Borowiec Anna, Dąbrowski Rafał, Kowalik Ilona, Firek Bohdan, Chwyczko Tomasz, Janas Janina, Szwed Hanna
II Ischemic Heart Disease Department, Institute of Cardiology, Warsaw, Poland.
J Cardiovasc Med (Hagerstown). 2015 Jun;16(6):444-50. doi: 10.2459/JCM.0000000000000035.
The aim of the present study was to evaluate value of osteoprotegerin (OPG) in patients with degenerative aortic stenosis and preserved left-ventricular ejection fraction.
We have prospectively followed 70 patients with aortic stenosis (mean aortic gradient ≥15 mmHg) and preserved left-ventricular ejection fraction for 1 year. In all patients, echocardiography and blood tests (OPG, lipids, high-sensitivity C-reactive protein) were performed at baseline and after 1 year of follow-up. Detailed medical history including atherosclerotic risk factors was obtained. The control group consisted of 20 healthy individuals with normal echocardiographic findings. Rapid progression of aortic stenosis was defined as more than 7 mmHg increase in mean aortic gradient per year.
Osteoprotegerin concentrations were significantly higher in patients with aortic stenosis (P < 0.0001) and correlated with the degree of aortic stenosis. In multivariable regression model analysis, age (β = 0.015, P < 0.0001), mean aortic gradient (β = 0.04, P = 0.0078) and presence of coronary artery disease (β = 0.111, P = 0.0408) were the only independent determinants of plasma OPG concentrations. There was no association between OPG concentrations and coronary artery disease risk factors: male sex, smoking, hypertension and hypercholesterolemia. Concentrations of high-sensitivity C-reactive protein correlated positively with OPG levels only in nonsurgical patients (with lower degree of stenosis) (r = 0.34, P = 0.01). Aortic stenosis progression was related to body mass, diabetes, triglyceride concentrations, metabolic syndrome and left-ventricular systolic volume. In multivariate analysis, only metabolic syndrome was an independent predictor of aortic stenosis progression.
Osteoprotegerin concentrations are linked to the presence and severity of aortic stenosis. Metabolic syndrome was the only independent predictor of degenerative aortic stenosis progression.
本研究旨在评估骨保护素（OPG）在退行性主动脉瓣狭窄且左心室射血分数保留的患者中的价值。
我们前瞻性地随访了70例主动脉瓣狭窄（平均主动脉瓣压差≥15 mmHg）且左心室射血分数保留的患者1年。所有患者在基线和随访1年后均进行了超声心动图检查和血液检测（OPG、血脂、高敏C反应蛋白）。获取了包括动脉粥样硬化危险因素在内的详细病史。对照组由20名超声心动图检查结果正常的健康个体组成。主动脉瓣狭窄的快速进展定义为平均主动脉瓣压差每年增加超过7 mmHg。
主动脉瓣狭窄患者的骨保护素浓度显著更高（P < 0.0001），且与主动脉瓣狭窄程度相关。在多变量回归模型分析中，年龄（β = 0.015，P < 0.0001）、平均主动脉瓣压差（β = 0.04，P = 0.0078）和冠状动脉疾病的存在（β = 0.111，P = 0.0408）是血浆OPG浓度的仅有的独立决定因素。OPG浓度与冠状动脉疾病危险因素（男性、吸烟、高血压和高胆固醇血症）之间无关联。高敏C反应蛋白浓度仅在非手术患者（狭窄程度较低）中与OPG水平呈正相关（r = 0.34，P = 0.01）。主动脉瓣狭窄进展与体重、糖尿病、甘油三酯浓度、代谢综合征和左心室收缩容积有关。在多变量分析中，只有代谢综合征是主动脉瓣狭窄进展的独立预测因素。
骨保护素浓度与主动脉瓣狭窄的存在和严重程度相关。代谢综合征是退行性主动脉瓣狭窄进展的唯一独立预测因素。
