Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy

Abstract

Background: A strong association between aortic valve sclerosis (AVSc), the earliest manifestation of calcific aortic valve disease, and atherosclerosis exists. The aim of the study was to evaluate the predictive capabilities of AVSc on long-term all-cause mortality, in patients requiring carotid endarterectomy (CEA).Methods and Results: 806 consecutive CEA patients were enrolled. Preoperative echocardiography was used to assess AVSc. Computed tomography angiography was applied for plaque characterization. Kaplan-Meier curves, Cox linear regression, and area under the receiving operator characteristic (AUC) curve analyses were used to evaluate the predictive capability of AVSc. Overall, 348 of 541 patients had AVSc (64%). Age, diabetes, and estimated glomerular filtration rate (eGFR) were associated with AVSc. In the 5-year follow-up, AVSc group had a mortality rate of 16.7% while in no-AVSc group was 7.8%. Independent predictors of all-cause mortality were age, sex, eGFR, left ventricular ejection fraction, and AVSc. After adjustments, AVSc was associated with a significant increase in all-cause mortality risk (hazard ratio, HR = 1.9; 95%CI: 1.04–3.54; p = 0.038). We stratify our cohort based on carotid atheromatous plaque-type: soft, calcified, and mixed-fibrotic. In patients with mixed-fibrotic plaques, the mortality rate of AVSc patients was 15.5% compared to 2.4% in no-AVSc patients. In this group, AVSc was associated with an increased long-term all-cause mortality risk with an adjusted HR of 12.8 (95%CI: 1.71–96.35; p = 0.013), and the AUC, combing eGFR and AVSc was 0.77 (p < 0.001).Conclusions: Our findings indicate that AVSc together with eGFR may be used to improve long-term risk stratification of patients undergoing CEA surgery.

Whole-Blood Transcriptome Unveils Altered Immune Response in Acute Myocardial Infarction Patients With Aortic Valve Sclerosis

“…In addition, the diversity within our patient population, encompassing various age groups, sexes, and comorbidities, strengthens the potential relevance of our findings to a broader spectrum of patients with AVSc. Furthermore, our findings are consistent with those of previous research, 3,4,35–37 which reinforce the notion that AVSc is associated with adverse cardiovascular outcomes. By continuing to unravel the intricate molecular mechanisms underlying this condition, our work may contribute to improved diagnosis and screening, offering potential benefits to patients affected by nonstenotic aortic valve fibro-calcification remodeling.…”

Aortic valve sclerosis in patients with acute myocardial infarction: a marker of increased risk of re-infarction

“…Previously, the results of a meta-analysis on more than 30 studies, which included 10537 patients with AVSc and 25005 controls, showed that the presence of AVSc is associated with coronary artery disease, stroke, and cardiovascular mortality 8 . Indeed, the prevalence of AVSc in patients with CAD is about 45% and even higher (> 60%) in patients with carotid atherosclerosis and after coronary or carotid revascularization these patients had increased overall mortality compared with patients without AVSc 10,11 . Moreover, in patients who underwent coronary artery bypass graft (CABG), the 90-day survival was significantly lower in the AVSc group and the addition of AVSc to the EuroSCORE II improved the stratification of these high-risk patients 9 .…”

“…Results of our previous studies demonstrated that the atherosclerosis risk factors, such as age, hypertension, dyslipidemia, and diabetes mellitus, are associated with AVSc 7 , while epidemiological studies suggested that AVSc is a predictor of both all-cause and cardiovascular mortality 8,9 . Thus, it is not surprising that atherosclerotic diseases (e.g., carotid or coronary atherosclerosis) and AVSc often coexist in the same subject 10,11 .…”

Purinergic Receptor P2Y2 Stimulation Averts Aortic Valve Interstitial Cell Calcification and Myofibroblastic Activation

“…Thus, P2RY2 stimulation could be implemented at the earliest stage of CAVS (i.e., aortic valve sclerosis; AVSc), which is an essential step toward the end-stage disease [ 6 , 25 ]. AVSc is an echocardiographic finding not well understood, which remains a very controversial topic considering it has no clinical symptoms but is linked to increased cardiovascular risk and associated mortality [ 26 , 27 , 28 ]. Taken together, these data suggest that P2RY2 selective activation should be further investigated as a pharmacological target for the prevention of CAVS progression, acting on both calcification and myofibroblastic activation of VICs.…”