Asemptomatik Hastalarda Aort Kapak Sklerozu ile Kalp-Ayak Bileği Damar İndeksi ve Klinik Faktörler Arasındaki İlişki

Yıl 2023, Cilt: 13 Sayı: 2, 255 - 264, 30.06.2023

Ali Rıza Akyüz , Ahmet Özderya , Ali Hakan Konuş

https://doi.org/10.31832/smj.1030413

Öz

Amaç: Bu çalışma, bilinen kardiyovasküler (KV) hastalığı olmayan asemptomatik bireylerde aort kapak sklerozu (AVS) ile arteriyel sertlik arasındaki ilişkiyi incelemeyi amaçlamıştır. Hem AVS hem de arteriyel sertlik ateroskleroz ile ilişkilidir ve daha önceki çalışmalarda KV hastalıklarla yakından ilişkili bulunmuştur. . Bu çalışmada, CAVI ile değerlendirilen arteriyel sertlik ile AVS arasındaki ilişkiyi incelemeyi amaçladık.
Yöntemler: Kardiyoloji polikliniğine başvuran hastalar sırayla çalışmaya dahil edildi. Olgular dışlama kriterlerine göre analiz edildi. Çalışmaya yüz altmış beş hasta dahil edildi ve bunların 35'inde (%21) AVS tespit edildi. Geriye kalan 130 (%79) hasta kontrol grubuna alındı. Ekokardiyografi ile AVS, VaSera VS-1000 CAVI cihazı ile arter sertliği ölçüldü. 9 ve üzeri CAVI değeri anormal olarak kabul edildi. İstatistikler AVS olan ve olmayan gruba göre yapılmıştır.
Bulgular: CAVI, AVS ve kontrol grupları arasında istatistiksel olarak farklıydı (9,47±1,64 vs. 7,60±1,27 p< 0,001). Pearson korelasyon testi, AVS ile artan CAVI değerleri arasındaki korelasyonu belirledi (p< 0,001). Çok değişkenli lojistik regresyon analizi modelinde, artan CAVI (OR: 2.048, %95 CI 1.183-3.547, p: 0.010) için bağımsız bir öngörücüydü. AVS.Diğerleri yaş (p:0.026) ve diabetes mellitus (p:0.037) olarak bulundu.
Sonuç: AVS ile arteriyel sertlik arasındaki ilişki aterosklerotik süreç ile ilişkilidir. Ekokardiyografi sırasında AVS saptanan veya CAVI değerleri yüksek olan asemptomatik bireylerin diğer KV hastalıklarda dikkatli araştırılması ve düzenli takibi önemlidir.

Anahtar Kelimeler

Aort kapak sklerozu, Arterial Sertlik, Asemptomatik hastalar, Kalp-ayak bileği damar indeksi

The Relationship Between Cardio-Ankle Vascular Index and Clinical Factors with Aortic Valve Sclerosis in Asymptomatic Patients

Öz

Objectives: This study aimed to examine the relationship between aortic valve sclerosis (AVS) and arterial stiffness in asymptomatic individuals without known cardiovascular (CV) disease.Both AVS and arterial stiffness are associated with atherosclerosis and have been closely related to CV diseases in previous studies. In this study, we aimed to examine the relationship between arterial stiffness assessed by CAVI and AVS.
Methods: Patients who applied to the cardiology outpatient clinic were included in the study sequentially. Subjects were analyzed according to exclusion criteria.One hundred sixty-five patients were included in the study, and AVS was detected in 35 (21%) of them. The remaining 130 (79%) patients were included in the control group.AVS was measured with echocardiography, and arterial stiffness was measured with the VaSera VS-1000 CAVI device. A CAVI value of 9 and above was accepted as abnormal. Statistics were made according to the group with and without AVS.
Results: CAVI was statistically different between the AVS and control groups(9.47±1.64 vs. 7.60±1.27 p< 0.001). The Pearson correlation test determined the correlation between AVS and increased CAVI values (p< 0.001).In the multivariable logistic regression analysis model, increased CAVI (OR: 2.048, 95%CI 1.183-3.547, p: 0.010) was an independent predictor for AVS.Others were found as age (p:0.026) and diabetes mellitus (p:0.037).
Conclusions: The relationship between AVS and arterial stiffness is associated with the atherosclerotic process.Careful investigation and regular follow-up of asymptomatic individuals with AVS detected during echocardiography or increased CAVI values are important in other CV diseases.

