Abstract 12915: Intraleaflet Hemorrhage is Associated with Rapid Progression of Degenerative Aortic Valve Stenosis
Background: The hemorrhage in the plaque (intraplaque hemorrhage) plays a critical role in the progression of atherosclerosis. The purpose of this study is to clarify whether the hemorrhage in the aortic valve leaflet (intraleaflet hemorrhage) accelerates the progression of aortic valve stenosis (AS).
Methods and Results: We examined specimens of aortic valve leaflets obtained from 41 patients who had undergone aortic valve replacement for degenerative AS and in whom echocardiographic data were available just before the operation and at least 90 days before the last study. Ten patients who had undergone aortic valve replacement for annulo-aortic ectasia (AAE) served as controls. The stenotic valves were examined by immunohistochemistry to detect intraleaflet hemorrhage with antibody against glycophorin A, an erythrocyte-specific protein, vascular endothelial cells with antibody against von Willebrand Factor, and macrophages with antibody against CD68. The progression of AS was assessed by annualized change in the aortic valve area (ΔAVA: cm2/y). Intraleaflet hemorrhage was observed in 76% of the specimens from AS, but not in those from AAE. Intraleaflet hemorrhage was associated with neovascularization (R=0.26, p<0.05) and macrophage infiltration (R=0.79, p<0.05). ΔAVA was associated with the areas of intraleaflet hemorrhage (R=0.54, p<0.05) and macrophage infiltration (R=0.43, p<0.05). Multivariate analysis has shown that the area of intraleaflet hemorrhage was a sole independent factor that positively correlated with ΔAVA (p<0.05).
Conclusions: Intraleaflet hemorrhage was frequently observed in the valve leaflets of degenerative AS and associated with a rapid progression of AS. The treatments that prevent intraleaflet hemorrhage may retard the progression of AS.
- © 2010 by American Heart Association, Inc.