CARDIOVASCULAR MEDICINE

T lymphocyte infiltration in non-rheumatic aortic stenosis: a comparative descriptive study between tricuspid and bicuspid aortic valves

L Wallby², B Janerot-Sjöberg², T Steffensen³, M Broqvist¹

¹ Department of Cardiology, University Hospital, Linköping, Sweden
² Department of Clinical Physiology, University Hospital, Linköping
³ Department of Pathology, University Hospital, Linköping

Correspondence to:
Correspondence to:
Dr Lars Wallby, Linköping Heart Centre, University Hospital, S-581 85 Linköping, Sweden;
lars.wallby{at}lio.se

Background: The two most common causes of aortic stenosis are primary "degenerative" calcification of tricuspid aortic valves and secondary calcification of congenital bicuspid valves. T lymphocyte infiltration occurs in stenotic tricuspid aortic valves, indicating an inflammatory component, but it has not been shown whether it also occurs in stenotic bicuspid valves.

Objective: To compare non-rheumatic tricuspid and bicuspid stenotic aortic valves for the presence and distribution of T lymphocytes.

Setting: University hospital.

Patients and design: Valve specimens were obtained from 29 patients (15 women, 14 men, mean age 69 years (range 52–81 years)), referred to the hospital for aortic valve replacement because of symptomatic aortic valve stenosis. There were 17 tricuspid valves (from 10 women and seven men, mean age 71 years) and 12 bicuspid valves (from five women and seven men, mean age 67 years). To identify mononuclear inflammatory cells, sections were stained with antibodies for CD3 (pan-T cell antigen, Dako 1:400) and then graded histologically according to the degree of T cell infiltrate.

Results: T lymphocyte infiltration was present in both tricuspid and bicuspid stenotic aortic valves, without any significant differences in extent or localisation.

Conclusions: Stenotic bicuspid aortic valves show the same degree of T lymphocyte infiltration as degenerative tricuspid aortic valves. Inflammation needs to be considered in the pathogenesis of acquired aortic stenosis, irrespective of the primary valve anomaly.

Keywords: aortic valve stenosis; pathology; lymphocytes; inflammation

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Ngo, D. T.M., Sverdlov, A. L., Willoughby, S. R., Nightingale, A. K., Chirkov, Y. Y., McNeil, J. J., Horowitz, J. D. (2009). Determinants of Occurrence of Aortic Sclerosis in an Aging Population. J Am Coll Cardiol Img 2: 919-927 [Abstract] [Full Text]  
• Dal-Bianco, J. P., Khandheria, B. K., Mookadam, F., Gentile, F., Sengupta, P. P. (2008). Management of Asymptomatic Severe Aortic Stenosis. J Am Coll Cardiol 52: 1279-1292 [Abstract] [Full Text]  
• 2006 WRITING COMMITTEE MEMBERS, , Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 118: e523-e661 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., O'Rourke, R. A., Shah, P. M. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52: e1-e142 [Full Text]  
• Toutouzas, K., Drakopoulou, M., Synetos, A., Tsiamis, E., Agrogiannis, G., Kavantzas, N., Patsouris, E., Iliopoulos, D., Theodoropoulos, S., Yacoub, M., Stefanadis, C. (2008). In Vivo Aortic Valve Thermal Heterogeneity in Patients With Nonrheumatic Aortic Valve Stenosis: The First In Vivo Experience in Humans. J Am Coll Cardiol 52: 758-763 [Abstract] [Full Text]  
• Demer, L. L., Tintut, Y. (2008). Vascular Calcification: Pathobiology of a Multifaceted Disease. Circulation 117: 2938-2948 [Full Text]  
• Jassal, D. S., Tam, J. W., Bhagirath, K. M., Gaboury, I., Sochowski, R. A., Dumesnil, J. G., Giannoccaro, P. J., Jue, J., Pandey, A. S., Joyner, C. D., Teo, K. K., Chan, K. L. (2008). Association of mitral annular calcification and aortic valve morphology: a substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study. Eur Heart J 29: 1542-1547 [Abstract] [Full Text]  
• Collins, M J, Butany, J, Borger, M A, Strauss, B H, David, T E (2008). Implications of a congenitally abnormal valve: a study of 1025 consecutively excised aortic valves. J. Clin. Pathol. 61: 530-536 [Abstract] [Full Text]  
• Wu, H. D., Maurer, M. S., Friedman, R. A., Marboe, C. C., Ruiz-Vazquez, E. M., Ramakrishnan, R., Schwartz, A., Tilson, M. D., Stewart, A. S., Winchester, R. (2007). The Lymphocytic Infiltration in Calcific Aortic Stenosis Predominantly Consists of Clonally Expanded T Cells. J. Immunol. 178: 5329-5339 [Abstract] [Full Text]  
• Towler, D. A. (2007). Imaging Aortic Matrix Metabolism: Mirabile Visu!. Circulation 115: 297-299 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48: e1-e148 [Full Text]  
• O'Brien, K. D. (2006). Pathogenesis of Calcific Aortic Valve Disease: A Disease Process Comes of Age (and a Good Deal More). Arterioscler. Thromb. Vasc. Bio. 26: 1721-1728 [Abstract] [Full Text]  
• Shao, J.-S., Cai, J., Towler, D. A. (2006). Molecular Mechanisms of Vascular Calcification: Lessons Learned From The Aorta. Arterioscler. Thromb. Vasc. Bio. 26: 1423-1430 [Abstract] [Full Text]  
• Freeman, R. V., Otto, C. M. (2005). Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies. Circulation 111: 3316-3326 [Full Text]  
• Lewin, M. B., Otto, C. M. (2005). The Bicuspid Aortic Valve: Adverse Outcomes From Infancy to Old Age. Circulation 111: 832-834 [Full Text]  
• Helske, S., Lindstedt, K. A., Laine, M., Mayranpaa, M., Werkkala, K., Lommi, J., Turto, H., Kupari, M., Kovanen, P. T. (2004). Induction of local angiotensin II-producing systems in stenotic aortic valves. J Am Coll Cardiol 44: 1859-1866 [Abstract] [Full Text]  
• Pohle, K., Otte, M., Maffert, R., Ropers, D., Schmid, M., Daniel, W. G., Achenbach, S. (2004). Association of Cardiovascular Risk Factors to Aortic Valve Calcification as Quantified by Electron Beam Computed Tomography. Mayo Clin Proc. 79: 1242-1246 [Abstract]  
• Vattikuti, R., Towler, D. A. (2004). Osteogenic regulation of vascular calcification: an early perspective. Am. J. Physiol. Endocrinol. Metab. 286: E686-E696 [Abstract] [Full Text]  
• Rahimtoola, S. H. (2004). The year in valvular heart disease. J Am Coll Cardiol 43: 491-504 [Full Text]  
• Warnes, C A (2003). Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart 89: 965-966 [Full Text]  
• Schmid, F.-X., Bielenberg, K., Schneider, A., Haussler, A., Keyser, A., Birnbaum, D. (2003). Ascending aortic aneurysm associated with bicuspid and tricuspid aortic valve: involvement and clinical relevance of smooth muscle cell apoptosis and expression of cell death-initiating proteins. Eur. J. Cardiothorac. Surg. 23: 537-543 [Abstract] [Full Text]  
• Otto, C M (2002). Calcification of bicuspid aortic valves. Heart 88: 321-322 [Full Text]