Malina Mateusz, Banasiak Waldemar, Doroszko Adrian
Clinical Department of Cardiology, Centre of Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland.
Clinical Department of Cardiology, Faculty of Medicine, Wroclaw University of Science and Technology, 51-612 Wroclaw, Poland.
Cells. 2025 Jun 11;14(12):885. doi: 10.3390/cells14120885.
Endothelial dysfunction (ED) has been identified as a precursor to micro- and macroangiopathic complications and an independent risk factor for major adverse cardiac events (MACEs). Recent studies have identified a novel risk factor for ED: severe aortic stenosis (AS). Traditionally linked to other established risk factors for endothelial cell dysregulation, AS has emerged as a contributor to ED, which is supported by the improvement of endothelial function following transcatheter (TAVR) or surgical (SAVR) interventions. Furthermore, the observation of ED in patients with a dysfunctional bicuspid aortic valve (BAV) at a younger age suggests a distinct impact of AS on ED. A promising hypothesis is a hemodynamic theory suggesting that changes in the shear stress of the ascending aortic wall and peripheral vessels, along with subclinical hemolysis caused by turbulent blood flow, could lead to reduced nitric oxide (NO) bioavailability. Current hypotheses on ED have yet to consider the influence of concomitant aortic stenosis in BAV. Additionally, studies examining potential intravascular hemolysis in BAV patients or the impact of surgical treatment of this defect on endothelial function are scarce. The aim of this review is to summarize the current knowledge on the mechanisms underlying ED in patients with AS or BAV and to identify possible directions for future research.
内皮功能障碍（ED）已被确认为微血管和大血管病变并发症的先兆以及主要不良心脏事件（MACE）的独立危险因素。最近的研究发现了ED的一个新危险因素：重度主动脉瓣狭窄（AS）。AS传统上与内皮细胞失调的其他既定危险因素相关联，现已成为ED的一个促成因素，经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）干预后内皮功能的改善支持了这一点。此外，在年龄较小的功能失调二叶式主动脉瓣（BAV）患者中观察到ED，提示AS对ED有独特影响。一个有前景的假说是一种血流动力学理论，该理论认为升主动脉壁和外周血管的剪切应力变化，以及湍流引起的亚临床溶血，可能导致一氧化氮（NO）生物利用度降低。目前关于ED的假说尚未考虑BAV中合并主动脉瓣狭窄的影响。此外，研究BAV患者潜在血管内溶血或该缺陷手术治疗对内皮功能影响的研究很少。本综述的目的是总结目前关于AS或BAV患者ED潜在机制的知识，并确定未来研究的可能方向。
