Differential determinants and prognostic value of aortic valve sclerosis over carotid atherosclerosis

Abstract

Background: Aortic valve sclerosis (AVS) is a progressive atherosclerotic disease associated with future cardiovascular events (CVE). However, whether its development and prognostic value are independent of arterial atherosclerosis has not been thoroughly investigated. We evaluated the determinants and prognostic value of AVS in conjunction with carotid atherosclerosis.

Methods: 4688 consecutive patients who underwent carotid ultrasonography and echocardiography were followed for an average of 3.6 ± 1.3 years, excluding those with bicuspid aortic valve, rheumatic heart disease, overt aortic stenosis, and prior aortic valve replacement. AVS was defined as any thickened cusps with hyper-echogenicity but a peak pressure gradient <2.5 m/s.

Results: The mean age of the patients was 61.1 ± 11.7 years, with 1836 (39 %) being women. Among them, 523 (11 %) had AVS. AVS was independently correlated with age, diabetes, lower high-density lipoprotein levels, and presence of carotid plaques. Moreover, it was significantly related to atherosclerotic CVE (acute coronary syndromes, and all-cause death; log-rank p = 0.011) and future heart failure (HF) admissions (p < 0.001). In multivariate analyses, AVS was significantly associated with atherosclerotic CVE regardless of age and sex but significantly attenuated by the presence of carotid plaques. Meanwhile, future HF admission was attenuated considerably after adjusting for E/e' and left ventricular (LV) ejection fraction.

Conclusions: AVS has prognostic value for future CVE and HF. Atherosclerotic CVE was primarily mediated by vascular atherosclerosis; however, future HF admissions were mainly mediated by concomitant LV systolic and diastolic dysfunction, suggesting that AVS serves as a surrogate marker rather than an independent risk factor.