The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis (original) (raw)
Related papers
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 sclerosis: not an innocent murmur but a marker of increased cardiovascular risk
Heart, 2005
The detection of an ejection systolic murmur in the aortic valve region often corresponds to a diagnosis of aortic sclerosis or minor disruption of the aortic valve with associated turbulence but minimal obstruction. Aortic sclerosis has two important clinical implications. Firstly, aortic sclerosis is an antecedent to clinically significant aortic valve obstruction and, secondly, it acts as a marker of increased risk of cardiovascular events. This article reviews the evidence that aortic sclerosis is a useful adjunctive tool in cardiovascular risk stratification and that its progression to haemodynamically significant aortic stenosis is a potential focus for individual monitoring and for interventional studies.
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.
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.
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.
Association between Aortic Sclerosis and Coronary Artery Disease
The Egyptian Journal of Hospital Medicine, 2022
Background: Although there is a recognized link between cardiovascular hazards and coronary artery disease (CAD), it is still unknown whether aortic sclerosis and CAD are linked. Objective: This study aimed to check whether if there is a link between aortic sclerosis and the existence and severity of coronary artery disease . Patients and methods: 204 individuals were enrolled in the study, transthoracic echocardiographic, and coronary angiography were done. Aortic leaflets were tested for the amount of thickness in the short axis view. The involvement of coronary arteries represented by the gensini score and the association between aortic valve sclerosis score and the degree and severity of coronary affection was investigated using the Gensini score. Results: The individuals were divided into 2 groups grounded on the severity of aortic valve sclerosis. Group A (GP A) included patients with aortic valve sclerosis (AVS) ≥ 2 and group B (GP B) included patients with AVS < 2. In GP ...
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.
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)
The American journal of cardiology, 2005
This study investigated whether aortic valve (AV) sclerosis was associated with traditional cardiovascular (CV) risk factors and CV events in hypertensive patients with electrocardiographic left ventricular (LV) hypertrophy, as previously demonstrated in the general population. AV sclerosis was associated with several CV risk factors and predicted CV events independently of prevalent CV disease and traditional CV risk factors, including LV mass and ejection fraction.
International Journal of Cardiology, 2016
Objective: Growing evidence suggested an association between aortic valve sclerosis (AVSc) and cardiovascular (CV) events. However, little is known about the association of AVSc with major markers of subclinical atherosclerosis. We performed a meta-analysis of literature studies to address this issue. Approach and Results: Studies on the relationship between AVSc and common carotid artery intima-media thickness (IMT), prevalence of carotid plaques (CPs), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and augmentation index (AIx) were systematically searched in electronic databases. Thirteen studies enrolling 1086 AVSc patients and 2124 controls were included. Compared to controls, AVSc patients showed higher IMT (MD: 0.32 mm; 95%CI: 0.07, 0.58; p=0.014), and higher prevalence of CPs (OR: 4.06; 95%CI: 2.38, 6.93; p<0.001). Moreover, lower FMD (MD:-4.48%; 95%CI:-7.23,-1.74; p=0.001) and higher PWV (MD: 0.96%; 95%CI: 0.11, 1.81; p=0.027) were found in AVSc subjects than in controls, with no differences in AIx (MD: 0.76%; 95%CI:-0.97, 2.49; p=0.389). In Meta-regression analyses body mass index and triglycerides levels have an impact on the difference in IMT between cases and controls, while male gender and smoking habit were associated with the difference in the prevalence of CPs between the two groups. Conclusion: AVSc is significantly associated with altered markers of subclinical atherosclerosis, thus supporting the concept that AVSc and atherosclerosis share common etiopathological mechanism and/or risk factors. On this basis, an echocardiogram carried out to assess the state of the aortic valve would be desirable whenever an altered subclinical marker of atherosclerosis is found.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2013
