the 2 groups with respect to the Gensini score (P = 0.372). Prior AMI was associated with AVS on age-adjusted logistic regression analyses. A multivariate analysis showed an independent association between the AVS and prior AMI and age (P < 0.0000001, P = 0.022, respectively). CONCLUSIONS Our results showed that the presence of AVS is associated with AMI recurrence.
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Affiliation(s)
- Ihsan Dursun
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.
| | - Selim Kul
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ali Bayraktar
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Hakan Erkan
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Muhammet Rasit Sayin
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Levent Korkmaz
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
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Seo JH, Chun KJ, Lee BK, Cho BR, Ryu DR. Statins Have No Role in Preventing the Progression of Aortic Valve Sclerosis. J Cardiovasc Imaging 2018; 26:229-237. [PMID: 30607391 PMCID: PMC6310758 DOI: 10.4250/jcvi.2018.26.e27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Statins are thought to have little effect on the progression of aortic stenosis, but the data on their role in patients with aortic valve sclerosis (AVS) are limited and inconsistent. METHODS We retrospectively analyzed 541 consecutive patients (214 men, age: 70 ± 11 years) with AVS. Each patient underwent two or more electrocardiography examinations at least 6 months apart at Kangwon National University Hospital from August 2010 to August 2015. AVS is defined as irregular thickening of the leaflets, focal increases in echogenicity and minimal elevation of the peak aortic valve velocity (> 1.5 and < 2 m/s). The progression rate of AVS was expressed as the increase in peak velocity per year (m/s/yr). RESULTS The mean follow-up duration was 24.9 ± 13.3 months in the statin-treated group and 24.1 ± 12.4 months in the non-statin-treated group (p = 0.460). There were no differences between the statin-treated and non-statin-treated groups in mean age, gender or smoking status. Relative to the non-statin-treated group, a higher number of patients in the statin-treated group had hypertension, diabetes, ischemic heart disease, and stroke. The progression rate of AVS did not differ between the statin-treated and non-statin-treated groups (0.012 ± 0.340 m/s/yr vs. 0.014 ± 0.245 m/s/yr, p = 0.956). Multivariate analysis showed initial peak aortic jet velocity was significantly associated with AVS progression (β = 0.153, p = 0.009). CONCLUSIONS Our study demonstrated that statins had no effect on the progression of AVS. However, well-designed studies are needed to define the prognosis and management of AVS.
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Affiliation(s)
- Jeong-Hun Seo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kwang-Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bong-Ki Lee
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Byung-Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dong Ryeol Ryu
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Abstract
OBJECTIVE We aimed to investigate whether increased whole blood viscosity (WBV) could be an important factor for the occurrence of aortic valve sclerosis (AVS). SUBJECTS AND METHODS A total of 209 patients were enrolled in the study. WBV was calculated using the hematocrit and total plasma protein at a low shear rate (LSR) and a high shear rate (HSR). AVS was defined as irregular valve thickening and calcification (without evidence of outflow obstruction) documented by a peak transvalvular velocity < 2.5 m/s on echocardiographic examination. The patient group consisted of 109 patients with AVS (77 females, 32 males), and 100 subjects without AVS (65 females, 35 males) were assigned to the control group. RESULTS In the AVS group, WBV values were significantly higher for HSR (17.4 ± 0.5 vs. 17.1 ± 0.7 208 s-1, p < 0.001) and LSR (65.9 ± 12.5 vs. 59.7 ± 16.7 0.5 s-1, p = 0.002). In multivariate logistic regression analysis, WBV at HSR and LSR were independent predictors of AVS (odds ratio, OR: 2.24, 95% confidence interval, CI: 1.38-3.64, p = 0.001; OR: 1.026, 95% CI: 1.006-1.046, p = 0.01, respectively). Receiver-operating characteristic (ROC) curve analysis indicated that a WBV cutoff value of 65.4 at LSR had a sensitivity of 46.8% and a specificity of 60.0% (area under the ROC curve, AUC: 0.615, 95% CI: 0.535-0.696, p = 0.004), and a WBV cutoff value of 17.1 at HSR had a sensitivity of 61.5% and specificity of 53% (AUC: 0.648, 95% CI: 0.571-0.725, p < 0.001) for the prediction of AVS. CONCLUSION This study demonstrated that WBV was independently associated with AVS. WBV could be an indicator of inflammation and vessel remodeling without evidence of outflow obstruction.
