Hypertension and Cardiometabolic Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Atherosclerosis. 2021 Sep;332:1-15. doi: 10.1016/j.atherosclerosis.2021.07.006. Epub 2021 Jul 13.
Degenerative aortic valve stenosis is the most common primary valve disease and a significant cause of cardiovascular morbidity and mortality. In an era when new techniques for the management of aortic stenosis are gaining ground, the understanding of this disease is more important than ever to optimize treatment. So far, the focus has been placed on the assessment of the valve itself. However, the role that the arterial system plays in the pathogenesis and natural history of the disease needs to be further elucidated. Arteriosclerosis, when it coexists with a stenotic valve, augments the load posed on the left ventricle contributing to greater impairment of cardiovascular function. Arterial stiffness, a well-established predictor for cardiovascular disease and all-cause mortality, could play a role in the prognosis and quality of life of this population. Several studies using a variety of indices to assess arterial stiffness have tried to address the potential utility of arterial function assessment in the case of aortic stenosis. Importantly, reliable data identify a prognostic role of arterial biomarkers in aortic stenosis and stress their possible use to optimize timing and method of treatment. This review aims at summarizing the existing knowledge on the interplay between the heart and the vessels in the presence of degenerative aortic stenosis, prior, upon and after interventional management. Further, it discusses the evidence supporting the potential clinical application of arterial biomarkers for the assessment of progression, severity, management and prognosis of aortic stenosis.
退行性主动脉瓣狭窄是最常见的原发性瓣膜病，也是心血管发病率和死亡率的重要原因。在主动脉瓣狭窄的治疗新技术不断发展的时代，对这种疾病的认识比以往任何时候都更为重要，以优化治疗效果。到目前为止，重点一直放在评估瓣膜本身。然而，动脉系统在疾病的发病机制和自然史中所起的作用需要进一步阐明。在存在狭窄瓣膜的情况下，动脉粥样硬化会增加左心室的负荷，导致心血管功能的更大损害。动脉僵硬度是心血管疾病和全因死亡率的一个既定预测因素，它可能在这一人群的预后和生活质量中发挥作用。一些使用各种指数评估动脉僵硬度的研究试图探讨在主动脉瓣狭窄的情况下评估动脉功能的潜在效用。重要的是，可靠的数据确定了动脉生物标志物在主动脉瓣狭窄中的预后作用，并强调了它们可能用于优化治疗的时机和方法。本综述旨在总结在退行性主动脉瓣狭窄存在的情况下，心脏和血管之间相互作用的现有知识，包括在介入治疗之前、期间和之后。此外，它还讨论了支持动脉生物标志物在评估主动脉瓣狭窄的进展、严重程度、管理和预后方面的潜在临床应用的证据。
