Sex-dependent aortic valve pathology in patients with rheumatic heart disease

Feng, Xiaojun; Zheng, Rui; Yang, Di; Cao, Kejiang; Zhang, Shijiang; Wu, Bingruo; Shao, Yongfeng; Zhou, Bin

doi:10.1371/journal.pone.0180230

Cited by 12 publications

(4 citation statements)

References 43 publications

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“…Furthermore, immunohistochemistry assays more comprehensively determine the role of inflammatory markers as compared to observational findings in our study, e.g., a recent study in China indicated the role of M1 macrophages in progressing atrial inflammation and thrombus formation in rheumatic MS patients with AF [29]. Finally, the small sample size hindered the observation of gender-based differences, such as the varied aortic valve pathology observed in a previous study [30].…”

Section: Discussionmentioning

confidence: 88%

Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement

Butt

Ahmad

Nawaz

et al. 2019

Cureus

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Background To assess the prevalence patterns of isolated/mixed rheumatic valvular lesions and associated risk factors among rheumatic heart disease (RHD) patients undergoing surgical valve replacement. Methods An analytical cross-sectional design was used. Purposive sampling was used to select 87 RHD patients who underwent a first-time valve replacement for mitral, aortic, or both valves between April 1 and October 20, 2016, at Punjab Institute of Cardiology, Lahore, Pakistan. Patients with systemic hypertension, diabetes mellitus type-II, congenital heart defects, coronary artery disease, non-rheumatic valvular degeneration, positive test for hepatitis C, or undergoing concomitant coronary artery bypass graft or a ‘redo’ valve replacement procedure were excluded. A proforma was used to collect preoperative data on patients’ demographics, laboratory investigations, electrocardiogram (ECG), and transthoracic echocardiography reports. Results Age (mean ± S.D.) was 32.79 ± 13.06 years, which was divided into four quartile-based groups. Forty-six (52.9%) cases were males. The majority (56.3%) of patients underwent mitral valve replacement. Mitral regurgitation (MR, 80%) was the most common lesion. Of 71 available ECGs, atrial fibrillation was observed in 46.5% cases. Increasing age group was negatively correlated with MR severity (τ c = -0.188, p-value = 0.033) and positively with aortic stenosis (AS) severity (τ c = 0.141, p-value = 0.010). No significant elevations were observed for anti-streptolysin O titer, C-reactive protein, and leukocyte count, though the erythrocyte sedimentation rate was abnormally high in 46.94% cases. Conclusions MR was the most common lesion. MR was more severe in younger patients whilst AS was more severe in older cases. There is little evidence of ongoing residual inflammation.

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Section: Discussionmentioning

confidence: 88%

Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement

Butt

Ahmad

Nawaz

et al. 2019

Cureus

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“…In line with these results, enhanced apoptosis in men-derived AVs and VICs could be a source of apoptotic bodies that would enhance calcific phenotypes in men. Conversely, reduced apoptotic signals have been previously described in women diagnosed with rheumatic heart disease as compared to men, which could explain the decrease in mineralization ( 35 ). Moreover, it has been suggested that apoptotic and necrotic cell loss in heavily calcified AVs may lead to the development of prevalent dystrophic mineralization found in 83% of the histological AV specimens ( 36 ).…”

Section: Discussionmentioning

confidence: 97%

Sex-Differences in Aortic Stenosis: Mechanistic Insights and Clinical Implications

Matilla

Garaikoetxea

Arrieta

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveWe aim to analyse sex-specific differences in aortic valves (AVs) and valve interstitial cells (VICs) from aortic stenosis (AS) patients.Approach and Results238 patients with severe AS undergoing surgical valve replacement were recruited. Two hundred and two AVs (39.1% women) were used for ex vivo analyses and 36 AVs (33.3% women) for in vitro experiments. AVs from men presented increased levels of the inflammatory molecules interleukin (IL)-1β, IL-6, Rantes, and CD45. Oxidative stress (eNOS, myeloperoxidase, malondialdehyde and nitrotyrosine) was upregulated in male AVs. Concerning fibrosis, similar levels of collagen type I, decreased levels of collagen type III and enhanced fibronectin, active Lox-1 and syndecan-1 expressions were found in AVs from men compared with women. Extracellular matrix (ECM) remodeling was characterized by reduced metalloproteinase-1 and 9 expression and increased tissue inhibitor of metalloproteinase-2 expression in male AVs. Importantly, osteogenic markers (bone morphogenetic protein-9, Rank-L, osteopontin, periostin, osteocalcin and Sox-9) and apoptosis (Bax, Caspase 3, p53, and PARP1) were enhanced in AVs from men as compared to women. Isolated male VICs presented higher myofibroblast-like phenotype than female VICs. Male VICs exhibited increased inflammatory, oxidative stress, fibrotic, apoptosis and osteogenic differentiation markers.ConclusionsOur results suggest that the mechanisms driving the pathogenesis of AS could be different in men and women. Male AVs and isolated VICs presented more inflammation, oxidative stress, ECM remodeling and calcification as compared to those from women. A better knowledge of the pathophysiological pathways in AVs and VICs will allow the development of sex-specific options for the treatment of AS.

