High prevalence of amyloid in 150 surgically removed heart valves--a comparison of histological and clinical data reveals a correlation to atheroinflammatory conditions.
BACKGROUND
The prevalence, pathophysiology, and clinical indicators of valvular amyloid deposition have not been clarified yet.


METHODS
One hundred fifty surgically resected heart valve specimens [67.4+/-1.0 years; aortic stenosis (AS), n=100; aortic regurgitation, n=19; mitral stenosis, n=7; mitral regurgitation, n=24] were qualitatively, semiquantitatively, and immunohistochemically analyzed and correlated with clinical data.


RESULTS
Amyloid was found in 83/150 specimens with highest prevalence in AS (74/100), intermediate prevalence in mitral stenosis (2/7) and regurgitation (7/24), and lowest prevalence in aortic regurgitation (2/19). Severe and polymorphic amyloid deposits were almost exclusively found in AS (35/100). Filamentous cloudy amyloid patterns occurred with the same frequency in AS (29/100). A combination of both was found only in AS (n=7/100). By immunohistochemistry, none of the most common amyloid proteins was identified except for a weak staining by the apolipoprotein AI antibody, but more intense adjacent to amyloid deposits. Amyloid correlated with valvular thickening (P<.05), hyperlipidemia (P=.07), coronary artery disease (P=.084), and obesity (P=.082).


CONCLUSIONS
Localized valvular amyloid is predominantly found in stenotic aortic valves. It appears to depend on atheroinflammatory conditions and high shear-stress hemodynamics. Further studies are needed to identify the underlying protein.
Kristen
Arnt V
AV
Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany. arnt_kristen@med.uni-heidelberg.de
Schnabel
Philipp A
PA
Winter
Bettina
B
Helmke
Burkhard M
BM
Longerich
Thomas
T
Hardt
Stefan
S
Koch
Achim
A
Sack
Falk-Udo
FU
Katus
Hugo A
HA
Linke
Reinhold P
RP
Dengler
Thomas J
TJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000682:Amyloid / Q000378:metabolism*; D000686:Amyloidosis / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000378:metabolism / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D050197:Atherosclerosis / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D002648:Child; D003324:Coronary Artery Disease / Q000150:complications / Q000378:metabolism / Q000473:pathology; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D006351:Heart Valves / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000378:metabolism / Q000473:pathology; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000378:metabolism / Q000473:pathology; D008946:Mitral Valve Stenosis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000473:pathology; D055815:Young Adult
D000682:Amyloid