Abstract 2309: Intra-Valve Hemorrhage is Associated with Increased Inflammation, Neovascularization and Calcification in Patients with Severe Aortic Stenosis
Intra-plaque hemorrhage is a manifestation of inflammation and neovascularization in atherosclerosis that may also play a role in severe calcific aortic stenosis (AS). This study tested the hypothesis that intra-valve hemorrhage (IVH) will have increased inflammation and neovascularization in severe AS. From Jan-Dec 2006, 94 patients underwent surgery for AS. Tissue specimens from all 94 valves were evaluated (H&E stain). IVH was defined as erythrocyte extravasation mostly located in severely calcified areas, as shown in Figure⇓. Seven specimens displayed IVH. Of the remaining 87 specimens without IVH, 44 served as controls. Immunohistochemistry was performed to quantify macrophage/T cell infiltration (CD-68+CD-3), and neovessel content (CD-34). Calcification (graded on a scale from 1 to 4) was also perfomed. IVH patients were younger (59 ± 12 versus 69 ± 9; P<0.05). Gender, risk factors, coronary disease, aortic valve area, gradient, and ejection fraction were similar in both groups. Macrophage/T cell content was increased in IVH when compared to controls (59 ± 22 versus 28 ± 22; P<0.05). Neovascularization was also increased in IVH when compared to controls (32 ± 6 versus 23 ± 10; P<0.05). Finally, calcification score was also increased in IVH when compared to controls (3.9 ± 0.4 versus 3 ± 0.9; P<0.01). IVH is associated with younger age, increased inflammation, neovascularization, and calcification in severe AS. These results suggest that IVH may play a role in the pathobiology of severe AS, accelerating the process of inflammation and calcification, which may trigger symptoms at a younger age.