Objective: Although aortic valve sclerosis (AVS) and atherosclerosis may share same atherosclerotic process, there is still a controversy whether AVS may be related to atherosclerotic and nonatherosclerotic processes. The purpose of present study was to investigate this relation. Methods: In this cross-sectional and observational study, we enrolled 60 patients diagnosed with AVS and risk factor matched 76 subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity (PWV). Control and AVS group were examined by B-mode ultrasound to measure the intima-media thickness (IMT). Continuous variables were compared using unpaired t-test and Mann-Whitney U test. Logistic regression analysis was performed in order to find independent predictors of AVS. Results: PWV and augmentation index did not differ between control and AVS groups (11.2±3.6 vs 12±3.2, p=0.18 and 26±7.6 vs 27±9.8, p=0.2 respectively). But IMT was significantly higher in AVS group than in control one (0.76 mm±0.17 vs 0.6 mm±0.16; p<0.001). There was a significant positive bivariate correlation between the presence of AVS, IMT (r=0.43, p<0.001), male gender(r=0.31, p<0.001), augmentation index (r=0.17, p:0,04), and age (r=0.36, p<0.001). Logistic regression analysis demonstrated that only IMT (OR: 1.46, 95% CI: 1.1-1.9, p=0.009) and age (OR: 1.1, 95% CI: 1.01-1.16, p=0.013) were independent predictors of AVS. Conclusion: Increased IMT but not PWV in subjects with AVS compared to control group may suggest that, AVS is probably a multifactorial disease, related to the both atherosclerotic and nonatherosclerotic processes.
Aortic valve sclerosis is associatedwith systemic endothelial dysfunction
Journal of The American College of Cardiology, 2003
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.
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...
International Journal of Cardiology, 2014
There are no studies analyzing the association between aortic valve sclerosis (AVS) and coronary artery disease (CAD) in a large and multicenter patient population with an overall low prevalence of CAD. We hypothesized that AVS could predict the presence and degree of CAD in patients with severe organic mitral regurgitation. Methods: We retrospectively analyzed consecutive patients with flail mitral leaflet who had coronary angiography for pre-surgical screening and not because suspect of CAD. End-points were considered: 1) any degree of CAD (stenosis N 20%) and 2) obstructive CAD (stenosis N 75% of at least one coronary artery). AVS was defined as focal areas of increased echogenicity and thickening of the leaflets. Traditional clinical risk factors were considered: age, male gender, hypertension (N 140/90 mmHg or medical therapy), hypercholesterolemia (total cholesterol N 200 mg/dl or statin), diabetes, family history of CAD and smoking habit. Results: 675 patients (mean age: 64 ± 12; 27% female) formed the study population. Among patients with AVS, 60% and 39% had any-CAD and ob-CAD respectively, on the opposite among patients without AVS 12% and 7% had any-CAD and ob-cad. After adjustment for clinical risk factors, AVS was associated with a 22.7 fold increased risk of any degree of CAD (95% CI 8.1 63.6 p b 0.0001) and with a 21.8 fold increased risk of obstructive-CAD (95% CI 6.6 71.9; p b 0.0001). Conclusion: In a large and multicenter sample of patient with flail mitral leaflet, AVS was strongly associated with the presence and degree of CAD independently of clinical risk factors.
Aortic sclerosis outcome in the elderly
Critical Care, 1999
Acute chest pain, cardiac troponin CK-MB, cTnT, myocardial injury Comments The Cardiovascular Health Study is a prospective study revealing important results as a consequence of the size of the study. Aortic sclerosis has traditionally been described as a benign condition and text books have been consistently reassuring about the clinical findings of a soft ejection murmur with normal character to the carotid pulse. In contrast, this study shows that aortic sclerosis appears to be a marker of coronary artery disease, and its presence may direct the physician to the need for further cardiac investigations. The pathophysiology is difficult to explain at present and awaits further investigation, but the epidemiology is convincing and aortic sclerosis should no longer be thought of as a trivial finding.