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Affiliation(s)
- Alper Sercelik
- *Assist. Prof. Alper Sercelik, Department of Cardiology, School of Medicine, Sanko University, Gazi Muhtar Paşa St. No. 36, TR-27090 Şehitkamil/Gaziantep (Turkey), E-Mail
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Duyuler PT, Duyuler S, İleri M, Demir M, Dolu AK, Başyiğit F. Evaluation of Whole Blood Viscosity in Patients with Aortic Sclerosis. J Tehran Heart Cent 2017; 12:6-10. [PMID: 28469685 PMCID: PMC5409952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Blood viscosity and aortic sclerosis (AS) are strong predictors of cardiovascular events. The effects of blood viscosity on AS have not been studied adequately. We aimed to investigate the potential connection between whole blood viscosity (WBV) and AS. Methods: AS was detected by transthoracic echocardiography. The estimation of WBV was carried out at both high shear rate (HSR) (208/s) and low shear rate (LSR) (0.5/s) by previously validated formulae using hematocrit (HcT) and total protein (TP) in g/L. WBV at HSR (208/s) is: (0.12 × HcT) + 0.17 (TP - 2.07) and WBV at LSR (0.5/s) is: (1.89 × HcT) + 3.76 (TP - 78.42). Comparisons of WBV at both HSR and LSR were made between patients with and without AS. Results: We included 94 patients with AS (male = 30.9%, mean age = 67.5 y) and 97 control subjects without AS (male =26.6%, mean age = 69.1 y). Almost all of the clinical, echocardiographic, and biochemical characteristics were similar, but TP values were significantly higher in the AS group than in the control group (72.9 ± 5 g/L vs. 75.8 ± 6.1 g/L; p value < 0.001). Hemoglobin and HcT levels were similar (p value = 0.604 and p value = 0.431, respectively). In the AS group, WBV at LSR and HSR was higher than that in the control group (p value = 0.001 for both LSR and HSR). In multiple stepwise logistic regression analysis, WBV was an independent predictor of AS (p value < 0.001). Conclusion: We found higher WBV in patients with AS than in patients without AS at both LSR (0.5/s) and HSR (208/s). WBV at both LSR and HSR was independently associated with AS.
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Affiliation(s)
- Pınar Türker Duyuler
- Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Serkan Duyuler
- Department of Cardiology, Acıbadem Ankara Hospital, Ankara, Turkey.,*Corresponding Author: Serkan Duyuler, Assistant Professor of Cardiology, Acıbadem Ankara Hastanesi Kardiyoloji Kliniği, Turan Güneş Bulvarı 630. Sokak, No. 6 Oran 06650, Çankaya, Ankara, Turkey. Tel: +90 5556182775. Fax: +90 3124903467..
| | - Mehmet İleri
- Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Mevlüt Demir
- Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Abdullah Kadir Dolu
- Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Funda Başyiğit
- Department of Cardiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
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Di Minno MND, Di Minno A, Songia P, Ambrosino P, Gripari P, Ravani A, Pepi M, Rubba PO, Medda E, Tremoli E, Baldassarre D, Poggio P. Markers of subclinical atherosclerosis in patients with aortic valve sclerosis: A meta-analysis of literature studies. Int J Cardiol 2016; 223:364-370. [PMID: 27543711 DOI: 10.1016/j.ijcard.2016.08.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Growing evidence suggested an association between aortic valve sclerosis (AVSc) and cardiovascular (CV) events. However, little is known about the association of AVSc with major markers of subclinical atherosclerosis. We performed a meta-analysis of literature studies to address this issue. METHODS Studies on the relationship between AVSc and common carotid artery intima-media thickness (IMT), prevalence of carotid plaques (CPs), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and augmentation index (AIx) were systematically searched in electronic databases. Thirteen studies enrolling 1086 AVSc patients and 2124 controls were included. RESULTS Compared to controls, AVSc patients showed higher IMT (MD: 0.32mm; 95%CI: 0.07, 0.58; p=0.014), and higher prevalence of CPs (OR: 4.06; 95%CI: 2.38, 6.93; p<0.001). Moreover, lower FMD (MD: -4.48%; 95%CI: -7.23, -1.74; p=0.001) and higher PWV (MD: 0.96%; 95%CI: 0.11, 1.81; p=0.027) were found in AVSc subjects than in controls, with no differences in AIx (MD: 0.76%; 95%CI: -0.97, 2.49; p=0.389). In meta-regression analyses, body mass index and triglyceride levels have an impact on the difference in IMT between cases and controls, while male gender and smoking habit were associated with the difference in the prevalence of CPs between the two groups. CONCLUSIONS AVSc is significantly associated with altered markers of subclinical atherosclerosis, thus supporting the concept that AVSc and atherosclerosis share common etiopathological mechanism and/or risk factors.
