The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis (original) (raw)
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Aortic Valve Sclerosis: Is It a Cardiovascular Risk Factor or a Cardiac Disease Marker
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2007
Background: Aortic valve sclerosis, without stenosis, has been associated with an increased cardiovascular mortality and morbidity due to myocardial infarction. However, it is unclear whether it is a cardiovascular risk factor or a cardiac disease marker. The goal of our study is to evaluate the difference in the prevalence of cardiovascular disease and risk factors among patients with or without aortic sclerosis. Methods: This observational study compared a group of 142 consecutive subjects with aortic valve sclerosis, assigned as group S, with a group of 101 subjects without aortic sclerosis, assigned as group C. Patients with bicuspid aortic valves and those with antegrade Doppler velocity across aortic valve leaflets exceeding 2.0 m/sec were excluded. Results: Mean ages of groups S and C were 71 ± 8, and 68.8 ± 6 years, respectively (P value = not significant). The prevalence of smoking, diabetes, hypercholesterolemia, hypertension, pulse pressure, left ventricular diastolic dysfunction, atrial fibrillation, and stroke was not significantly different between the two groups. However, there was a significantly higher prevalence of left ventricular hypertrophy (P = 0.05), ventricular arrhythmias (P = 0.02), myocardial infarction (P = 0.04), and systolic heart failure (P = 0.04) in aortic sclerosis group. Conclusions: Aortic sclerosis is associated with a higher prevalence of left ventricular hypertrophy, ventricular arrhythmias, myocardial infarction, and systolic heart failure, while the prevalence of cardiovascular risk factors is not different between aortic sclerosis patients and controls. Hence, aortic sclerosis represents a cardiac disease marker useful for early identification of high-risk patients beyond cardiovascular risk factors rate.
Aortic Valve Sclerosis in High-Risk Coronary Artery Disease Patients
Frontiers in Cardiovascular Medicine, 2021
Background: Current knowledge regarding the relationship between aortic valve sclerosis (AVSc), cardiovascular risk factors, and mortality in patients with known coronary artery disease (CAD) is still unclear. The present study aimed at investigating the prevalence of AVSc as well as its association with long-term all-cause mortality in high-risk CAD patients that has never been explored in large cohorts thus far. Methods and Results: In this retrospective and observational cohort study we enrolled high-risk CAD patients, hospitalized at Centro Cardiologico Monzino (CCM), Milan, Italy, between January 2006 and December 2016. The morphology and function of the aortic valve were assessed from the recorded echocardiographic images to evaluate the presence of AVSc, defined as a non-uniform thickening of the aortic leaflets with no consequences on hemodynamics. Data on 5-year all-cause mortality was retrieved from a Regional database. Of the 5,489 patients initially screened, 4,938 (mean age 67 ± 11 years, 3,954 [80%] men) were enrolled in the study. In the overall population, AVSc was detected in 2,138 (43%) patients. Multivariable LASSO regression revealed that age, female gender, diabetes mellitus, previous MI, and left ventricular ejection fraction were independently associated with AVSc. All-cause mortality (adjusted hazard ratio: 1.29, 95%CI: 1.05-1.58) was significantly higher in AVSc than in non-AVSc patients. Conclusions: AVSc is frequently detected in high-risk CAD patients and is associated with long-term mortality. Our findings corroborate the hypothesis that AVSc is an underestimated marker of systemic cardiovascular risk. Thus, AVSc detection may be used to improve long-term risk stratification of high-risk CAD patients.
ASSESSMENT OF AORTIC VALVE SCLEROSIS AS A MARKER OF CORONARY ARTERY DISEASE AND ITS RISK FACTORS.
Introdution: Aortic valve sclerosis is defined as calcification of the aortic leaflets without impairment in leaflet excursion or antegrade velocity across the valve < 2.5 m/s. It is characterized by a gradual progression beginning with calcium deposition that may ultimately transform to aortic stenosis (AS) with obstruction of outflow from the left ventricle. Aortic valve sclerosis (AVS) presence is associated with an increase in cardiovascular mortality and morbidity . Aims & Objective: The aim of this study is to investigate the association between presence of AVS with occurrence of coronary artery disease and classical risk factors. Materials And Methods: The relationship among aortic sclerosis, the presence and acuity of CAD and cardiovascular outcomes in patients presenting with chest pain was studied by prospective follow-up of a cohort of patients from an observational cross-sectional study. A total of 275 Patients were enrolled for the study and all the patients underwent transthoracic echocardiography and diagnostic coronary angiography to assess AVS and to evaluate the extent of coronary artery involvement respectively. Results: Elderly patients aged > 60 years with aortic valve sclerosis had higher prevalence of obstructive coronary artery disease with p value of <0.05 & AVS is considered as independent predictor of obstructive CAD. Conclusion: Our study concludes that AVS is strongly associated with the extent of coronary artery disease and that echocardiographic detection of AVS in patients undergoing coronary angiography may be considered as a new surrogate marker for the extent of coronary atherosclerosis and thereof CAD.
