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You are here: Contents > 2012 > Volume 21 Number 4 July 2012 > AORTIC VALVE DISEASE > Editorial Potentially Modifiable Biological Targets in Aortic Regurgitation

Editorial Potentially Modifiable Biological Targets in Aortic Regurgitation

Ajit D. Pai, Ramdas G. Pai

Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA

In this issue of The Journal of Heart Valve Disease, Zendaoui et al. report the potential beneficial effects of spironolactone in a rat model of chronic aortic regurgitation (AR) (1). This seems to be mediated through a reduction of myocardial fibrosis associated with a reduced expression of collagen I and LOX 1 mRNAs, and has important implications in volume overload types of valvular disorder.
During recent years, valvular lesions have been thought of as simple mechanical or hydrodynamic issues, much in the way that heart failure or coronary artery disease was considered 25 years ago. However, today it is being increasingly recognized that valvular lesions are complex biological processes, not only at the valvular level but also at ventricular and systemic levels. However, these disturbed biological processes may offer potential therapeutic targets.

The potential targets could be on the valve itself, on the left ventricle, which bears the brunt of volume overload or pressure overload, or on the systemic neurohormonal and inflammatory processes that are similar to heart failure syndrome. Although pharmacological treatments designed to modify the biology of valves (as in aortic stenosis) have not been shown to affect the rate of progression in clinical trials, there is some promise that these processes may be modifiable if the treatment is started early enough. For example, in a patient with aortic stenosis, different processes such as the initiation of valvular damage resulting in inflammation, fibrosis and calcification may play principal roles at different stages of the process. Hence, therapeutic maneuvers may have to be more specific and based on the operating mechanisms at a specific stage of the degenerative process.

Editorial Potentially Modifiable Biological Targets in Aortic Regurgitation

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