Journal article
Calcification and extracellular matrix dysregulation in human postmortem and surgical aortic valves
Heart (British Cardiac Society), Vol.105(21), pp.1616-1621
11/01/2019
DOI: 10.1136/heartjnl-2019-314879
PMID: 31171628
Abstract
ObjectivesCalcific aortic valve disease (CAVD) is a progressive disease ranging from aortic valve (AoV) sclerosis to AoV stenosis (AS), characterised by severe calcification with impaired leaflet function. Due to the lack of early symptoms, the pathological progression towards valve dysfunction is poorly understood. The early patterns of AoV calcification and altered extracellular matrix (ECM) organisation were analysed in individuals postmortem without clinical AS compared with clinical AS.MethodsHistological patterns of calcification and ECM organisation in postmortem AoV leaflets without clinical AS obtained from a tissue repository and surgical specimens obtained from individuals with clinical AS were compared with in vivo imaging prior to transcatheter AoV implantation.ResultsAoV calcification was detected in all samples from individuals >50 years old, with severity increasing with age, independent of known CAVD risk factors. Two distinct types of calcification were identified: ‘Intrinsic’, primarily found at the leaflet hinge of postmortem leaflets, accompanied by abnormal collagen and proteoglycan deposition; and ‘Nodular’, extending from the middle to the tip regions in more severely affected postmortem leaflets and surgical specimens, associated with increased elastin fragmentation and loss of elastin integrity. Even in the absence of increased thickening, abnormalities in ECM composition were observed in postmortem leaflets without clinical AS and worsen in clinical AS.ConclusionsTwo distinct phenotypes of AoV calcification are apparent. While the ‘nodular’ form is recognised on in vivo imaging and is present with CAVD and valve dysfunction, it is unclear if the ‘intrinsic’ form is pathological or detected on in vivo imaging.
Details
- Title: Subtitle
- Calcification and extracellular matrix dysregulation in human postmortem and surgical aortic valves
- Creators
- M Victoria Gomez-Stallons - Cincinnati Children's Hospital Medical CenterJustin T Tretter - Cincinnati Children's Hospital Medical CenterKeira Hassel - Cincinnati Children's Hospital Medical CenterOsniel Gonzalez-Ramos - Cincinnati Children's Hospital Medical CenterDorothy Amofa - Cincinnati Children's Hospital Medical CenterNicholas J Ollberding - Cincinnati Children's Hospital Medical CenterWojciech Mazur - Christ HospitalJoseph K Choo - Christ HospitalJ Michael Smith - TriHealthDean J Kereiakes - Christ HospitalKatherine E Yutzey - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- Heart (British Cardiac Society), Vol.105(21), pp.1616-1621
- DOI
- 10.1136/heartjnl-2019-314879
- PMID
- 31171628
- ISSN
- 1355-6037
- eISSN
- 1468-201X
- Language
- English
- Date published
- 11/01/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984843606002771
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