Increasing baseline aortic valve peak flow velocity is associated with progression of aortic valve stenosis in osteoporosis patients-a possible link to low vitamin D status

Abstract

Purpose: The purpose of this study was to investigate the morphological characteristics of the aortic valve and identify factors associated with the progression of aortic valve stenosis (AS) in osteoporosis patients.

Methods: In this single-center prospective cohort study, we recruited 10 patients (mean age: 75 ± 7 years, 90% female) who were taking anti-resorptive medicines at the outpatient clinic of University of Miyazaki Hospital, Japan. Baseline assessments, including transthoracic echocardiogram, blood sampling, and dual energy X-ray absorptiometry, were performed. Follow-up assessments were conducted at 6, 12, 18, and 24 months.

Results: During the 2-year follow-up, three patients with aortic valve peak flow velocity (AV PFV) ≥2 m/s at baseline developed moderate AS, which is defined as AV PFV ≥3 m/s. However, seven patients with AV PFV <2 m/s did not exhibit any progression of AS. There were significant variations in terms of bone mineral density, T-score values, and biomarkers associated with bone turnover (i.e., bone alkaline phosphatase, tartrate-resistance acid phosphatase-5b) among the enrolled patients, but none of these factors were found to be associated with the progression of AS. All patients exhibited low vitamin D status, with a median level of 16.1 ng/mL (25^th percentile, 9.7 ng/mL; 75^th percentile, 23 ng/mL). The baseline levels of AV PFV values were negatively correlated with 25-hydroxyvitamin D levels, determined by univariate linear regression analysis (beta coefficient = -0.756, 95% confidence interval, -0.136 ̶ -0.023, p = 0.011).

Conclusion: Our data suggest that low vitamin D status might be a potential risk factor for the progression of AS in osteoporosis patients undergoing treatment with anti-resorptive medicines. Elderly patients with osteoporosis patients exhibited a subset of aortic valve stenosis. Our data suggest that the baseline aortic valve peak flow velocity predicts the progression of aortic valve stenosis, and there might be an association between the progression and the co-existing low vitamin D status in these patients.

Keywords: Calcium; Echocardiogram; Osteoporosis; Valvular disease; Vitamin D.

Fig. 1

Spaghetti graphs displaying the changes in aortic valve peak flow velocity (AV PFV) (A), mean pressure gradient (PG) (B), aortic valve area index (AVAI) (C), and left ventricular ejection fraction (LVEF) (D) over the 24-month follow-up period in 10 osteoporosis patients. In the figure, case 1 is represented by a red circle and line, case 4 by a blue circle and line, and case 7 by a green triangle and line

Fig. 2

Spaghetti graphs depicting the changes in brain natriuretic peptide (BNP) (A), estimated glomerular filtration rate (eGFR) (B), bone alkaline phosphatase (BAP) (C), tartrate resistance acid phosphatase (TRACP)-5b (D), albumin-corrected calcium (E), phosphate (F), fibroblast growth factor (FGF)-23 (G), intact parathyroid hormone (iPTH) (H), 25-hydroxyvitamin D (25(OH)D) (I), and 1,25-dihydroxyvimatin D (1,25(OH)₂D) (J) over the 24-month follow-up period in 10 osteoporosis patients. In the figure, case 1 is represented by a red circle and line, case 4 by a blue circle and line, and case 7 by a green triangle and line. The clinical events of case 1 are indicated at the specified time in panel A

Fig. 3

Relationship between aortic valve peak velocity (AV PFV) and 25-hydroxyvitamin D (25(OH)D) levels in 10 osteoporosis patients at baseline. Linear regression was performed to determine the predictive value of 25(OH)D on AV PFV