Progression of aortic valve sclerosis to aortic stenosis
The American Journal of Cardiology, 2003
level or low-density lipoprotein cholesterol and highdensity lipoprotein cholesterol concentrations. It would be interesting to know the effects of these factors on severe calcific AS.
2010
The aim of this study was to examine the association between atherosclerosis risk factors, aortic atherosclerosis and aortic valve abnormalities in the general population. BACKGROUND Clinical and experimental studies suggest that aortic valve sclerosis (AVS) is a manifestation of the atherosclerotic process. METHODS Three hundred eighty-one subjects, a sample of the Olmsted County (Minnesota) population, were examined by transthoracic and transesophageal echocardiography. The presence of AVS (thickened valve leaflets), elevated transaortic flow velocities and aortic regurgitation (AR) was determined. The associations between atherosclerosis risk factors, aortic atherosclerosis (imaged by transesophageal echocardiography) and aortic valve abnormalities were examined. RESULTS Age, male gender, body mass index (odds ratio [OR]: 1.07 per kg/m 2 ; 95% confidence interval [CI]: 1.02 to 1.12), antihypertensive treatment (OR: 1.93; CI: 1.12 to 3.32) and plasma homocysteine levels (OR: 1.89 per twofold increase; CI: 0.99 to 3.61) were independently associated with an increased risk of AVS. Age, body mass index and pulse pressure (OR: 1.21 per 10 mm Hg; CI: 1.00 to 1.46) were associated with elevated (upper quintile) transaortic velocities, whereas only age was independently associated with AR. Sinotubular junction sclerosis (p ϭ 0.001) and atherosclerosis of the ascending aorta (p ϭ 0.03) were independently associated with AVS and elevated transaortic velocities, respectively. CONCLUSIONS Atherosclerosis risk factors and proximal aortic atherosclerosis are independently associated with aortic valve abnormalities in the general population. These observations suggest that AVS is an atherosclerosis-like process involving the aortic valve. (J Am Coll Cardiol 2001; 38:827-34) © 2001 by the American College of Cardiology Calcific ("degenerative") aortic valve disease is the most common etiology of acquired aortic valve stenosis (1). Histopathologically, the early lesions of aortic valve sclerosis (AVS) resemble arterial atherosclerotic plaques (2). Furthermore, atherosclerosis risk factors (3,4) and clinical atherosclerotic cardiovascular disease (5) are independently associated with AVS, suggesting that AVS represents an atherosclerosis-like process involving the aortic valve (6). The objectives of our study were to examine the associations between atherosclerosis risk factors, anatomically defined atherosclerosis (atherosclerosis of the thoracic aorta imaged by transesophageal echocardiography [TEE]) and aortic valve abnormalities in the general population. Aortic valve morphology and function were assessed comprehensively by a combination of transthoracic echocardiography (TTE) and TEE in a population-based cohort.
Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation
Journal of the American College of Cardiology, 2004
The present study was designed to evaluate the relationship between the presence of aortic sclerosis, serologic markers of inflammation, and adverse cardiovascular outcomes. BACKGROUND Aortic sclerosis is associated with adverse cardiovascular outcomes. However, the mechanism by which such nonobstructive valve lesions impart excess cardiovascular risk has not been delineated.
Aortic Valve Sclerosis in Patients with Peripheral and/or Coronary Arterial Disease
Echocardiography, 2010
Background: Aortic valve sclerosis (AVS) is a marker of cardiovascular risk; its prevalence increases in elderly and in patients with hypertension and/or coronary arterial disease (CAD). There are no data available in patients with peripheral arterial disease (PAD) and with both CAD and PAD. Methods: To investigate the presence of AVS, 57 patients with stable CAD, 38 with PAD, and 62 with CAD + PAD where studied by echocardiography. Results: The prevalence of AVS progressively increased within groups (P = 0.005). The prevalence of AVS in PAD doubled that in CAD group (42.1% vs. 22.8%, P < 0.05). PAD patients had a 4.634 (95% CI: 1.02-17.88; P = 0.026) fold increased risk of AVS compared to CAD. Also CAD + PAD group had a higher prevalence of aortic sclerosis when compared to CAD group (50.8% vs. 22.8%, P = 0.001). CAD + PAD showed a 3.799 (95% CI: 1.26-11.45; P < 0 .01) fold greater risk of aortic sclerosis than CAD group. There were no differences in AVS prevalence between CAD + PAD and PAD group (50.8% vs. 42.1%; P = 0.36). Age was related to AVS in both analysis (PAD vs. CAD and CAD + PAD vs. CAD: OR = 1.09, 95% CI: 1.02-1.16, P = 0.011 and OR = 1.13, 95% CI: 1.07-1.21; P < 0.001) but no classical cardiovascular risk factors. Conclusions: PAD patients have an elevated prevalence of AVS greater than CAD patients. In patients with both disease, the prevalence of AVS is similar to that of patients with PAD alone. (Echocardiography 2010;27:608-612)
Journal of Clinical Medicine, 2019
Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006–2016). Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement...