Key result
Degenerative aortic valve stenoinsufficiency was associated with higher MACE and mortality than pure stenosis, despite comparable calcium scores (mild AR 4270.7 vs PAS 3507.3).
Why the study?
Does the presence of aortic regurgitation in degenerative aortic valve stenoinsufficiency worsen clinical outcomes compared to pure stenosis or pure regurgitation?
Cohort (n=112)
Does the presence of aortic regurgitation in degenerative aortic valve stenoinsufficiency worsen clinical outcomes compared to pure stenosis or pure regurgitation?
Degenerative aortic valve stenoinsufficiency is associated with a more adverse myocardial and valve remodeling profile and worse clinical outcomes compared to pure stenosis or pure regurgitation.
Should not yet change aortic valve management thresholds; leaves open whether mixed stenoinsufficiency requires distinct risk stratification beyond calcium scoring.
OBJECTIVES: It was the aim of this study to assess the pathophysiological, prognostic role of aortic regurgitation (AR) in the 'mixed pictures' of degenerative aortic valve stenoinsufficiency (ASI) by a multimarker clinical approach. METHODS: We enrolled 112 consecutive surgical PATIENTS: 19 with pure valve stenosis (PAS), 39 with mild regurgitation, 29 with severe regurgitation, and 25 controls with annulo-ectatic AR. All underwent complete echocardiography, carotid ultrasound and aortic/coronary multislice computed tomography calcium score evaluation. We determined tissue semiquantitative osteopontin, metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs) and circulating brain natriuretic peptide. We evaluated major adverse cardiac events and cardiovascular early, long-term mortality after bioprosthetic valve implantation. RESULTS: Tissue calcification, carotid and coronary atherosclerotic disease were prevalent in PAS versus ASI and AR patients. The multislice computed tomography calcium score (Agatston) was comparable between PAS and ASI (PAS 3,507.3 + 2,442.6; mild AR 4,270.7 + 2,213.5; severe AR 3,568.5 + 1,823.4), but much lower in AR (1,247.8 + 2,708.6). In ASI, a plasma/tissue 'profibrotic' MMP/TIMP balance prevailed, with circulating and echocardiographic indices of myocardial dysfunction. Percentages of major adverse cardiac events and early, long-term mortality were higher in ASI. CONCLUSIONS: In ASI, different, still unknown, genetic and dysplastic factors could work synergically with cardiovascular risk factors, determining a much more adverse myocardial and valve remodeling, resulting in worse clinical outcome.
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Vianello et al. (2013) conducted a cohort in Degenerative aortic valve disease (n=112). Degenerative aortic valve stenoinsufficiency (ASI) vs. Pure valve stenosis (PAS) and annulo-ectatic AR was evaluated on Major adverse cardiac events and cardiovascular early, long-term mortality. Degenerative aortic valve stenoinsufficiency was associated with higher MACE and mortality than pure stenosis, despite comparable calcium scores (mild AR 4270.7 vs PAS 3507.3).
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