Clinical Heart and Vascular Center
The Emerging Science in Valvular Heart Disease
By Gail Peterson, M.D.
Professor of Internal Medicine
I had the pleasure of moderating a session that highlighted research in valvular heart disease. One area of focus during the session was the identification of factors that might modulate the progression of this condition. Circulating soluble endothelial protein C receptor levels were found to be inversely associated with the severity of aortic bioprosthetic valve calcification. In another study, increased levels of oxidized phosphatidylcholine and lysophosphatidic acid accumulation were associated with more severe calcification in pathologic specimens of native aortic valves. Finally, there might be differences in progression of valvular heart disease between black and white patients with advanced chronic kidney disease and mild aortic valve narrowing. Specifically, the progression of aortic stenosis was reported to be more rapid among whites than blacks in one study presented during the session.
Novel imaging assessment of valvular disease was another area of focus. In one reported study, characterization of the mitral valve via 3-D echocardiography deformation analysis was performed in different disease states and appeared promising. Another study assessed left atrial peak longitudinal strain and contraction strain and found significant LA functional remodeling as assessed by these strain techniques even in patients with only mild mitral regurgitation, independent of the presence of heart failure.
There might be differences in progression of valvular heart disease between black and white patients with advanced chronic kidney disease and mild aortic valve narrowing. Specifically, the progression of aortic stenosis was reported to be more rapid among whites than blacks.
A different investigative group sought to understand why 18F-FDG PET imaging is superior for the diagnosis of infective endocarditis (IE) of prosthetic valves when compared to native valves. This group enrolled patients with IE who had undergone PET imaging followed by valve removal surgery and then examined the histologic findings of the valves. They reported that there was a greater degree of inflammatory infiltrate and lower amount of fibrosis in the prosthetic versus native valves. These results potentially explain the difference in PET accuracy between these two conditions.