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Affiliation(s)
| | - Alessandro Di Minno
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolare, Università degli Studi di Milano, Milan, Italy
| | - Paola Songia
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolare, Università degli Studi di Milano, Milan, Italy
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Paolo Osvaldo Rubba
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Emanuela Medda
- Genetic Epidemiology Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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13
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Di Minno MND, Di Minno A, Ambrosino P, Songia P, Tremoli E, Poggio P. Aortic valve sclerosis as a marker of atherosclerosis: Novel insights from hepatic steatosis. Int J Cardiol 2016; 217:1-6. [PMID: 27164417 DOI: 10.1016/j.ijcard.2016.04.162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nowadays, aortic valve sclerosis (AVSc) might be considered an atherosclerosis-like process due to significant association with age, male gender and some major features of metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) has been recognized as a clinical expression of the metabolic syndrome and as a predictor of cardiovascular events. We aim, with this meta-analysis, to evaluate the correlation between NAFLD and AVSc; this finding might suggest new insights and interactions among NAFLD, AVSc and the atherosclerotic process. METHODS AND RESULTS A detailed search was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to identify all studies providing data about the association between AVSc and NAFLD. 3 studies enrolling a total of 1172 patients with NAFLD and 1467 controls without NAFLD were included in the meta-analysis. The prevalence of AVSc was 41.3% (95% CI: 32.0%, 51.4%) in NAFLD patients and 24.6% (18.4%, 32.0%) in subjects without NAFLD with a corresponding OR of 2.28 (95% CI: 1.21, 4.28, p=0.01, I(2): 77.6%, p=0.011). A meta-regression analysis showed that age, prevalence of male gender, hypertension, body mass index, and dyslipidemia were directly and significantly associated with the difference in the prevalence of AVSc between patients with NAFLD and those without. CONCLUSIONS In conclusion, our meta-analysis shows a significant association between NAFLD and AVSc. However, further evidence is needed to validate these findings and find out if there is a real link or just a mere association.
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Affiliation(s)
- Matteo Nicola Dario Di Minno
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Alessandro Di Minno
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; University of Milan, Department of Pharmacological and Biomolecular Sciences, Milan, Italy
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paola Songia
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; University of Milan, Department of Pharmacological and Biomolecular Sciences, Milan, Italy
| | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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14
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Norimatsu K, Miura SI, Suematsu Y, Shiga Y, Miyase Y, Nakamura A, Zhang B, Saku K. Association between pentraxin 3 levels and aortic valve calcification. J Cardiol 2015; 68:76-82. [PMID: 26388550 DOI: 10.1016/j.jjcc.2015.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/05/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Aortic valve calcification (AVC) reflects the state of aortic valve sclerosis (AVS), which is a precursor to aortic valve stenosis (AS). Therefore, we investigated the presence of AVC in patients who underwent coronary computed tomography angiography (CTA), which is an effective tool for evaluating early-stage AVC, and examined the association between plasma levels of pentraxin 3 (PTX3) and AVC. METHODS AND RESULTS The subjects consisted of 162 consecutive patients who underwent CTA and in whom we could measure plasma levels of PTX3. We divided the patients into an AVC group (n=42) and a non-AVC group (n=120), as assessed by CT. Furthermore, we divided the patients without AS, assessed by echocardiography, into non-AS AVC (n=23) and non-AS non-AVC groups (n=60). We analyzed the predictors of the presence of AVC in all patients by a logistic regression analysis. AVC was independently associated with PTX3, in addition to age, chronic kidney disease, and coronary artery calcification. We also examined the predictors of the presence of AVC in patients without AS. PTX3, in addition to age, was an independent predictor of the presence of AVC in patients without AS. Finally, we found that adding PTX3 to the model containing age improves the specificity and, therefore, positive predictive value for AVC. CONCLUSIONS PTX3, in addition to age, was shown to be an independent predictor of AVC in patients without AS. The combination of age and PTX3 may be a better approach to the evaluation of AVC than either of these alone.
