CLINICAL STUDY: DISEASE OF THE AORTIC VALVE OR AORTA
Aortic valve sclerosis is associatedwith systemic endothelial dysfunction
Elisa Poggianti, RN*,
Lucia Venneri, MD*,
Vlad Chubuchny, MD*,
Zoltan Jambrik, MD*,
Liz Andrea Baroncini, MD* and
Eugenio Picano, MD, PhD*,*
* Echocardiography Laboratory, Institute of Clinical Physiology, CNR, Pisa, Italy
Manuscript received March 27, 2002;
revised manuscript received September 10, 2002,
accepted September 20, 2002.
* Reprint requests and correspondence: Dr. Eugenio Picano, CNR, Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy.
picano{at}ifc.cnr.it
OBJECTIVES: We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process.
BACKGROUND: Clinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery.
METHODS: A total of 102 in-hospital patients (76 men; mean age 63.5 ± 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD).
RESULTS: Aortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 ± 28.6 vs. 35.2 ± 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 ± 3.5% vs. 5.3 ± 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01).
CONCLUSIONS: Aortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events.
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Abbreviations and Acronyms
| | AVS | | aortic valve sclerosis | | CAD | | coronary artery disease | | FMD | | flow-mediated dilation | | LV | | left ventricle/ventricular | | MAC | | mitral annular calcification | | MI | | myocardial infarction | | TTE | | transthoracic echocardiography |
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