Anahtar Kelimeler

Aortic valve sclerosis, Arterial stiffness, Asymptomatic patients, Cardio-Ankle Vascular Index (CAVI)

Kaynakça

• 1. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med. 1999; 341(3):142-147.
• 2. Di Minno MND, Di Minno A, Ambrosino P, Songia P, Pepi M, Tremoli E et al. Cardiovascular morbidity and mortality in patients with aortic valve sclerosis: A systematic review and meta-analysis. Int J Cardiol. 2018 Jun 1; 260:138-144.
• 3. Poggio P, Branchetti E, Grau JB, Lai EK, Gorman RC, Gorman JH 3rd et al. Osteopontin-CD44v6 interaction mediates calcium deposition via phospho-Akt in valve interstitial cells from patients with noncalcified aortic valve sclerosis. Arterioscler Thromb. Vasc. Biol. 2014; 34: 2086–94.
• 4. Gharacholou SM, Karon BL, Shub C, Pellikka PA, Aortic valve sclerosis and clinical outcomes: moving toward a definition, Am. J. Med. 2011; 124: 103–110
• 5. Cosmi JE, Kort S, Tunick PA, Rosenzweig BP, Freedberg RS, Katz ES et al. The risk of the development of aortic stenosis in patients with “benign” aortic valve thickening. Arch Intern Med. 2002; 162(20): 2345-47
• 6. Volzke H, Haring R, Lorbeer R, Wallaschofski H, Reffelmann T, Empen K et al. Heart valve sclerosis predicts all-cause and cardiovascular mortality. Atherosclerosis. 2010; 209: 606- 10.
• 7. Rossi A, Gaibazzi N, Dandale R, Agricola E, Moreo A, Berlinghieri N et al. Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease. Int J Cardiol 2014; 172: 364–7
• 8. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–605.
• 9. Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: A longitudinal study. Hypertension, 2002; 39: 10–15
• 10. Heo J, Schauer JJ, Yi O, Paek D, Kim H, Yi SM: Fine particle air pollution and mortality: Importance of specific sources and chemical species. Epidemiology 25: 379-388, 2014
• 11. Kim KJ, Lee BW, Kim HM, Shin JY, Kang ES, Cha BS et al. Associations between cardio-ankle vascular index and microvascular complications in type 2 diabetes mellitus patients. J Atheroscler Thromb 2011; 18: 328–36
• 12. Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T et al. Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb 2011; 18: 924–38
• 13. Matsushita K, Ding N, Kim ED, Budoff M, Chirinos JA, Fernhall B et al. Cardio-ankle vascular index and cardiovascular disease: Systematic review and meta-analysis of prospective and cross-sectional studies. J Clin Hypertens (Greenwich). 2019 2 1(1):16-24.
• 14. S. Coffey, B. Cox, M.J. Williams. The prevalence, incidence, progression, and risks of aortic valve sclerosis: a systematic review and meta-analysis, J. Am. Coll. Cardiol. 2014; 63: 2852–61
• 15. Otto CM. Why is aortic sclerosis associated with adverse clinical outcomes? J Am Coll Cardiol, 2004; 43: 176–8.
• 16. Nabati M, Favaedi M, Kheirgoo M, Yazdani J, Dabirian M. Correlation between epicardial fat thickness and aortic valve sclerosis. Asian Cardiovasc Thorac Ann. 2018; 26(3):188-95.
• 17. Singh S, Torzewski M. Fibroblasts and Their Pathological Functions in the Fibrosis of Aortic Valve Sclerosis and Atherosclerosis. Biomolecules. 2019; 10: 472.
• 18. Durham AL, Speer MY, Scatena M, Giachelli CM, Shanahan CM. Role of smooth muscle cells in vascular calcification: implications in atherosclerosis and arterial stiffness. Cardiovasc Res. 2018: 15;11:590-600.
• 19. Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA 2012; 308 :875-81.
• 20. Edwards DG, Schofield RS, Magyari PM, Nichols WW, Braith RW. Effect ofexercise training on central aortic pressure wave reflection in coronary artery disease.Am J Hypertens. 2004;17(6):540-3.
• 21. Chirinos JA, Segers P, Hughes T, Townsend R. Large-Artery Stiffness in Health and Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;74:1237-1263.
• 22. Chandra HR, Goldstein JA, Choudhary N, O'Neill CS, George PB, Gangasani SR et al. Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation. J Am Coll Cardiol, 2004; 43: 169–175.
• 23. Mozos I, Malainer C, Horbańczuk J, Gug C, Stoian D, Luca CT et al. Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases. Front Immunol. 2017; 8: 1058.
• 24. Celik S, Durmuş I, Korkmaz L, Gedikli O, Kaplan S, Orem C et al. Aortic pulse wave velocity in subjects with aortic valve sclerosis. Echocardiography. 200; 10: 1112-6.
• 25. Cecelja M, Chowienczyk P. Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: A systematic review. Hypertension, 2009; 54: 1328–1336.
• 26. Korkmaz L, Ağaç MT, Bektas H, Varol MO, Erkan H, Acar Z et al. Aortic valve sclerosis is a sign of increased arterial stiffness in clinically asymptomatic subjects. Cardiol J. 2013; 20(3): 318-22.
• 27. Duprez DA, Cohn JN. Arterial stiffness as a risk factor for coronary atherosclerosis. Curr Atheroscler Rep. 2007; 9: 139-44.