Document Detail


Metabolic syndrome is associated with faster degeneration of bioprosthetic valves.
MedLine Citation:
PMID:  16820629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Several studies have reported similarities between calcification of the native aortic valve and atherosclerosis. Recent studies also suggested that hypercholesterolemia may be a risk factor for calcific degeneration of bioprosthetic valves. The metabolic syndrome (MS) is associated with a higher risk of vascular atherosclerosis. We thus hypothesized that the atherogenic features of MS could accelerate bioprosthetic valve degeneration. METHODS AND RESULTS: We included 217 patients who underwent aortic valve replacement with a bioprosthetic valve in the study. Of these patients, 71 patients (33%) had MS defined according to the modified criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III. The annualized increase in mean transprosthetic gradient and the worsening of transprosthetic regurgitation measured by Doppler echocardiography were used to assess the deterioration of valve hemodynamic function. Patients with MS had higher progression of gradient (+4+/-5 mm Hg/year versus +2+/-2 mm Hg/year, P<0.001), higher proportion of > or = 1/3 degree worsening of regurgitation (25% versus 12%, P=0.02), and higher proportion of valve function deterioration defined as regurgitation worsening and/or > or = 3 mm Hg/year increase in gradient (41% versus 25%, P=0.02) when compared with patients without MS. On multivariate analysis, MS was an independent predictor of gradient progression (P=0.01), regurgitation worsening (P=0.02), and valve function deterioration (P=0.02). The other independent predictors were diabetes, renal insufficiency, and higher mean gradient at baseline. CONCLUSIONS: This is the first study to report that the MS is independently associated with faster bioprosthetic valve degeneration. This study could pave the way for the development of a new medical therapy able to significantly reduce the structural valve deterioration of bioprostheses.
Authors:
Martin Briand; Philippe Pibarot; Jean-Pierre Després; Pierre Voisine; Jean G Dumesnil; François Dagenais; Patrick Mathieu
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  114     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-05     Completed Date:  2006-08-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  I512-7     Citation Subset:  AIM; IM    
Affiliation:
Laval Hospital Research Center/Québec Heart Institute, Laval University, 2725 Chemin Sainte-Foy, Sainte-Foy, Québec, Canada, G1V-4G5.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve Insufficiency / etiology,  ultrasonography
Aortic Valve Stenosis / complications,  physiopathology*,  surgery
Atherosclerosis / complications,  physiopathology*
Bioprosthesis*
Calcinosis / complications,  physiopathology*,  surgery
Disease Susceptibility
Female
Heart Valve Prosthesis*
Hemodynamics
Humans
Hypercholesterolemia / complications,  physiopathology*
Kidney Failure, Chronic / complications,  physiopathology
Male
Metabolic Syndrome X / complications,  physiopathology*
Middle Aged
Prosthesis Failure
Recurrence
Time Factors
Comments/Corrections
Comment In:
Nat Clin Pract Cardiovasc Med. 2007 Apr;4(4):192-3   [PMID:  17297484 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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