Kim Minjeong, Seo Jiwon, Kim In-Soo, Cho Sungsoo, Rim Se-Joong, Kown Hyuck Moon, Choi Eui-Young
Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2025 Mar 1;422:132980. doi: 10.1016/j.ijcard.2025.132980. Epub 2025 Jan 11.
Aortic valve sclerosis (AVS) is a progressive atherosclerotic disease associated with future cardiovascular events (CVE). However, whether its development and prognostic value are independent of arterial atherosclerosis has not been thoroughly investigated. We evaluated the determinants and prognostic value of AVS in conjunction with carotid atherosclerosis.
4688 consecutive patients who underwent carotid ultrasonography and echocardiography were followed for an average of 3.6 ± 1.3 years, excluding those with bicuspid aortic valve, rheumatic heart disease, overt aortic stenosis, and prior aortic valve replacement. AVS was defined as any thickened cusps with hyper-echogenicity but a peak pressure gradient <2.5 m/s.
The mean age of the patients was 61.1 ± 11.7 years, with 1836 (39 %) being women. Among them, 523 (11 %) had AVS. AVS was independently correlated with age, diabetes, lower high-density lipoprotein levels, and presence of carotid plaques. Moreover, it was significantly related to atherosclerotic CVE (acute coronary syndromes, and all-cause death; log-rank p = 0.011) and future heart failure (HF) admissions (p < 0.001). In multivariate analyses, AVS was significantly associated with atherosclerotic CVE regardless of age and sex but significantly attenuated by the presence of carotid plaques. Meanwhile, future HF admission was attenuated considerably after adjusting for E/e' and left ventricular (LV) ejection fraction.
AVS has prognostic value for future CVE and HF. Atherosclerotic CVE was primarily mediated by vascular atherosclerosis; however, future HF admissions were mainly mediated by concomitant LV systolic and diastolic dysfunction, suggesting that AVS serves as a surrogate marker rather than an independent risk factor.
主动脉瓣硬化（AVS）是一种与未来心血管事件（CVE）相关的进行性动脉粥样硬化疾病。然而，其发展及预后价值是否独立于动脉粥样硬化尚未得到充分研究。我们结合颈动脉粥样硬化评估了AVS的决定因素及预后价值。
4688例连续接受颈动脉超声检查和超声心动图检查的患者平均随访3.6±1.3年，排除患有二叶式主动脉瓣、风湿性心脏病、明显主动脉狭窄及既往接受主动脉瓣置换术的患者。AVS定义为任何瓣叶增厚且回声增强但峰值压力梯度<2.5m/s。
患者的平均年龄为61.1±11.7岁，其中1836例（39%）为女性。其中，523例（11%）患有AVS。AVS与年龄、糖尿病、高密度脂蛋白水平降低及颈动脉斑块的存在独立相关。此外，它与动脉粥样硬化性CVE（急性冠状动脉综合征和全因死亡；对数秩检验p=0.011）及未来心力衰竭（HF）住院（p<0.001）显著相关。在多变量分析中，无论年龄和性别，AVS均与动脉粥样硬化性CVE显著相关，但颈动脉斑块的存在使其显著减弱。同时，在调整E/e'和左心室（LV）射血分数后，未来HF住院显著减弱。
AVS对未来CVE和HF具有预后价值。动脉粥样硬化性CVE主要由血管动脉粥样硬化介导；然而，未来HF住院主要由伴随的LV收缩和舒张功能障碍介导，这表明AVS是一个替代标志物而非独立危险因素。