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Affiliation(s)
- Kenji Norimatsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan.
| | - Yasunori Suematsu
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuiko Miyase
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ayumi Nakamura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Bo Zhang
- Department of Biochemistry, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Molecular Cardiovascular Therapeutics, Fukuoka University School of Medicine, Fukuoka, Japan
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15
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Mantovani A, Pernigo M, Bergamini C, Bonapace S, Lipari P, Valbusa F, Bertolini L, Zenari L, Pichiri I, Dauriz M, Zoppini G, Barbieri E, Byrne CD, Bonora E, Targher G. Heart valve calcification in patients with type 2 diabetes and nonalcoholic fatty liver disease. Metabolism 2015; 64:879-87. [PMID: 25957758 DOI: 10.1016/j.metabol.2015.04.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/03/2015] [Accepted: 04/20/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are two powerful predictors of adverse cardiovascular outcomes in patients with type 2 diabetes, but the etiology of valvular calcification is uncertain. Nonalcoholic fatty liver disease (NAFLD) is an emerging cardiovascular risk factor and is very common in type 2 diabetes, but whether NAFLD is associated with valvular calcification in this group of patients is presently unknown. METHODS We undertook a cross-sectional study of 247 consecutive type 2 diabetic outpatients with no previous history of heart failure, valvular heart diseases (aortic stenosis, mitral stenosis, moderate or severe aortic and mitral regurgitation) or hepatic diseases. Presence of MAC and AVS was detected by echocardiography. NAFLD was diagnosed by ultrasonography. RESULTS Overall, 139 (56.3%) patients had no heart valve calcification (HVC-0), 65 (26.3%) patients had one valve affected (HVC-1) and 43 (17.4%) patients had both valves affected (HVC-2). 175 (70.8%) patients had NAFLD and the prevalence of this disease markedly increased in patients with HVC-2 compared with either HVC-1 or HVC-0 (86.1% vs. 83.1% vs. 60.4%, respectively; p < 0.001). NAFLD was significantly associated with AVS and/or MAC (unadjusted-odds ratio 3.51, 95% CI 1.89-6.51, p < 0.001). Adjustments for age, sex, waist circumference, smoking, blood pressure, hemoglobin A1c, LDL-cholesterol, kidney function parameters, medication use and echocardiographic variables did not appreciably weaken this association (adjusted-odds ratio 2.70, 95% CI 1.23-7.38, p < 0.01). CONCLUSIONS Our results show that NAFLD is an independent predictor of cardiac calcification in both the aortic and mitral valves in patients with type 2 diabetes.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Matteo Pernigo
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Corinna Bergamini
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Paola Lipari
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Filippo Valbusa
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Dauriz
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Barbieri
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR) Italy
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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16
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Bhatt H, Sanghani D, Julliard K, Fernaine G. Does aortic valve sclerosis predicts the severity and complexity of coronary artery disease? Indian Heart J 2015; 67:239-44. [PMID: 26138181 DOI: 10.1016/j.ihj.2015.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 01/23/2023] Open
Abstract
AIM We assessed the association of aortic valve sclerosis (AVS) with atherosclerotic risk factors and severity and complexity of coronary artery disease (CAD). METHODS In this retrospective study, a total of 482 eligible patients were divided into 2 groups: AVS present and AVS absent. All major cardiovascular risk factors and coronary lesion characteristics were included. RESULTS Age was the only independent predictor of AVS. AVS was not independently associated with the number of obstructive vessels, degree of lesion obstruction and SYNTAX score. CONCLUSION AVS is probably a benign marker of age-related degenerative changes in the heart independent of the severity and complexity of CAD.