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“…14 Females tend to have more severe aortic valve lesions compared to males. 16 Statistical analysis showed that sex was not associated with RHD severity (p=0.235). According to Lubega et al 17 there is no association between sex and tricuspid regurgitation, mitral stenosis severity.…”

Section: Discussionmentioning

confidence: 97%

Clinical Characteristics and Number of Valve Lesion in Rheumatic Heart Disease Severity

Desita

Lefi

Rahman

et al. 2021

Glob Med Health Commun

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Rheumatic heart disease (RHD) occurs due to sequelae in the form of damage to the heart valves from the failure of acute rheumatic fever (ARF) therapy. Heart valve damage can cause various complications such as congestive heart failure, arrhythmias, pulmonary hypertension, atrial fibrillation, endocarditis, which can cause death. The study aimed to assess the association between clinical characteristics and valve lesion and rheumatic heart disease severity. The study was an analytic observational with a cross-sectional design of 73 patients with definite RHD from September 2019 to March 2020 in Dr. Soetomo Regional General Hospital. The majority of patients were female (80%, p=0.235) 30–39 years old (34%, p=0.157). The mean age was 42.08±12.16 years. The majority of patients have low socioeconomic status (78%, p=0.025) and rural dwelling location (70%, p=0.138) over three-quarters of patients living with more than four people in the same house (75%). Multivalvular lesions (90%, p=0.003) and severe RHD (77%) were present predominantly. In conclusion, low socioeconomic status and multivalvular lesions are associated with rheumatic heart disease severity. KARAKTERISTIK KLINIS DAN JUMLAH LESI KATUP PADA DERAJAT KEPARAHAN PENYAKIT JANTUNG REUMATIKPenyakit jantung reumatik (PJR) adalah penyakit yang terjadi akibat gejala sisa berupa kerusakan katup jantung dari kegagalan terapi demam reumatik akut (DRA). Kerusakan katup jantung pada PJR dapat menimbulkan berbagai komplikasi seperti gagal jantung kongesti, aritmia, hipertensi pulmonal, atrial fibrilasi, dan endokarditis yang dapat menyebabkan kematian. Penelitian ini bertujuan mencari hubungan karakteristik klinis dan jumlah lesi katup dengan derajat keparahan PJR. Penelitian ini merupakan analitik observasional menggunakan pendekatan cross-sectional. Sampel penelitian ini adalah pasien yang terdiagnosis definitif PJR berdasar atas ekokardiografi pada bulan Sepetember 2019–Maret 2020 di RSUD Dr. Soetomo Surabaya. Didapatkan 73 pasien sesuai dengan kriteria inklusi. Mayoritas pasien berjenis kelamin perempuan (80%; p=0,235), dengan kelompok usia 30–39 (34%; p=0,157). Usia rerata 42,08±12,16 tahun. Sebagian besar pasien berstatus sosial ekonomi rendah (78%, p=0,025) dan lokasi tinggal pedesaan (70%; p=0,138). Lebih dari tiga perempat pasien tinggal dengan ≤4 orang di satu atap (75%). Lesi multivalvular (90%; p=0,003) dan PJR berat (77%) ditemukan secara dominan. Simpulan, status sosial ekonomi rendah dan lesi katup multivalvular berhubungan dengan derajat keparahan penyakit jantung reumatik.

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Sex-dependent aortic valve pathology in patients with rheumatic heart disease

Cited by 12 publications

References 43 publications

Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement

Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement

Sex-Differences in Aortic Stenosis: Mechanistic Insights and Clinical Implications

Clinical Characteristics and Number of Valve Lesion in Rheumatic Heart Disease Severity

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