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Aortic valve sclerosis is a high predictive marker of systemic endothelial dysfunction in hypertensive patients

Aortenklappensklerose ist ein hoch prädiktiver Marker systemischer endothelialer Dysfunktion bei Hypertoniepatienten

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Abstract

Background

Aortic valve sclerosis (AVS) is closely related to hypertension and is an important predictor of coronary artery disease as well as cardiovascular morbidity and mortality. However, the mechanisms causing AVS have not yet been clarified. Therefore, we planned to investigate the influence of atherosclerosis-related risk factors including C-reactive protein (CRP), epicardial adipose tissue (EAT), carotid intima-media thickness (CIMT), pulse wave velocity (PWV), left ventricular hypertrophy, and the conventional risk parameters as well as endothelial dysfunction in untreated hypertensive patients.

Methods and results

Our study was cross-sectional and observational, and included 107 consecutive untreated hypertensive patients. All patients underwent vascular evaluation by CIMT, PWV, flow-mediated dilation (FMD%), as well as echocardiographic examinations. Age (OR = 1.180, p < 0.001), male sex (OR = 3.056, p = 0.019), waist circumference (OR = 1.082, p = 0.004), EAT (OR = 1.419, p = 0.001), smoking status (OR = 3.161, p = 0.014), FMD% (OR = 0.649, p < 0.001), mean CIMT (OR = 2.481, P < 0.001), and carotid plaque (OR = 4.692, P = 0.001) were associated with AVS in univariate analyses. Multivariate analyses revealed only age (OR = 1.144, P = 0.006) and FMD% (OR = 0.691, 0.001) as independent predictors of AVS. The presence of AVS had a high positive predictive value (100 %) but a low negative predictive value (51 %) for endothelial dysfunction (FMD < 12 %) in hypertensive patients.

Conclusion

Our study supports the theory that systemic endothelial dysfunction has an initial and independent effect on AVS pathogenesis. Moreover, we demonstrated that the presence of AVS in patients with hypertension predicts endothelial dysfunction, with a high positive predictive value. Thus, AVS in hypertensive patients may urge clinicians toward aggressive risk factor modification and intensive treatment.

Zusammenfassung

Hintergrund

Aortenklappensklerose (“aortic valve sclerosis”, AVS) hängt eng mit Hypertonie zusammen und ist ein wichtiger Prädiktor sowohl der koronaren Herzkrankheit als auch von kardiovaskulärer Morbidität und Mortalität. Jedoch sind die Mechanismen, die zur AVS führen, bisher noch nicht genau geklärt. Daher war das Ziel dieser Studie, den Einfluss von Risikofaktoren für Atherosklerose unter Einschluss von C-reaktivem Protein (CRP), epikardialem Fettgewebe („epicardal adipose tissue“, EAT), der Karotis-Intima-Media-Dicke („carotid intima-media thickness“, CIMT), Pulswellengeschwindigkeit („pulse wave velocity“, PWV), linksventrikulärer Hypertrophie und den herkömmlichen Risikofaktoren sowie endothelialer Dysfunktion bei unbehandelten Hypertoniepatienten zu untersuchen.

Methoden und Ergebnisse

An der vorliegenden Querschnitts- und Beobachtungsstudie nahmen 107 konsekutive unbehandelte Hypertoniepatienten teil. Bei sämtlichen Patienten wurde der Gefäßstatus mittels CIMT, PWV und flussvermittelter Dilatation („flow-mediated dilation“, FMD%) erhoben sowie eine Echokardiographie durchgeführt. Alter (Odds Ratio, OR: 1,180; p < 0,001), männliches Geschlecht (OR: 3,056; p = 0,019), Taillenumfang (OR: 1,082; p = 0,004), EAT (OR: 1,419; p = 0,001), Raucherstatus (OR: 3,161; p = 0,014), FMD% (OR: 0,649; p < 0,001), durchschnittliche CIMT (OR: 2,481; p < 0,001) und Karotisplaques (OR: 4,692; p = 0,001) gingen in univariaten Analysen mit AVS einher. In multivariaten Analysen stellten sich lediglich Alter (OR: 1,144; p = 0,006) und FMD% (OR: 0,691; 0,001) als unabhängige Prädiktoren der AVS heraus. Das Vorliegen einer AVS wies einen hohen positiven prädiktiven Wert (100%), aber einen niedrigen negativen prädiktiven Wert (51%) für endotheliale Dysfunktion (FMD < 12 %) bei Hypertoniepatienten auf.

Schlussfolgerung

Die vorliegende Studie stützt die Theorie, dass eine systemische endotheliale Dysfunktion einen anstoßenden und unabhängigen Effekt auf die AVS-Pathogenese hat. Darüber hinaus wurde gezeigt, dass das Vorliegen einer AVS bei Patienten mit Hypertonie Prädiktor endothelialer Dysfunktion mit hohem prädiktivem Wert ist. Eine AVS bei Hypertoniepatienten könnte daher Anlass für klinisch tätige Ärzte sein, aggressiv Einfluss auf Risikofaktoren zu nehmen und eine intensive Behandlung durchzuführen.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, Rize University Medical Faculty, Rize, Turkey

    T. Erdoğan & M.E. Durakoğlugil

  2. Department of Cardiology, Rize Education and Research Hospital, 53020, Rize, Turkey

    M. Çetin,  S.A. Kocaman, E. Ergül & A. Çanga

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  1. T. Erdoğan
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  2. M. Çetin
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  3. S.A. Kocaman
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  4. M.E. Durakoğlugil
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Correspondence to S.A. Kocaman.

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Erdoğan, T., Çetin, M., Kocaman, S. et al. Aortic valve sclerosis is a high predictive marker of systemic endothelial dysfunction in hypertensive patients. Herz 38, 915–921 (2013). https://doi.org/10.1007/s00059-013-3763-9

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  • DOI: https://doi.org/10.1007/s00059-013-3763-9

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