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You are here: Contents > 2013 > Volume 22 Number 2 March > AORTIC VALVE DISEASE > Comparison of Transesophageal Echocardiographic Analysis and Circulating Biomarker Expression Profile in Calcific Aortic Valve Disease

Comparison of Transesophageal Echocardiographic Analysis and Circulating Biomarker Expression Profile in Calcific Aortic Valve Disease

Rachana Sainger, Juan B. Grau, Emanuela Branchetti, Paolo Poggio1, Eric Lai, Erblina Koka, William J. Vernick, Robert C. Gorman, Joseph E. Bavaria, Giovanni Ferrari

Perelman School of Medicine at University of Pennsylvania, Department of Surgery, Division of Cardiovascular Surgery, Philadelphia, PA, The Valley-Columbia Heart Center, Columbia University College of Physicians and Surgeons, Ridgewood, NJ, USA, Centro Cardiologico Monzino, University of Milan, Italy

Background and aim of the study: Aortic valve sclerosis (AVSc), the early asymptomatic stage of calcific aortic valve disease (CAVD), is characterized by a progressive thickening of the aortic cusps without obstruction of the left ventricular outflow. In spite of its high prevalence, there are no molecular markers to characterize the early stages of CAVD before it progresses to a severe, symptomatic stage of aortic valve stenosis (AVS). The study aim was to identify any correlation between circulating biomarkers and transesophageal echocardiography (TEE) evaluation.

Methods: A total of 330 patients with various degrees of CAVD was enrolled into the study. Blood was collected from each patient prior to surgery, and analyzed using ELISA kits following the manufacturers’ instructions.

Results: Significantly higher plasma osteopontin (OPN) levels were observed in AVSc patients (72.7 ± 1.8 ng/ml; p <0.001) and AVS patients (64.3 ± 5.1 ng/ml; p <0.001) when compared to controls (30.3 ± 1.8 ng/ml). Parathyroid hormone (PTH) levels in AVSc and AVS patients (164.1 ± 16.5 and 134.3 ± 14.6 pg/ml; p <0.001 and p = 0.04, respectively) were also significantly higher than in controls (61.8 ± 4.92 pg/ml). Upon further analysis, plasma levels of OPN (p <0.001) and PTH (p <0.001) were found to be significantly higher in asymptomatic AVSc patients, even before calcium deposition was detected on TEE evaluation. Fetuin-A levels were lower at all stages of CAVD when compared to controls (p <0.001 and p ≤ 0.05, respectively), but were comparable among the patient groups. NT-proBNP levels were significantly higher in AVS patients than in controls (p ≤ 0.01).

Conclusion: Serum levels of OPN, PTH, and fetuin-A showed a significant association with different stages of CAVD, with variations in their levels occurring before calcium nodules are visualized during TEE evaluation. The study results may help not only to provide a better understanding of the progression of CAVD but also to develop new tools that can be used to stage these patients.


The Journal of Heart Valve Disease 2013;22:156-165

Comparison of Transesophageal Echocardiographic Analysis and Circulating Biomarker Expression Profile in Calcific Aortic Valve Disease

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