Cardiovascular Division, Department of Cardiology, AP-HP, Bichat Hospital, Paris, France.
Eur Heart J. 2013 Jul;34(25):1915-22. doi: 10.1093/eurheartj/ehs450. Epub 2013 Jan 17.
There is currently no medical therapy that can prevent the progression of aortic valve stenosis (AS). Recent data highlight a possible relationship between bone metabolism and AS progression but prospective data are lacking.
Serum levels of calcium, phosphorus, creatinine, 25-OH vitamin D, intact parathyroid hormon (iPTH), C-terminal-telopeptide of type-1-collagen (CTX) and osteocalcin were assessed at baseline in 110 elderly patients (age ≥70 years) with at least mild AS. CTX/osteocalcin ratio was calculated as a marker of bone remodelling balance. AS severity was assessed at baseline and 1-year based on the mean gradient. Two-thirds of patients had low 25-OH vitamin D and 20% had secondary hyperparathyroidism. AS progression was not associated with age, glomerular filtration rate (GFR), calcium and phosphorus levels, calcium-phosphorus product, but significantly with iPTH, CTX/osteocalcin and vitamin D status (all P < 0.01). There was no correlation between iPTH and CTX/osteocalcin (R = 0.04, P = 0.70) and AS progression was associated with CTX/osteocalcin (R = 0.42, P = 0.009), but not with iPTH (R = 0.10, P = 0.55) in patients with normal vitamin D levels, whereas it was associated with iPTH (R = 0.47, P < 0.001) and not with CTX/osteocalcin (R = 0.04, P = 0.73) in those with low vitamin D levels, especially if mild renal insufficiency was present (R = 0.61, P < 0.001).
In elderly patients with AS, we observed an association between AS progression and vitamin D, iPTH and CTX/osteocalcin ratio and their respective influence varied according to the vitamin D status. In patients with normal vitamin D levels, AS progression was associated with a bone resorptive balance, whereas in patients with low vitamin D levels, AS progression was associated with iPTH and secondary hyperparathyroidism, especially if mild renal insufficiency was present. These findings may have important prognostic and therapeutic implications. Trial registration information: Clinicaltrials.gov identifier number: NCT00338676, funded by AP-HP, the COFRASA study.
目前尚无医学疗法可以预防主动脉瓣狭窄（AS）的进展。最近的数据强调了骨代谢与 AS 进展之间可能存在的关系，但缺乏前瞻性数据。
在 110 名年龄≥70 岁且至少有轻度 AS 的老年患者中，在基线时评估了血清钙、磷、肌酐、25-羟维生素 D、完整甲状旁腺激素（iPTH）、I 型胶原 C 端肽（CTX）和骨钙素的水平。CTX/骨钙素比被计算为骨重塑平衡的标志物。根据平均梯度，在基线和 1 年时评估 AS 严重程度。三分之二的患者存在低 25-羟维生素 D，20%的患者存在继发性甲状旁腺功能亢进。AS 进展与年龄、肾小球滤过率（GFR）、钙和磷水平、钙磷乘积无关，但与 iPTH、CTX/骨钙素和维生素 D 状态显著相关（均 P<0.01）。iPTH 与 CTX/骨钙素之间无相关性（R=0.04，P=0.70），在维生素 D 水平正常的患者中，AS 进展与 CTX/骨钙素相关（R=0.42，P=0.009），但与 iPTH 无关（R=0.10，P=0.55），而在维生素 D 水平低的患者中，AS 进展与 iPTH 相关（R=0.47，P<0.001），与 CTX/骨钙素无关（R=0.04，P=0.73），尤其是在存在轻度肾功能不全的情况下（R=0.61，P<0.001）。
在患有 AS 的老年患者中，我们观察到 AS 进展与维生素 D、iPTH 和 CTX/骨钙素比值之间存在关联，并且它们各自的影响根据维生素 D 状态而有所不同。在维生素 D 水平正常的患者中，AS 进展与骨吸收平衡有关，而在维生素 D 水平低的患者中，AS 进展与 iPTH 和继发性甲状旁腺功能亢进有关，尤其是在存在轻度肾功能不全的情况下。这些发现可能具有重要的预后和治疗意义。
Clinicaltrials.gov 标识符编号：NCT00338676，由 AP-HP 资助，COFRASA 研究。
