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Role of inflammation in non-rheumatic, regurgitant heart valve disease: A comparative, descriptive study regarding apolipoproteins and inflammatory cells in non-rheumatic heart valve disease
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics. (Landstinget i Östergötland)
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
2007 (English)In: Cardiovascular pathology, ISSN 1054-8807, E-ISSN 1879-1336, Vol. 16, no 3, 171-178 p.Article in journal (Refereed) Published
Abstract [en]

Background: Nonrheumatic aortic stenosis is the predominant cause of heart valve surgery in the Western world. Aortic and mitral regurgitation account for a lesser amount of the heart valve surgery. During the 1990s, inflammatory cell infiltrates have been demonstrated in nonrheumatic stenotic aortic valves. These findings suggest an inflammatory component in the pathogenesis of nonrheumatic aortic valve stenosis. However, nonrheumatic regurgitant aortic and mitral valves have not been investigated in this respect. The aim of this study was to compare nonrheumatic regurgitant aortic and mitral valves with stenotic aortic valves regarding the presence of T lymphocytes, macrophages, apolipoprotein B, and apolipoprotein A-I.

Methods: Valve specimens were obtained from 42 patients referred to hospital for surgery because of significant heart valve disease. From these patients, 29 aortic stenotic valves, 9 aortic regurgitant, and 6 mitral regurgitant valves, all nonrheumatic, were obtained for the study. Fourteen valves collected from subjects undergoing clinical/medicolegal autopsy were used as control. In order to identify mononuclear inflammatory cells and apolipoproteins, sections were investigated with immunohistochemical analyses and then categorized semiquantitatively.

Results: Regurgitant and control valves showed a significantly lower degree of inflammatory cell infiltrate and a lower degree of apolipoprotein deposition as compared to stenotic aortic valves.

Conclusions: The signs of inflammation seen in nonrheumatic aortic stenosis are not prominent features in the nonrheumatic, regurgitant valves. This is consistent with the multi-factorial pathogenesis of these conditions.

Place, publisher, year, edition, pages
2007. Vol. 16, no 3, 171-178 p.
Keyword [en]
Aortic valve regurgitation, Mitral valve regurgitation, T Lymphocytes, Apolipoproteins
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13047DOI: 10.1016/j.carpath.2006.10.004OAI: oai:DiVA.org:liu-13047DiVA: diva2:17734
Available from: 2008-03-18 Created: 2008-03-18 Last updated: 2017-12-13
In thesis
1. Signs of inflammation in different types of heart valve disease: The VOCIN study
Open this publication in new window or tab >>Signs of inflammation in different types of heart valve disease: The VOCIN study
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Heart valve dysfunction is a relatively common condition in the population, whereas significant heart valve disease is more unusual. The cause of different types of heart valve disease depends on which valve is concerned. Rheumatic heart valve disease, has for a long time been considered to constitute a post-inflammatory condition. During the 1990s it was also shown that the so-called non-rheumatic or degenerative tricuspid aortic stenosis, comprised signs of inflammation.

In this study, 118 patients (the VOCIN study group) referred to the University Hospital for preoperative investigation due to significant heart valve disease, were examined regarding signs of inflammation.

Twenty-nine aortic valves from patients with significant aortic stenosis were divided into tricuspid and bicuspid aortic valves. The bicuspid aortic stenotic valves revealed signs of inflammation to a similar extent as the tricuspid valves. However, the tricuspid and bicuspid valves differed regarding distribution of calcification. In contrast, inflammation was not a predominant feature in 15 aortic and mitral valves from patients with significant heart valve regurgitation.

Gross valvular pathology consistent with rheumatic aortic stenosis was found in 10 patients. These valves revealed a somewhat lower degree of inflammatory cell infiltration, but on the whole, there were no substantial differences when compared to non-rheumatic aortic stenotic valves. They did, however, reveal a similar distribution of calcification as the bicuspid, non-rheumatic aortic valves.

The VOCIN study group was compared to an age- and gender matched control group with regard to history and signs of rheumatic disease. There was not any increased prevalence of clinical manifestations of non-cardiac inflammatory disease in patients with significant heart valve disease, when compared to healthy control subjects. However, patients with heart valve disease had significantly increased serum levels of inflammatory markers compared to controls. The increase in inflammatory markers remained significant even in the subgroup of non-rheumatic aortic stenosis devoid of coronary artery disease. These results indicate that a systemic inflammatory component is associated with stenotic, non-rheumatic heart valve disease.

The similarities between different forms of calcific aortic valve disease indicate a similar pathogenesis. The question is raised whether aortic stenosis is one disease, mainly caused by a general and non-specific response to dynamic tissue stress due to an underlying malformation of the valve.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1052
Keyword
Heart valve dysfunction, heart valve disease, VOCIN study group, aortic valves, Gross valvular pathology
National Category
Dentistry
Identifiers
urn:nbn:se:liu:diva-11330 (URN)978-91-7393-949-2 (ISBN)
Public defence
2008-04-18, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-03-18 Created: 2008-03-18 Last updated: 2009-08-22

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Wallby, LarsBroqvist, Mats

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