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Affiliation(s)
- Hemal Bhatt
- Department of Internal Medicine, Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220, USA.
| | - Dharmesh Sanghani
- Department of Internal Medicine, Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220, USA
| | - Kell Julliard
- Department of Internal Medicine, Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220, USA
| | - George Fernaine
- Department of Cardiology, Lutheran Medical Center, 150 55th Street, Brooklyn, NY 11220, USA
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17
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Bertolotti M, Lonardo A, Mussi C, Baldelli E, Pellegrini E, Ballestri S, Romagnoli D, Loria P. Nonalcoholic fatty liver disease and aging: Epidemiology to management. World J Gastroenterol 2014; 20:14185-14204. [PMID: 25339806 PMCID: PMC4202348 DOI: 10.3748/wjg.v20.i39.14185] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/17/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is common in the elderly, in whom it carries a more substantial burden of hepatic (nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma) and extra-hepatic manifestations and complications (cardiovascular disease, extrahepatic neoplasms) than in younger age groups. Therefore, proper identification and management of this condition is a major task for clinical geriatricians and geriatric hepatologists. In this paper, the epidemiology and pathophysiology of this condition are reviewed, and a full discussion of the link between NAFLD and the aspects that are peculiar to elderly individuals is provided; these aspects include frailty, multimorbidity, polypharmacy and dementia. The proper treatment strategy will have to consider the peculiarities of geriatric patients, so a multidisciplinary approach is mandatory. Non-pharmacological treatment (diet and physical exercise) has to be tailored individually considering the physical limitations of most elderly people and the need for an adequate caloric supply. Similarly, the choice of drug treatment must carefully balance the benefits and risks in terms of adverse events and pharmacological interactions in the common context of both multiple health conditions and polypharmacy. In conclusion, further epidemiological and pathophysiological insight is warranted. More accurate understanding of the molecular mechanisms of geriatric NAFLD will help in identifying the most appropriate diagnostic and therapeutic approach for individual elderly patients.
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Sider KL, Zhu C, Kwong AV, Mirzaei Z, de Langé CFM, Simmons CA. Evaluation of a porcine model of early aortic valve sclerosis. Cardiovasc Pathol 2014; 23:289-97. [PMID: 24998316 DOI: 10.1016/j.carpath.2014.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/05/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Calcific aortic valve disease (CAVD) is associated with significant cardiovascular morbidity. While late-stage CAVD is well-described, early pathobiological processes are poorly understood due to the lack of animal models that faithfully replicate early human disease. Here we evaluated a hypercholesterolemic porcine model of early diet-induced aortic valve sclerosis. METHODS Yorkshire swine were fed either a standard or high-fat/high-cholesterol diet for 2 or 5 months. Right coronary aortic valve leaflets were excised and analyzed (immuno)histochemically. RESULTS Early human-like proteoglycan-rich onlays formed between the endothelial layer and elastic lamina in the fibrosa layer of valve leaflets, with accelerated formation associated with hypercholesterolemia (P<.05). Lipid deposition was more abundant in hypercholesterolemic swine (P<.001), but was present in a minority (28%) of onlays. No myofibroblasts, MAC387-positive macrophages, or fascin-positive dendritic cells were detected in 2-month onlays, with only scarce myofibroblasts present at 5 months. Cells that expressed osteochondral markers Sox9 and Msx2 were preferentially found in dense proteoglycan-rich onlays (P<.05) and with hypercholesterolemia (P<.05). Features of more advanced human CAVD, including calcification, were not observed in this necessarily short study. CONCLUSIONS Early aortic valve sclerosis in hypercholesterolemic swine is characterized by the formation of proteoglycan-rich onlays in the fibrosa, which can occur prior to significant lipid accumulation, inflammatory cell infiltration, or myofibroblast activation. These characteristics mimic those of early human aortic valve disease, and thus the porcine model has utility for the study of early valve sclerosis.