Age Distribution of Aortic Sclerosis among Bangladeshi Population
Bangladesh Heart Journal
Aortic sclerosis (ASc) is defined as thickening or calcification of the aortic valve without significant obstruction of blood flow. Aortic sclerosis is diagnosed when in echocardiography, thickening and calcification of one or more cusps of a tricuspid aortic valve is manifested, whereas in aortic stenosis, cusp separation is restricted and the velocity through the aortic valve is > 2.5 m/s. Its prevalence increases with age. Aortic valve stenosis is associated with systemic endothelial dysfunction, and it carries a 50% increase in risk of cardiac death or myocardial infarction. As aortic sclerosis has proved to be more and more relevant in recent days, it has been important to identify epidemiological data and demographic information of aortic sclerosis in Bangladeshi population. This study tried to determine age distribution of aortic sclerosis in Bangladehsi population. Median age of aortic sclerosis patients was 65 years (mean 67 ± 12 years), most of the patients (17.2%) were...
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Journal of Clinical Medicine
Hypercholesterolemia and statins are risk factors for aortic stenosis (AS) and vascular calcification, respectively. Whether heterozygous subjects with familial hypercholesterolemia (HeFH) treated with statins are at risk of AS is unknown. We study the prevalence of AS, aortic valve calcification (AoVC), and aortic sclerosis (ASc) in elderly subjects with HeFH in a prolonged statin treatment. Case-control study, cases were adults ≥65 years of age with a genetic diagnosis of HeFH, LDLc >220 mg/dl, and statin treatment ≥5 years. Controls were relatives of HeFH patients, with LDLc <190 mg/dl. Participants underwent a cardiac ultrasound for aortic valve analysis. We studied 205 subjects, 112 HeFH and 93 controls, with mean age 71.8(6.5) years and 70.0(7.3) years, respectively. HeHF, with respect to controls, presented greater gradients of aortic transvalvular pressure, 7.4(7.3) mmHg versus 5.0(2.8) mmHg, and maximum aortic velocity, 1.7(0.7) m/s versus 1.5(0.4) m/s, and lower aort...
Epigenome alterations in aortic valve stenosis and its related left ventricular hypertrophy
Clinical epigenetics, 2017
Aortic valve stenosis is the most common cardiac valve disease, and with current trends in the population demographics, its prevalence is likely to rise, thus posing a major health and economic burden facing the worldwide societies. Over the past decade, it has become more than clear that our traditional genetic views do not sufficiently explain the well-known link between AS, proatherogenic risk factors, flow-induced mechanical forces, and disease-prone environmental influences. Recent breakthroughs in the field of epigenetics offer us a new perspective on gene regulation, which has broadened our perspective on etiology of aortic stenosis and other aortic valve diseases. Since all known epigenetic marks are potentially reversible this perspective is especially exciting given the potential for development of successful and non-invasive therapeutic intervention and reprogramming of cells at the epigenetic level even in the early stages of disease progression. This review will examine...
Journal of Clinical Medicine
Aortic valve sclerosis (AVSc) is characterized by non-uniform thickening of the leaflets without hemodynamic changes. Endothelial dysfunction, also caused by dysregulation of glutathione homeostasis expressed as ratio between its reduced (GSH) and its oxidised form (GSSG), could represent one of the pathogenic triggers of AVSc. We prospectively enrolled 58 patients with overt atherosclerosis and requiring coronary artery bypass grafting (CABG). The incidence of AVSc in the studied population was 50%. The two groups (No-AVSc and AVSc) had similar clinical characteristics. Pre-operatively, AVSc group showed significantly lower GSH/GSSG ratio than No-AVSc group (p = 0.02). Asymmetric dimethylarginine (ADMA) concentration was significantly higher in AVSc patients compared to No-AVSc patients (p < 0.0001). Explanted sclerotic aortic valves presented a significantly increased protein glutathionylation (Pr-SSG) than No-AVSc ones (p = 0.01). In vitro, inhibition of glutathione reductase ...
Journal of Clinical Medicine
The risk prediction of future cardiovascular events is mainly based on conventional risk factor assessment by validated algorithms, such as the Framingham Risk Score, the Pooled Cohort Equations and the European SCORE Risk Charts. The identification of subclinical atherosclerosis has emerged as a promising tool to refine the individual cardiovascular risk identified by these models, to prognostic stratify asymptomatic individuals and to implement preventive strategies. Several imaging modalities have been proposed for the identification of subclinical organ damage, the main ones being coronary artery calcification scanning by cardiac computed tomography and the two-dimensional ultrasound evaluation of carotid arteries. In this context, echocardiography offers an assessment of cardiac calcifications at different sites, such as the mitral apparatus (including annulus, leaflets and papillary muscles), aortic valve and ascending aorta, findings that are associated with the clinical mani...
