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Sarkar A, Chowdhury S, Kumar A, Khan B, Chowdhury S, Gupta R, Hajra A, Aronow WS. Biomarkers as Prognostic Markers for Aortic Stenosis: A Review. Am J Cardiol 2023; 206:53-59. [PMID: 37683577 DOI: 10.1016/j.amjcard.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 09/10/2023]
Abstract
Aortic stenosis (AS) is the most frequent valvular heart disease among the older individuals. Current guidelines indicate intervention for patients with symptomatic or fast progressive severe AS and asymptomatic patients with a reduced left ventricular (LV) ejection fraction by 50%. Interestingly, myocardial damage may have already happened by the time symptoms appear or LV function deteriorates. Serum biomarkers can be an early indicator to show LV function decline and AS progression even before clinical symptom onset. Studies have shown that cardiac biomarkers have prognostic value in patients with AS. Hence, cardiac biomarkers can be helpful in determining the optimum time to intervene. Transcatheter aortic valve replacement is a less invasive alternative to conventional surgical aortic valve replacement. The elevation of cardiac biomarkers at discharge has been associated with 2-year mortality after transcatheter aortic valve replacement. The correlation between biomarkers and AS-associated morbidity and mortality is an area to explore further. The authors of this review article have discussed the role of cardiac biomarkers in patients with AS for better risk stratification and identification of patients who would benefit from early intervention.
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Affiliation(s)
- Ankit Sarkar
- Ruby General Hospital, Kolkata, West Bengal, India
| | | | | | - Baseer Khan
- Liaquat National Hospital, Karachi, Pakistan
| | | | - Rahul Gupta
- Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Wilbert S Aronow
- New York Medical College at Westchester Medical Center, New York
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Martín-Núñez E, Goñi-Olóriz M, Matilla L, Garaikoetxea M, Mourino-Alvarez L, Navarro A, Fernández-Celis A, Tamayo I, Gainza A, Álvarez V, Sádaba R, Barderas MG, Jover E, López-Andrés N. Influence of diabetes mellitus on the pathological profile of aortic stenosis: a sex-based approach. Cardiovasc Diabetol 2023; 22:280. [PMID: 37848892 PMCID: PMC10583330 DOI: 10.1186/s12933-023-02009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) accelerates the progression of aortic stenosis (AS), but how their underlying molecular mechanisms interact is not clear. Moreover, whether DM contributes to clinically relevant sex-differences in AS is unknown. In this work we aim to characterize the sex-specific profile of major pathological mechanisms fundamental to aortic valve (AV) degeneration in AS patients with or without concomitant DM. METHODS 283 patients with severe AS undergoing surgical valve replacement (27.6% DM, 59.4% men) were recruited. Expression of pathological markers related to AS were thoroughly assessed in AVs and valve interstitial cells (VICs) according to sex and presence of DM. Complementary in vitro experiments in VICs in the presence of high-glucose levels (25 mM) for 24, 48 and 72 h were performed. RESULTS Oxidative stress and metabolic dysfunction markers were increased in AVs from diabetic AS patients compared to non-diabetic patients in both sexes. However, disbalanced oxidative stress and enhanced inflammation were more predominant in AVs from male AS diabetic patients. Osteogenic markers were exclusively increased in the AVs of diabetic women. Basal characterization of VICs confirmed that oxidative stress, inflammation, calcification, and metabolic alteration profiles were increased in diabetic VICs with sex-specific differences. VICs cultured in hyperglycemic-like conditions triggered inflammatory responses in men, whereas in women rapid and higher production of pro-osteogenic molecules. CONCLUSIONS DM produces sex-specific pathological phenotypes in AV of AS patients. Importantly, women with diabetes are more prone to develop AV calcification. DM should be considered as a risk factor in AS especially in women.
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Affiliation(s)
- Ernesto Martín-Núñez
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Miriam Goñi-Olóriz
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Lara Matilla
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Mattie Garaikoetxea
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, Spain
- Hospital Nacional de Paraplejicos, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, Spain
| | - Adela Navarro
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Amaya Fernández-Celis
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Ibai Tamayo
- Research Methodology Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia Gainza
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Virginia Álvarez
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - Rafael Sádaba
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, Spain
- Hospital Nacional de Paraplejicos, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, Spain
| | - Eva Jover
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain.
| | - Natalia López-Andrés
- Cardiovascular Translational Research, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), C/Irunlarrea 3, 31008, Pamplona, Spain.
