Abstract 3111: Hypoadiponectinemia is Associated with Aortic Valve Inflammation and Faster Disease Progression in Patients with Aortic Stenosis
Background: Adiponectin is a novel adipocyte-specific protein with an insulin enhancing activity as well as with anti-inflammatory and anti-atherogenic properties, which has been shown to have a protective effect on the development of atherosclerosis. We recently reported that the metabolic syndrome is associated with faster disease progression and worse outcome in patients with aortic stenosis (AS). Adiponectin plasma levels are reduced in presence of abdominal obesity and metabolic syndrome. The objective of this study was thus to examine the relationship between adiponectinemia and:
hemodynamic progression of AS and
degree of inflammation in the valve explanted at the time of aortic valve replacement.
Methods: Plasma level of adiponectin was measured by ELISA technique in 37 patients undergoing aortic valve replacement. Their aortic valve (AV) was explanted and studied for immunohistochemical analysis of leukocytes (CD45+), T lymphocytes (CD3+) and blood vessels density (vWF). Furthermore, these patients had ≥ 2 echocardiographic studies separated by at least 6 months, thereby allowing for the assessment of the rate of progression of the stenosis during the preoperative period.
Results: Patients with lower plasma level of adiponectin (<5μg/ml) had much faster progression rate of peak transvalvular gradient before surgery than those with higher level: 13±2vs.7±2mmHg/year (p= 0.01). Moreover, these patients with hypoadiponectinemia had significantly more CD45+leukocytes (42±10 vs. 21±8 cells/400x field, p=0.05), more T lymphocytes CD3+ (7±3 vs. 0 cells/400xfield, p=0.02), and a higher blood vessels density (18±7 vs 5±2 blood vessels/400x field) (p=0.02) in their valves compared to those with higher adiponectin levels.
Conclusion: These findings support the notion that hypoadiponectinemia associated with obesity and MS may play a role in the inflammatory process and the progression of calcific AS. Further studies are needed to determine if adiponectin should be considered as a new therapeutic target for the medical management of patients with AS.