title: Aortic valve sclerosis is associated with systemic endothelial dysfunction.
abstract: OBJECTIVE
  We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process.
  
  
  BACKGROUND
  Clinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery.
  
  
  METHODS
  A total of 102 in-hospital patients (76 men; mean age 63.5 +/- 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD).
  
  
  RESULTS
  Aortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 +/- 28.6 vs. 35.2 +/- 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 +/- 3.5% vs. 5.3 +/- 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01).
  
  
  CONCLUSIONS
  Aortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events.
authors.affiliation: Echocardiography Laboratory, Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Poggianti
authors.forename: Lucia
authors.initials: L
authors.lastname: Venneri
authors.forename: Vlad
authors.initials: V
authors.lastname: Chubuchny
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Jambrik
authors.forename: Liz Andrea
authors.initials: LA
authors.lastname: Baroncini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D001161:Arteriosclerosis / Q000150:complications*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications; D004108:Dilatation, Pathologic; D004452:Echocardiography; D025401:Echocardiography, Stress; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012598:Sclerosis; D014463:Ultrasonography