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Affiliation(s)
- Krista L Sider
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, Canada, M5S 3G9
| | - Cuilan Zhu
- Department of Animal and Poultry Science, University of Guelph, 50 Stone Road East, Building #70, Guelph, Ontario, Canada, N1G 2W1
| | - Andrea V Kwong
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, Canada, M5S 3G9
| | - Zahra Mirzaei
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, Canada, M5S 3G9
| | - Cornelius F M de Langé
- Department of Animal and Poultry Science, University of Guelph, 50 Stone Road East, Building #70, Guelph, Ontario, Canada, N1G 2W1
| | - Craig A Simmons
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Toronto, Ontario, Canada, M5S 3G9; Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario, Canada, M5S 3G8.
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Poggio P, Sainger R, Branchetti E, Grau JB, Lai EK, Gorman RC, Sacks MS, Parolari A, Bavaria JE, Ferrari G. Noggin attenuates the osteogenic activation of human valve interstitial cells in aortic valve sclerosis. Cardiovasc Res 2013; 98:402-10. [PMID: 23483047 DOI: 10.1093/cvr/cvt055] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIMS Aortic valve sclerosis (AVSc) is a hallmark of several cardiovascular conditions ranging from chronic heart failure and myocardial infarction to calcific aortic valve stenosis (AVS). AVSc, present in 25-30% of patients over 65 years of age, is characterized by thickening of the leaflets with marginal effects on the mechanical proprieties of the valve making its presentation asymptomatic. Despite its clinical prevalence, few studies have investigated the pathogenesis of this disease using human AVSc specimens. Here, we investigate in vitro and ex vivo BMP4-mediated transdifferentiation of human valve interstitial cells (VICs) towards an osteogenic-like phenotype in AVSc. METHODS AND RESULTS Human specimens from 60 patients were collected at the time of aortic valve replacement (AVS) or through the heart transplant programme (Controls and AVSc). We show that non-calcified leaflets from AVSc patients can be induced to express markers of osteogenic transdifferentiation and biomineralization through the combinatory effect of BMP4 and mechanical stimulation. We show that BMP4 antagonist Noggin attenuates VIC activation and biomineralization. Additionally, patient-derived VICs were induced to transdifferentiate using either cell culture or a Tissue Engineering (TE) Aortic Valve model. We determine that while BMP4 alone is not sufficient to induce osteogenic transdifferentiation of AVSc-derived cells, the combinatory effect of BMP4 and mechanical stretch induces VIC activation towards a phenotype typical of late calcified stage of the disease. CONCLUSION This work demonstrates, for the first time using AVSc specimens, that human sclerotic aortic valves can be induced to express marker of osteogenic-like phenotype typical of advanced severe aortic stenosis.
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Affiliation(s)
- Paolo Poggio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ferreira-González I, Pinar-Sopena J, Ribera A, Marsal JR, Cascant P, González-Alujas T, Evangelista A, Brotons C, Moral I, Permanyer-Miralda G, García-Dorado D, Tornos P. Prevalence of calcific aortic valve disease in the elderly and associated risk factors: a population-based study in a Mediterranean area. Eur J Prev Cardiol 2012; 20:1022-30. [PMID: 22679252 DOI: 10.1177/2047487312451238] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To determine the prevalence of aortic valve sclerosis (ASC) and stenosis (AS) in the elderly in a Mediterranean area and to identify associated clinical factors. METHODS AND RESULTS Population cross-sectional study in a random sample of 1068 people ≥65 years in a Mediterranean area. ASC was categorized as absent, mild-to-moderate, or moderate-to-severe depending on the severity of thickening and calcification. The relation between the severity of ASC and potential risk factors was assessed by multinomial logistic regression analysis. Some degree of thickening and/or calcification was present in 45.4%, of the sample, 73.5% in >85 years. AS prevalence was 3% for the total cohort and 7.4% in >85 years. Adjusting for gender it was found that age, smoking habit, hypertension, waist circumference, and ankle-brachial index <0.9 were associated with degrees of ASC. Except for waist circumference, there was a gradient between the magnitude of association and the severity of ASC. The OR for age was 1.56 (95% CI 1.39-1.76) for mild-to-moderate ASC and 2.03 (95% CI 1.72-2.4) for moderate-to-severe ASC, and for smoking habit 1.59 (95% CI 1.08-2.34) for mild-to-moderate ASC and 2.13 (95% CI 1.19-3.78) for moderate-to-severe ASC. Diabetes and renal impairment were associated with advanced but not with early stages of ASC. CONCLUSIONS The prevalence of ASC and AS in people ≥65 years is similar to that reported in other regions. The gradient in the association of cardiovascular risk factors with the severity of ASC suggests that they may be causally implied in the pathogenesis of the disease.
