Document Detail


A multimarker study of degenerative aortic valve disease: stenoinsufficiency shows more indices of bad prognosis.
MedLine Citation:
PMID:  23428667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: It was the aim of this study to assess the pathophysiological, prognostic role of aortic regurgitation (AR) in the 'mixed pictures' of degenerative aortic valve stenoinsufficiency (ASI) by a multimarker clinical approach.
METHODS: We enrolled 112 consecutive surgical
PATIENTS: 19 with pure valve stenosis (PAS), 39 with mild regurgitation, 29 with severe regurgitation, and 25 controls with annulo-ectatic AR. All underwent complete echocardiography, carotid ultrasound and aortic/coronary multislice computed tomography calcium score evaluation. We determined tissue semiquantitative osteopontin, metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs) and circulating brain natriuretic peptide. We evaluated major adverse cardiac events and cardiovascular early, long-term mortality after bioprosthetic valve implantation.
RESULTS: Tissue calcification, carotid and coronary atherosclerotic disease were prevalent in PAS versus ASI and AR patients. The multislice computed tomography calcium score (Agatston) was comparable between PAS and ASI (PAS 3,507.3 + 2,442.6; mild AR 4,270.7 + 2,213.5; severe AR 3,568.5 + 1,823.4), but much lower in AR (1,247.8 + 2,708.6). In ASI, a plasma/tissue 'profibrotic' MMP/TIMP balance prevailed, with circulating and echocardiographic indices of myocardial dysfunction. Percentages of major adverse cardiac events and early, long-term mortality were higher in ASI.
CONCLUSIONS: In ASI, different, still unknown, genetic and dysplastic factors could work synergically with cardiovascular risk factors, determining a much more adverse myocardial and valve remodeling, resulting in worse clinical outcome.
Authors:
Annamaria Vianello; Stefano Perlini; Stefania Cappelli; Giuseppina Palladini; Maria Carmela Epistolato; Daniele Della Latta; Alfredo Cerillo; Sergio Berti; Dante Chiappino; Piero Tanganelli; Mattia Glauber; Annamaria Mazzone
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Publication Detail:
Type:  Journal Article     Date:  2013-02-21
Journal Detail:
Title:  Cardiology     Volume:  124     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2013  
Date Detail:
Created Date:  2013-03-15     Completed Date:  2013-08-19     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  126-37     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 S. Karger AG, Basel.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Insufficiency / mortality*,  pathology,  surgery
Aortic Valve Stenosis / mortality*,  pathology
Atherosclerosis / mortality,  pathology
Biological Markers / metabolism*
Bioprosthesis / adverse effects
Carotid Stenosis / mortality,  pathology
Case-Control Studies
Female
Heart Valve Prosthesis Implantation / adverse effects
Humans
Male
Metalloproteases / metabolism
Natriuretic Peptide, Brain / metabolism
Osteopontin / metabolism
Prognosis
Prospective Studies
Tissue Inhibitor of Metalloproteinases / metabolism
Vascular Calcification / mortality,  pathology
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Tissue Inhibitor of Metalloproteinases; 106441-73-0/Osteopontin; 114471-18-0/Natriuretic Peptide, Brain; EC 3.4.-/Metalloproteases

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


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