Osteoprotegerin and Myocardial Fibrosis in Patients with Aortic Stenosis

Figures

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  Figure 1. Box and Whisker Plots of Osteoprotegerin levels by Aortic Stenosis Severity. Patients with severe disease had higher serum OPG levels than those with mild/moderate disease (7.91 ± 3.82 pmol/L vs 5.76 ± 1.96 pmol/L, p = 0.002). Diamond represents the mean OPG level. Outlier data are included on the plots.

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  Figure 2. Box and Whisker Plots of Osteoprotegerin levels by pattern of Myocardial Fibrosis on CMR. Patients with midwall fibrosis on CMR did not have significantly higher levels of OPG compared to those without fibrosis (median 6.78 pmol/L [IQR 4.64–8.61] vs median 5.25 pmol/L [IQR 4.26–7.95 pmol/L], p = 0.12). There was no difference between those with midwall or chronic infarction pattern fibrosis (median 6.78 pmol/L [IQR 4.64–8.61 pmol/L] vs median 6.97 pmol/L [IQR 5.43–11.12 pmol/L], p = 0.27). However, OPG levels in patients with chronic infarction fibrosis were significantly higher than those without fibrosis (p = 0.005). Diamond represents the mean OPG level. Outlier data are included on the plots.

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  Figure 3. Effect of Extent of Fibrosis on OPG per %LGE on CMR. Panel (A) On multivariable linear regression analysis, ‘any’ fibrosis (per % increase in LGE on CMR) increased serum OPG by 0.16 pmol/L (95% CI 0.03–0.30 pmol/L, p = 0.02). Panel (B) Separating out patients based on pattern of fibrosis, midwall fibrosis had no effect on OPG levels (0.10 pmol/L, 95% CI −0.13–0.32, p = 0.39), whereas chronic infarction pattern fibrosis increased serum OPG by 0.19 pmol/L (95% CI 0.03–0.35 pmol/L) for every 1% increase in LGE on CMR (p = 0.02).

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  Figure 4. Effect of EF on OPG Levels. On multivariable linear regression analysis (adjusted for age, sex, AS severity, and presence of myocardial fibrosis), serum OPG levels remained unchanged per 10% change in LV ejection fraction (0.18 pmol/L, 95% CI −0.23–0.59 pmol/L, p = 0.39).