IntroductIon Aortic stenosis (AS) is the most common valvular heart disease in adults, with the highest prevalence among elderly patients. Aortic valvular lesions have some similarities to atherosclerosis including chronic inflammation, the presence of lipoproteins, cholesterol, macrophages, T cells, 1 and calcification. 2 Growing evidence indicates that AS is an active, potentially modifiable inflammatory process.In contrast to multiple cytokines involved in the development of AS, adipocytokines in AS have attracted less inter est despite their role in atherosclerosis. Adiponectin, leptin, and resistin play a major role in glucose meta bolism, insulin
This study is the first to show that AVS is characterized by increased plasma Lp-PLA2 levels associated with the severity of AVS, which suggests active involvement of Lp-PLA2 in the pathogenesis of AVS.
BackgroundWe evaluated exercise-induced changes in the profile of circulating cytokines and growth factors in patients with AS.MethodsWe studied 32 consecutive asymptomatic moderate-to-severe AS patients and 32 age and sex-matched controls. Plasma levels of interleukin (IL)-6, IL-10, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF)-β were measured at 4 time points, i.e. at rest, at peak bicycle exercise, one hour and 24 hours after a symptom-limited exercise.ResultsExercise increased all the 5 markers in both groups (all p<0.0001). The maximum levels of all tested cytokines were higher in the AS group (all p<0.05) compared with controls. In AS patients the highest levels of VEGF, IL-6, and IL-10 were observed one hour after exercise, while in the control group at peak exercise. In both groups maximum TGF- β levels were observed one hour after exercise. HGF levels were higher at peak and one hour after test in the AS group (p = 0.0001), however the maximum value in AS was observed at peak while in controls after test. In both groups TGF-β was the only marker that remained increased 24 hours after exercise compared with the value at rest (p = 0.0001). The cytokines and growth factors showed no association with heart rate and the workload.ConclusionIn asymptomatic patients with moderate-to-severe AS, exercise produces a different pattern of changes in circulating cytokines and growth factors, and maximum levels of all tested cytokines were significantly higher in AS patients compared with the control group.
Asymptomatic moderate-to-severe AS patients respond to exercise with more pronounced and prolonged increase in thrombin generation, together with impaired fibrinolysis as compared to controls. Repeated episodes of exercise-induced prothrombotic state in AS might contribute to the progression of this disease.
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