Aortic Valve Sclerosis in High-Risk Coronary Artery Disease Patients

Abstract

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.

Whole-Blood Transcriptome Unveils Altered Immune Response in Acute Myocardial Infarction Patients With Aortic Valve Sclerosis

“…Indeed, our previous clinical studies, conducted on a much larger cohort, suggest that AVSc is associated with both all-cause and cardiovascular mortality, and AVSc can be considered as an independent prognostic risk marker of adverse outcomes in patients with AMI. 4,33 Furthermore, our findings are consistent with recent evidence suggesting that patients with AMI and moderate aortic stenosis (a more advanced stage of aortic valve degeneration) experience worse clinical outcomes at 1-year follow-up compared with those with mild or no aortic stenosis. 34 This adds further support to our observation that patients with AMI and AVSc are at increased risk of adverse cardiovascular outcomes.…”

“…Experienced cardiologists of Centro Cardiologico Monzino performed echocardiographic scans according to current guidelines. [9][10][11] As previously performed by us, 4 the morphology and function of the aortic valve were assessed from the recorded echocardiographic images to evaluate the presence of AVSc, expressed as a dichotomous variable (yes or no). In cases where echocardiographic analysis of the aortic valve was not detailed on admission, we evaluated echocardiographic images before discharge of the patients.…”

“…Consistently, patients with AVSc have been frequently reported to concurrently have underlying CAD, either subclinical or overt, and AVSc has been associated with both short- and long-term mortality in patients with CAD. 3 , 4 These common features between AVSc and CAD have prompted clinicians to evaluate the effectiveness of more aggressive pharmacological treatments to tackle both conditions at once. 4 Indeed, the detection of AVSc could help physicians to make timely decisions to prevent further fatal and nonfatal ischemic events (ie, acute myocardial infarction [AMI]).…”

“… 3 , 4 These common features between AVSc and CAD have prompted clinicians to evaluate the effectiveness of more aggressive pharmacological treatments to tackle both conditions at once. 4 Indeed, the detection of AVSc could help physicians to make timely decisions to prevent further fatal and nonfatal ischemic events (ie, acute myocardial infarction [AMI]). However, evidence of pathophysiological traits that specifically characterize AVSc in the context of an ongoing AMI is currently lacking.…”

Purinergic Receptor P2Y2 Stimulation Averts Aortic Valve Interstitial Cell Calcification and Myofibroblastic Activation

“…Thus, P2RY2 stimulation could be implemented at the earliest stage of CAVS (i.e., aortic valve sclerosis; AVSc), which is an essential step toward the end-stage disease [ 6 , 25 ]. AVSc is an echocardiographic finding not well understood, which remains a very controversial topic considering it has no clinical symptoms but is linked to increased cardiovascular risk and associated mortality [ 26 , 27 , 28 ]. Taken together, these data suggest that P2RY2 selective activation should be further investigated as a pharmacological target for the prevention of CAVS progression, acting on both calcification and myofibroblastic activation of VICs.…”