Aortic Valve Stenosis and Cardiac Amyloidosis: A Misleading Association
Journal of Clinical Medicine
The association between aortic stenosis (AS) and cardiac amyloidosis (CA) is more frequent than expected. Albeit rare, CA, particularly the transthyretin (ATTR) form, is commonly found in elderly people. ATTR-CA is also the most prevalent form in patients with AS. These conditions share pathophysiological, clinical and imaging findings, making the diagnostic process very challenging. To date, a multiparametric evaluation is suggested in order to detect patients with both AS and CA and choose the best therapeutic option. Given the accuracy of modern non-invasive techniques (i.e., bone scintigraphy), early diagnosis of CA is possible. Flow-charts with the main CA findings which may help clinicians in the diagnostic process have been proposed. The prognostic impact of the combination of AS and CA is not fully known; however, new available specific treatments of ATTR-CA have changed the natural history of the disease and have some impact on the decision-making process for the management...
European heart journal, 2016
Valvular heart disease (VHD) is expected to become more common as the population ages. However, current estimates of its natural history and prevalence are based on historical studies with potential sources of bias. We conducted a cross-sectional analysis of the clinical and epidemiological characteristics of VHD identified at recruitment of a large cohort of older people. We enrolled 2500 individuals aged ≥65 years from a primary care population and screened for undiagnosed VHD using transthoracic echocardiography. Newly identified (predominantly mild) VHD was detected in 51% of participants. The most common abnormalities were aortic sclerosis (34%), mitral regurgitation (22%), and aortic regurgitation (15%). Aortic stenosis was present in 1.3%. The likelihood of undiagnosed VHD was two-fold higher in the two most deprived socioeconomic quintiles than in the most affluent quintile, and three-fold higher in individuals with atrial fibrillation. Clinically significant (moderate or se...
Markers of Subclinical Atherosclerosis in Severe Obesity and One Year after Bariatric Surgery
Journal of Clinical Medicine
Background: Aortic valve sclerosis (AVS), mitral valve sclerosis (MVS), remodeling of major arteries, and increased pericardial fat are associated with subclinical atherosclerosis. We assessed these markers of atherosclerosis in severely obese patients before and 1 year after bariatric surgery. Methods: Eighty-seven severely obese patients (43 ± 10 years, preoperative body mass index [BMI] 41.8 ± 5 kg/m2) underwent echocardiography before and 1 year after Roux-en-Y bypass surgery in the FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic aortic wall thickness (AWT), pericardial fat thickness at the right ventricular free wall, and AVS/MVS based on combined aortic leaflet thickness and hyperechoic valve lesions. Results: Postoperatively, patients experienced a reduction of 12.9 ± 3.9 kg/m2 in BMI, 0.5 ± 1.9 mm in AWT, 2.6 ± 2.3 mm in pericardial fat, and 45%/53% in AVS/MVS (p < 0.05). In multivariate regression analyses with adjustment for ...
Echocardiography, 2019
Aortic stenosis (AS) is one of the most common heart valve lesions in Western countries1 with an estimated incidence of 12.4% in the elderly;2 this rate reaches up to 13% among people over 75 years of age.3 This condition inevitably progresses. Although the early stage is asymptomatic and the prognosis is good, the late stage can lead to high morbidity and mortality.4-6 AS is characterized by progressive valvular narrowing and subsequent left ventricular remodeling, which result in left ventricular systolic and diastolic dysfunction.7 A new echocardiography technique called vector flow mapping (VFM) has been recently proposed to visualize and quantify the blood flow in the ventricle and cardiovascular cavity.8,9 On the basis of color flow Doppler imaging and speckle tracking imaging,10 the technique allows the direct and accurate calculation of details of hemodynamics, including blood velocity, direction and volume, and laminar or eddy flow.11 The energy loss derived from the intra-...
