Dialysis Amyloid Deposition in the  Aortic Valve and Its Association with  Aortic Stenosis.
BACKGROUND
The relationship between dialysis amyloid (DA) deposition in the aortic valve (AV) and aortic stenosis (AS) is unknown.


METHODS
This was a cross-sectional study. AV specimens of dialysis patients (median vintage: 8.8 years) consecutively collected from cardiac surgeries (n = 56) or autopsies (n = 13) were examined by a board-certified pathologist blinded to clinical data. DAs were considered to be present if deposits were stained both by Congo red with apple-green birefringence under polarized light and by anti-β2-microblobulin antibody. Degree of deposition was graded as follows: Amyloid (-), no deposit; Amyloid (1+), occasional small deposits; Amyloid (2+), multiple small to large deposits or a single large deposit. Calcification was defined as a calcified deposit with a diameter >1 mm in the specimen. Severe AS (sAS) was defined as a mean gradient >50 mm Hg by echocardiogram. We examined the proportion of DAs and the association between DAs and the sAS.


RESULTS
DAs were present in 71% (n = 49) of specimens and primarily co-localized with calcification. Non-dialysis related amyloid was found in one specimen. After excluding this specimen, sAS was associated with ‘Amyloid (1+) and Calcification >1 mm' and ‘Amyloid (2+) and Calcification >1 mm' (vs. ‘Amyloid (-) and Calcification ≤1 mm', odds ratios (ORs): 13.5 and 34.2, respectively). Furthermore, after adjustment for covariates, sAS was found to be associated with ‘Amyloid (2+) and Calcification >1 mm' (OR: 24.3).


CONCLUSIONS
DA deposition in the AV was prevalent among dialysis patients. DA deposition with accompanying calcification might contribute to the severity of AS.
Noriaki
N
Kurita
Akiko
A
Fujii
Nagaaki
N
Kotera
Mototsugu
M
Tanaka
Shinji
S
Tanaka
Takeshi
T
Miyairi
Tokuichiro
T
Sugimoto
Masaya
M
Mori
Shunichi
S
Fukuhara
Naobumi
N
Mise
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000378:metabolism / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D001323:Autoantibodies / Q000097:blood; D002114:Calcinosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D004396:Coloring Agents; D003224:Congo Red; D003430:Cross-Sectional Studies; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D058225:Plaque, Amyloid / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects*; D012720:Severity of Illness Index; D001613:beta 2-Microglobulin / Q000097:blood
D001323:Autoantibodies; D004396:Coloring Agents; D001613:beta 2-Microglobulin; D003224:Congo Red