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Sverdlov AL, Ngo DT, Horowitz JD. Pathogenesis of aortic sclerosis: association with low BMI, tissue nitric oxide resistance, but not systemic inflammatory activation. Am J Cardiovasc Dis 2011; 2:43-49. [PMID: 22254213 PMCID: PMC3257151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 11/11/2011] [Indexed: 05/31/2023]
Abstract
Aortic sclerosis (ASc) represents the earliest stage of development of aortic valve thickening, and may eventually progress to aortic valve stenosis (AS). ASc is associated with intra-valvular inflammatory activation, and potentially with attenuation of the anti-inflammatory effect of nitric oxide (NO). We have shown that ASc occurs less frequently in obese individuals, in whom systemic inflammatory activity is generally increased. We explored these relationships further by stratifying a population of 253 ageing individuals according to BMI. Increasing BMI was associated with increased hs-CRP concentrations (r=0.43; p<0.001). However, presence/absence of ASc did not significantly modify this relationship. Furthermore, increasing BMI was independent of tissue responsiveness to NO, as measured via inhibition of platelet aggregation by the NO donor sodium nitroprusside. Therefore the association of low BMI with increased risk of ASc appears to interact neither with systemic inflammatory activation in such individuals, nor with any "paradoxical" occurrence of NO resistance.
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Affiliation(s)
- Aaron L Sverdlov
- University of Adelaide, The Queen Elizabeth Hospital Adelaide, Australia
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Yamaura Y, Watanabe N, Obase K, Hayashida A, Okura H, Yoshida K. Relation between progression of aortic valve sclerosis and carotid intima-media thickening in asymptomatic subjects with cardiovascular risk factors. J Echocardiogr 2010; 8:87-93. [PMID: 27278799 DOI: 10.1007/s12574-010-0038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/01/2010] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aortic valve sclerosis (AVS) is the early lesion of calcific aortic valve disease and may subsequently progress toward valvular stenosis. Histopathological and clinical evidence has suggested that AVS and atherosclerosis share similar mechanisms. However, little is known regarding the relation between the early AVS progression and the early atherosclerosis progression. The carotid intima-media thickness (IMT) by carotid ultrasonography has been established as the surrogate marker of the early atherosclerosis. The aim of this study was to examine the association between progression of early AVS and increase of carotid IMT. METHODS We retrospectively analyzed the data of 127 asymptomatic subjects (49 ± 8 years, 114 men) with ≥1 cardiovascular (CV) risk factors, without history of CV disease, who underwent echocardiographic and carotid ultrasonographic examinations twice ≥6 months apart. We evaluated aortic valve morphology and function and carotid IMT at the baseline and at follow-up examinations. RESULTS During a follow-up of 25 ± 15 months, the number of subjects with AVS was significantly increased (34 vs. 47%, P < 0.0001) and the mean value of carotid IMT was significantly increased (1.16 ± 0.33 vs. 1.29 ± 0.41 mm, P < 0.0001). The progression of AVS was observed in 26 subjects. By logistic regression analysis, the baseline carotid IMT value was an independent predictor of AVS progression (odds ratio = 4.07, P = 0.026). CONCLUSION In asymptomatic subjects with CV risk factors, progression of AVS and increase of carotid IMT were observed during a mean follow-up period of 25 months. Progression of AVS in asymptomatic subjects with CV risk factors was associated with carotid intima-media thickening.
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