A multimarker study of degenerative aortic valve disease: Stenoinsufficiency shows more indices of bad prognosis

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

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)126-137
Number of pages12
JournalCardiology
Volume124
Issue number2
DOIs
Publication statusPublished - Mar 2013

Keywords

  • Atherosclerosis
  • Clinical outcome
  • Degenerative aortic valve disease
  • Stenoinsufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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