Ventricular Remodeling in Aortic Sclerosis
Internal Medicine, 2020
Background and aims. Aortic sclerosis associates an increased risk of cardiovascular morbidity and mortality. Recent studies suggest that aortic sclerosis is able to produce ventricular remodeling through inflammatory, non-hemodynamic mechanisms. Our study aims to evaluate the correlation between ventricular remodeling and aortic sclerosis severity. Method. 68 patients with aortic sclerosis without other signifficant associated valvulopathies were examined clinically, biologically and echocardiographic. In 20 patients, we quantiffied the severity of aortic valve calciffication using the backscatter ecographic technique, in parasternal long and short axis view. Backscatter values obtained at the valvular level were calibrated to the blood and pericardium backscatter values. Results. In the 68 patients group, transvalvular aortic velocity correlates with left ventricular mass (p =0.031), which in turn incline to augment with increasing calciffication severity assessed by backscatter. ...
A novel in vivo assessment of fluid dynamics on aortic valve leaflet using epi‐aortic echocardiogram
Echocardiography, 2020
Background-Mechanical stress caused by blood flow, such as wall shear stress (WSS) and its related parameters, are key moderators of endothelial degeneration. However, an in vivo method to measure WSS on heart valves has not been developed. Methods-We developed a novel approach, based on vector flow mapping using intraoperative epi-aortic echocardiogram, to measure WSS and oscillatory shear index (OSI) on the aortic valve. We prospectively enrolled 15 patients with normal valves, who underwent coronary artery bypass graft. Results-Systolic WSS on the ventricularis [2.40 ± 0.44 Pa (1.45-3.00 Pa)] was higher than systolic WSS on the fibrosa [0.33 ± 0.08 Pa (0.14-0.47 Pa), P<0.001] and diastolic WSS on the ventricularis [0.18± 0.07 Pa (0.04-0.28 Pa), P<0.001]. OSI on the fibrosa was higher than on the ventricularis (0.
Fiber Scaffold Patterning for Mending Hearts: 3D Organization Bringing the Next Step
Advanced Healthcare Materials, 2019
failure imposes an enormous burden on society. [1] Despite major advances in cardiovascular therapy, there is still no cure available for the rapidly increasing HF-patient population. A few of the most common causes of HF progression are ischemic heart disease, hypertension and valve disorders. [2] The result of these events is an altered structure and function of the heart, impairing the heart's contractility and/or pump function. In the case of myocardial infarction, up to a billion of cardiomyocytes (CM) are lost. [3] This loss of CMs is considered to be irreversible in the adult human heart, as the regenerative capacity of the myocardium is extremely limited. [4] The damaged myocardium is replaced by a noncontractile, fibrotic scar resulting in a loss of pump function through a remodeling process involving myocardial cell death, an inflammatory response, fibrosis, myocyte hypertrophy, and chamber dilation, leading to cardiac dysfunction and ultimately heart failure. To date, the only viable curative therapy for patients with end-stage HF is heart transplantation. However, due to organ donor shortage, heart transplantation is unavailable for most patients and not realistic as a standard therapy. [5] Heart failure (HF) is a leading cause of death worldwide. The most common conditions that lead to HF are coronary artery disease, myocardial infarction, valve disorders, high blood pressure, and cardiomyopathy. Due to the limited regenerative capacity of the heart, the only curative therapy currently available is heart transplantation. Therefore, there is a great need for the development of novel regenerative strategies to repair the injured myocardium, replace damaged valves, and treat occluded coronary arteries. Recent advances in manufacturing technologies have resulted in the precise fabrication of 3D fiber scaffolds with high architectural control that can support and guide new tissue growth, opening exciting new avenues for repair of the human heart. This review discusses the recent advancements in the novel research field of fiber patterning manufacturing technologies for cardiac tissue engineering (cTE) and to what extent these technologies could meet the requirements of the highly organized and structured cardiac tissues. Additionally, future directions of these novel fiber patterning technologies, designs, and applicability to advance cTE are presented.