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Huang R, Xu X, Xu C, Zhang S, Xiong Z, Liu M, Huang Y, Wen H, Guo Y, Liao X, Zhuang X. Association between the insulin resistance and all-cause mortality in patients with moderate and severe aortic stenosis: a retrospective cohort study. Cardiovasc Diabetol 2023; 22:238. [PMID: 37660027 PMCID: PMC10475183 DOI: 10.1186/s12933-023-01975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index is a reliable surrogate marker of insulin resistance (IR). However, whether the TyG index has prognostic value in patients with moderate to severe aortic stenosis (AS) remains unclear. METHODS This study enrolled 317 patients with moderate to severe AS at the First Affiliated Hospital of Sun Yat-Sen University. The patients were grouped according to the cut-off value of the TyG index. Cox regression with Firth's penalized maximum likelihood method and restricted cubic splines regression were conducted to assess the association between the TyG index and all-cause mortality. The added value of the TyG index included in the traditional risk factors model for outcome prediction was also analyzed. RESULTS Among 317 patients (mean age 67.70 years, 62.8% male), there was 84 all-cause mortality during a median 38.07 months follow-up. After fully adjusting for confounders, a per-unit increase in the TyG index was associated with a 62% higher all-cause mortality risk (HR 1.622, 95% CI 1.086-2.416, p = 0.018). The restricted cubic splines regression model revealed a linear association between the TyG index and the risk of all-cause mortality (p for nonlinearity = 0.632). The addition of the TyG index in the basic risk model has an incremental effect on the prediction of mortality [C-statistic change from 0.755 to 0.768; continuous net reclassification improvement (95% CI): 0.299 (0.051-0.546), p = 0.017; integrated discrimination improvement: 0.017 (0.001-0.033), p = 0.044]. CONCLUSIONS Higher IR assessed by the TyG index was associated with a higher risk of all-cause mortality in patients with moderate and severe AS.
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Affiliation(s)
- Rihua Huang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Chaoguang Xu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Yiquan Huang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Han Wen
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
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A Molecular (Not Very Becoming) Picture of Stressed Arteries and Heart, with Some Therapeutic Hope. Int J Mol Sci 2023; 24:ijms24043870. [PMID: 36835280 PMCID: PMC9968135 DOI: 10.3390/ijms24043870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
This Special Issue has focused on molecular mechanisms (vascular calcification, endothelial dysfunction, cardiac remodelling, inflammation, oxidative stress, etc [...].
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Castro-Pinto M, López-Menéndez J, Sánchez-Esteban S, Hernández I, Reventún P, Rodríguez-Roda J, Zaragoza C, Saura M. Niveles de quinasa ligada a la integrina endotelial y calcificación valvular: estudio molecular de la calcificación en la estenosis valvular aórtica. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Wachtell K. The sweet development and progression of aortic stenosis. Heart 2022; 108:1759-1760. [PMID: 35738896 DOI: 10.1136/heartjnl-2022-321331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kristian Wachtell
- Department of Cardiology, Cornell University Joan and Sanford I Weill Medical College, New York, New York, USA
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Erkhem-Ochir B, Tatsuishi W, Yokobori T, Gombodorj N, Saeki H, Shirabe K, Abe T. Immunohistochemical Detection of Bacteria in the Resected Valves was Associated with Stromal Immune Checkpoint Protein Expression that may Contribute to Calcific Aortic Stenosis. Semin Thorac Cardiovasc Surg 2021; 34:1170-1177. [PMID: 34688900 DOI: 10.1053/j.semtcvs.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 02/08/2023]
Abstract
Aortic stenosis (AS) is a disease characterized by narrowing of the aortic valve (AV) orifice. The purpose of this study was to clarify the significance of bacterial detection and clinicopathological factors, including valve-infiltrating immune cells and disease severity, in relation to AS. After obtaining the written informed consent form from 50 patients with AS, we performed immunohistochemical analysis of lipopolysaccharide (LPS) for gram-negative bacteria and lipoteichoic acid (LTA) for gram-positive bacteria on surgically resected-AVs. Moreover, we evaluated the relationships among the presence of bacteria, immune checkpoint protein PD-L1 expression, and immune cell infiltrations such as CD8-positive T lymphocytes, CD163-positive macrophages, and FOXP3-positive regulatory T cell (Treg) in resected-aortic valves. LPS detection in the resected-aortic valve tissues was significantly associated with stromal PD-L1 expression, valve calcification, and LTA existence in resected samples. We showed that the presence of LPS was significantly related to high PD-L1 expression only in calcified-AVs, not in non-calcified-AVs. Moreover, the high expression of PD-L1 in AS samples without LPS was significantly associated with positive infiltration of CD163-positive macrophages and FOXP3-positive Tregs. Immunohistochemical bacterial detection in resected-aortic valves was associated with PD-L1 accumulation and valve calcification. PD-L1 significantly accumulated only in calcified valves with LPS existence.
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Affiliation(s)
- Bilguun Erkhem-Ochir
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi Gunma, Japan; Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi Gunma, Japan
| | - Wataru Tatsuishi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi Gunma, Japan
| | - Takehiko Yokobori
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi Gunma, Japan.
| | - Navchaa Gombodorj
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi Gunma, Japan; Department of Radiation Oncology, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
| | - Hiroshi Saeki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi Gunma, Japan
| | - Tomonobu Abe
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi Gunma, Japan
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