title: Aortic stenosis, atherosclerosis, and skeletal bone: is there a common link with calcification and inflammation?
abstract: OBJECTIVE
  The pathophysiology of aortic stenosis shares many similarities with atherosclerosis and skeletal bone formation. Using non-invasive imaging, we compared aortic valve calcification and inflammation activity with that measured in atherosclerosis and bone.
  
  
  RESULTS
  Positron emission and computed tomography was performed using 18F-sodium fluoride (18F-NaF, calcification) and 18F-fluorodeoxyglucose (18F-FDG, inflammation) in 101 patients with calcific aortic valve disease (81 aortic stenosis and 20 aortic sclerosis). Calcium scores and positron emission tomography tracer activity (tissue-to-background ratio; TBR) were measured in the aortic valve, coronary arteries, thoracic aorta, and bone. Over 90% of the cohort had coexistent calcific atheroma, yet correlations between calcium scores were weak or absent (valve vs. aorta r(2) = 0.015, P = 0.222; valve vs. coronaries r(2) = 0.039, P = 0.049) as were associations between calcium scores and bone mineral density (BMD vs. valve r(2) = 0.000, P = 0.766; vs. aorta r(2) = 0.052, P = 0.025; vs. coronaries r(2) = 0.016, P = 0.210). 18F-NaF activity in the valve was 28% higher than in the aorta (TBR: 2.66 ± 0.84 vs. 2.11 ± 0.31, respectively, P < 0.001) and correlated more strongly with the severity of aortic stenosis (r(2) = 0.419, P < 0.001) than 18F-NaF activity outwith the valve (valve vs. aorta r(2) = 0.167, P < 0.001; valve vs. coronary arteries r(2) = 0.174, P < 0.001; valve vs. bone r(2) = 0.001, P = 0.806). In contrast, 18F-FDG activity was lower in the aortic valve than the aortic atheroma (TBR: 1.56 ± 0.21 vs. 1.81 ± 0.24, respectively, P < 0.001) and more closely associated with uptake outwith the valve (valve vs. aorta r(2) = 0.327, P < 0.001).
  
  
  CONCLUSIONS
  In patients with aortic stenosis, disease activity appears to be determined by local calcific processes within the valve that are distinct from atherosclerosis and skeletal bone metabolism.
authors: Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh, UK. mdweck@staffmail.ed.ac.uk
authors: Marc R
authors: MR
authors: Dweck
authors: H J
authors: HJ
authors: Khaw
authors: G K Z
authors: GK
authors: Sng
authors: E L C
authors: EL
authors: Luo
authors: A
authors: A
authors: Baird
authors: M C
authors: MC
authors: Williams
authors: P
authors: P
authors: Makiello
authors: S
authors: S
authors: Mirsadraee
authors: N V
authors: NV
authors: Joshi
authors: E J R
authors: EJ
authors: van Beek
authors: N A
authors: NA
authors: Boon
authors: J H F
authors: JH
authors: Rudd
authors: D E
authors: DE
authors: Newby
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology*; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology*; D015519:Bone Density; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D010000:Osteitis / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride
keywords: Aortic stenosis; Atherosclerosis; Calcification; Inflammation; Positron emission tomography