Aortic valve sclerosis is associated with systemic endothelial dysfunction

• Published in: Journal of the American College of Cardiology Vol. 41; no. 1; pp. 136 - 141
• Main Authors: POGGIANTI, Elisa, VENNERI, Lucia, CHUBUCHNY, Vlad, JAMBRIK, Zoltan, BARONCINI, Liz Andrea, PICANO, Eugenio
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 2003
• Subjects: Aged; Aortic Valve - pathology; Aortic Valve Insufficiency - complications; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - physiopathology; Arteriosclerosis - complications; Biological and medical sciences; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Cardiology. Vascular system; Coronary Angiography; Coronary Artery Disease - complications; Dilatation, Pathologic; Echocardiography; Echocardiography, Stress; Endocardial and cardiac valvular diseases; Endothelium, Vascular - pathology; Endothelium, Vascular - physiopathology; Female; Heart; Heart Valve Diseases - complications; Heart Valve Diseases - diagnosis; Heart Valve Diseases - pathology; Humans; Male; Medical sciences; Middle Aged; Risk Factors; Sclerosis; Ultrasonography; Vascular disease; Human; Cardiac valvular disease; Pathogenesis; Dysfunction; Atherosclerosis; Cardiovascular disease; Narrowing; Aortic valve; Sclerosis; Endothelium
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)02622-0

We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process.
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.
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).
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).
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.