Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 5;8(8):1172.
doi: 10.3390/jcm8081172.

Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis

Paolo Poggio  1 , Laura Cavallotti  2 , Veronika A Myasoedova  2 , Alice Bonomi  2 , Paola Songia  2 , Paola Gripari  2 , Vincenza Valerio  2   3 , Mauro Amato  2 , Simone Barbieri  2 , Pompilio Faggiano  4 , Francesco Alamanni  2 , Fabrizio Veglia  2 , Mauro Pepi  2 , Elena Tremoli  2 , Damiano Baldassarre  2   5
Affiliations

Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis

Paolo Poggio et al. J Clin Med. .

Abstract

Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006-2016).

Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement (IDI) analyses were used to evaluate AVSc in predicting 90-day mortality.

Results: AVSc 90-day survival (97.6%) was lower than in no-AVSc (99.4%; p < 0.0001) with a hazard ratio (HR) of 4.0 (95%CI: 1.78, 9.05; p < 0.0001). The HR for AVSc, adjusted for propensity score, was 2.7 (95%CI: 1.17, 6.23; p = 0.02) and IDI statistics confirmed that AVSc significantly adds (p < 0.001) to the identification of high-risk patients than EuroSCORE II alone.

Conclusion: Our data supports the hypothesis that a risk stratification strategy based on AVSc, added to ESII, may allow better recognition of patients at high-risk of short-term mortality after isolated surgical myocardial revascularization. Results from this study warrant further confirmation.

Keywords: EuroSCORE II; aortic valve sclerosis; surgical myocardial revascularization; survival.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Case study selection.
Figure 2
Figure 2
Kaplan-Meier cumulative incidence of patients that underwent surgical myocardial revascularization. (A) unadjusted and (B) adjusted for propensity score survival curves. Patients are stratified accordingly to normal aortic valve morphology (no-AVSc) or to aortic valve sclerosis (AVSc).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Gharacholou S.M., Karon B.L., Shub C., Pellikka P.A. Aortic valve sclerosis and clinical outcomes: Moving toward a definition. Am. J. Med. 2011;124:103–110. doi: 10.1016/j.amjmed.2010.10.012. - DOI - PubMed
    1. Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P., 3rd, Fleisher L.A., Jneid H., Mack M.J., McLeod C.J., O’Gara P.T., et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A Report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017 doi: 10.1161/CIR.0000000000000503. - DOI - PubMed
    1. Poggio P., Branchetti E., Grau J.B., Lai E.K., Gorman R.C., Gorman J.H., 3rd, Sacks M.S., Bavaria J.E., Ferrari G. Osteopontin-CD44v6 interaction mediates calcium deposition via phospho-Akt in valve interstitial cells from patients with noncalcified aortic valve sclerosis. Arterioscler Thromb. Vasc. Biol. 2014;34:2086–2094. doi: 10.1161/ATVBAHA.113.303017. - DOI - PMC - PubMed
    1. Otto C.M., Kuusisto J., Reichenbach D.D., Gown A.M., O’Brien K.D. Characterization of the early lesion of ‘degenerative’ valvular aortic stenosis. Histological and immunohistochemical studies. Circulation. 1994;90:844–853. doi: 10.1161/01.CIR.90.2.844. - DOI - PubMed
    1. Chandra H.R., Goldstein J.A., Choudhary N., O’Neill C.S., George P.B., Gangasani S.R., Cronin L., Marcovitz P.A., Hauser A.M., O’Neill W.W. Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation. J. Am. Coll. Cardiol. 2004;43:169–175. doi: 10.1016/j.jacc.2003.08.036. - DOI - PubMed