title: High levels of platelet-monocyte aggregates after valve replacement for aortic stenosis: relation to soluble P-selectin and P-selectin glycoprotein ligand-1 genes.
abstract: BACKGROUND
  Calcific aortic valve stenosis is linked to atherosclerosis. The latter is associated with increased levels of platelets adhering to monocytes (PMA).
  
  
  OBJECTIVE
  The hemodynamic impairment in symptomatic aortic valve stenosis can be abated by valve replacement. We investigated the effect of valve replacement on PMA and receptor-ligand axis P-selectin - P-selectin glycoprotein ligand-1 (PSGL-1) in severe aortic valve stenosis.
  
  
  METHODS
  PMA, plasma P-selectin (sP-selectin) and polymorphisms within the coding region for PSGL-1 (SELPLG) were determined in 42 patients with severe aortic valve stenosis before and 4 to 8 months after valve replacement. Ten patients suffered from significant coronary artery disease and received also a coronary artery bypass graft. Thirty-four patients received a bioprosthetic valve and 8 patients who were <65 years old received a mechanical valve.
  
  
  RESULTS
  Before the intervention, PMA levels were significantly higher in patients with aortic valve stenosis than in two control cohorts, namely healthy indviduals and 88 age- and sex-matched patients with severe atherosclerosis, but without aortic valve stenosis (p<0.001). PMA decreased after surgery, but normalized in only 3 patients, while further increases were noted in 11 patients. sP-selectin was elevated in 3 and 4 patients before and after valve replacement, respectively. sP-selectin increased significantly after surgery, but remained within the normal range. There was no correlation between changes of PMA and sP-selectin or any of the polymorphisms within SELPLG.
  
  
  CONCLUSIONS
  Exceedingly high PMA in aortic stenosis are independent of SELPLG polymorphisms, and largely of the hemodynamic compromise caused by the stenotic valve.
authors.affiliation: Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria.
authors.forename: Roza
authors.initials: R
authors.lastname: Badr Eslam
authors.forename: Thomas
authors.initials: T
authors.lastname: Gremmel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schneller
authors.forename: Michael
authors.initials: M
authors.lastname: Stegfellner
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kaider
authors.forename: Christine
authors.initials: C
authors.lastname: Mannhalter
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.forename: Simon
authors.initials: S
authors.lastname: Panzer
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D009000:Monocytes / Q000378:metabolism* / Q000473:pathology; D019007:P-Selectin / Q000097:blood* / Q000737:chemistry; D010974:Platelet Aggregation; D012995:Solubility; D016896:Treatment Outcome
chemical_list: D008562:Membrane Glycoproteins; D019007:P-Selectin; C084882:P-selectin ligand protein