Introduction Aortic stenosis (AS) is the most common valvular heart disease in westernized societies. AS is a disease process akin to atherosclerosis in which calcification and tissue remodeling play a crucial role. In patients with moderate/severe AS, we sought to determine if the remodeling process would be in relationship with transvalvular gradients and circulating oxidized low-density lipoprotein (ox-LDL) levels.
Methods In 105 patients with AS, the aortic valve and blood plasma were collected at the time of valve replacement surgery. The degree of valve tissue remodeling was assess using a scoring system (Score: 1-4) and the amount of calcium within the valve cusps was determined. Standard plasma lipid profile as well as the size of LDL particles and the plasma level of circulating ox-LDL (4E6 antibody) were determined.
Results After adjustment for covariables, aortic remodeling score was significantly related to transvalvular gradients measured by Doppler-echocardiography before surgery. Patients with higher valve remodeling score had higher circulating ox-LDL levels (score 2: 27.3 ± 2.6 U/L; score 3: 32.2 ± 2.3 U/L; score 4: 38.3±2.3 U/L; p=0.02). After correction for age, gender, hypertension and HDL-C, the plasma level of ox-LDL remained significantly associated with the aortic valve remodeling score (p=0.0009). The plasma level of ox-LDL was significantly associated with LDL-C (r=0.40; p<0.0001), apoB (r=0.59; p<0.0001), triglyceride (r=0.39; p<0.0001), Apo A-I (r=0.23; p=0.01) and cholesterol in small (<255 Å) LDL particles (r=0.22; p=0.02). After correction for covariables, circulating ox-LDL levels remained significantly associated with apoB (p=0.0003) and triglyceride (p=0.01) levels.
Conclusion Increased level of circulating ox-LDL is associated with worse fibro-calcific remodeling of valvular tissue in AS. It remains to be determined whether circulating ox-LDL is a risk marker for a highly atherogenic profile and/or a circulating molecule which is actively involved in the pathogenesis of calcific aortic valve disease.
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