Morphological study of the spectrum of lesions encountered in the heart and coronaries on autopsy

Background and Objectives: This research study has been carried out to study the various morphological changes in the heart in medicolegal autopsies and to compile data for the frequency of heart diseases found in autopsy cases. Methods: The present study comprised 430 medicolegal autopsy cases. Details of the cases were entered in a proforma prepared for the study. The heart was fixed in 10% formalin, and then, opened along the flow of blood. The findings were based on gross and microscopic examinations. Results: Out of 430 adult hearts, 211 (49.0%) cases showed 253 cardiac lesions; 35 (8.1%) cases of coronary atherosclerosis and 196 (45.5%) aortic atherosclerosis were noted; 7 cases of ischemic lesions (1.6%) were identified; 12 (2.7%) cases of hypertrophy; 2 cases of valve calcification; and 1 of cardiomyopathy were noted. Conclusion: In the present study, among medicolegal autopsies, atherosclerotic disease was the most frequently encountered lesion followed by hypertrophy. The incidence of atherosclerosis was found to be 47.6%. This study shows the high prevalence of atherosclerosis in the population.

Cardiac valve calcification in patients with end stage renal disease and its correlation with left ventricular function / 医学研究生学报

ObjectiveCardiovascular calcification is a highly common complication in patients with end stage renal disease. The aim of this study was to explore the effect of cardiac valve calcification (VC) on left ventricular function and morphology in patients with end stage renal disease by echocardiography. Methods Echocardiography results of 137 patients with end stage renal disease who underwent hemodialysis in the general hospital of the eastern theater of war from June 2013 to August 2013 were retrospectively analyzed. The morphological structure and function parameters of the left ventricle were measured by echocardiography and tissue doppler imaging to assess cardiovascular calcification. Logistic regression analysis was used to investigate the independent risk factors of cardiac valve calcification.Results VC was found in 55 patients (40.1%) in this study. The age [(52.7±11.1) vs (42.6±12.3)], low density lipoprotein [(2.7±0.8)mg/dL vs (2.2±0.6)mg/dL], cholesterol [(5.2±1.1)mg/dL vs (4.5±0.9)mg/dL] levels were higher, while serum creatinine [(10.7±2.7)mg/dL vs (13.2±8.5)mg/dL] was lower in patients with VC than patients without VC (P<0.05). Logistic regression analysis showed that the older age, longer dialysis time and higher mean value of mitral annular systolic values were the independent risk factors for VC. The morphological and structural parameters of the left ventricle of the group with VC were higher than those of the group without VC (P<0.05), while the parameters of left ventricular diastolic function of the group with VC were lower than those of the group without VC (P<0.05).ConclusionVC diagnosed by echocardiography in patients with end stage renal disease may indicate significantly higher incidence of left ventricular hypertrophy and reduction of left ventricular diastolic function in comparison to those without VC.

Effects of neutrophils-to-lymphocytes ratio on heart valve calcification in maintenance hemodialysis patients / 医学研究生学报

ObjectiveCardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with hemodialysis (HD) end-stage renal disease (ESRD). This paper analyzes and discusses the relationship between neutrophils-to-lymphocytes ratio (NLR) and heart valve calcification (CVC) in maintenance hemodialysis (MHD) patients to provide theoretical basis for the prevention and treatment of CVC.MethodsThe demographic data, relevant clinical indicators and laboratory examination results of 135 patients with MHD in the Second Hospital of Anhui Medical University were retrospectively analyzed to calculate the NLR value. Echocardiography was used to detect the incidence of CVC in the patients, and they were divided into calcification group and non-calcification group. The correlation between NLR value and CVC in MHD patients was analyzed, and the independent risk factors of CVC were discussed by using Logistic regression.ResultsAmong the 135 MHD patients, CVC was found in 59 cases (43.7%). Compared with the non-calcification group, patients in the calcification group showed significant increases in age, dialysis age, high-sensitivity c-reactive protein (HsCRP), ALP and NLR, with statistically significant differences (P5.02 (OR=17.709, P=0.046) were independent risk factors for heart valve calcification in MHD patients.ConclusionThe incidence of heart valve calcification is high in MHD patients, and NLR is an independent risk factor for it.

Prevalence and risk factors of aortic valve calcification among the elderly residents of Wuxi city, Jiangsu province / 中华心血管病杂志

Objective@#To evaluate the prevalence and risk factors of aortic valve calcification among the elderly (≥65 years old) resident of Wuxi city, Jiangsu province.@*Methods@#The household registration population aged ≥65 years old in Wuxi city was selected as the research subject by stratified sampling method from August 2017 to December 2018. Echocardiography was performed to assess the aortic valve calcification, and the participants were divided into calcification group and non-calcification group. Multivariate logistic regression analysis was used to explore the related risk factors of aortic valve calcification.@*Results@#The age of the respondents was (73.6±7.1) years old, of which 48.8% (461 cases) were males.The prevalence rate of aortic valve calcification was 22.0% (208/944) in the elderly (≥ 65 years old) residents in Wuxi city. The prevalence rate in 65-69 years old, 70-74 years old, 75-79 years old, 80-84 years old and ≥85 years old was 16.7% (58/347),16.7% (41/245),16.2% (26/161),23.3% (24/103), and 67.0% (59/88),respectively. There were significant differences in age, weight, abdominal circumference, hip circumference, high-salt diets, exercise, hypertension, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease, and carotid atherosclerosis between the non-calcified group (736 cases) and the calcified group (208 cases) (P<0.01 or 0.05).Multivariate logistic regression analysis showed that age (OR=1.077, 95%CI 1.053-1.101, P<0.001), diabetes mellitus (OR=1.697, 95%CI 1.174-2.453, P=0.005), and coronary heart disease (OR=1.964, 95%CI 1.378-2.799, P<0.001) were the risk factors of aortic valve calcification.@*Conclusions@#The prevalence of aortic valve calcification in the elderly (≥65 years old) residents in Wuxi city of Jiangsu province increases with aging. Age, diabetes mellitus and coronary heart disease are the risk factors of aortic valve calcification in this population cohort.

Research on relationship of FGF-23 and sKL with cardiac valve calcification in CAPD patients / 上海交通大学学报（医学版）

Objective· To explore the relationship of fibroblast growth factor-23 (FGF-23) and soluble klotho (sKL) with cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis (CAPD).Methods· 147 CAPD patients from the dialysis center of the First Affiliated Hospital of Soochow University were enrolled.The concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assays (ELISA).Echocardiography was applied to evaluate cardiac valve calcification.The patients were divided into normal cardiac valve group (group A) and cardiac valve calcification group (group B).SPSS 23.0 software was used for data analysis.Results· The incidence of cardiac valve calcification in CAPD patients was 54.42％.The risk of cardiac valve calcification showed positive correlation with age,dialysis age,serum creatinine,corrected calcium,serum phosphorus,serum alkaline phosphatase,parathyroid hormone,and the level of FGF-23 (P=0.045,P=0.022,P=0.006,P=0.024,P=0.000,P=0.017,P=0.022,P=0.000),and negative correlation with urea clearance index,the level of sKL and residual renal function (P=0.045,P=0.000,P=0.011).Multivariate Logistic regression analysis showed that the increase of FGF-23 (OR=5.007,95％ CI 1.446-17.339,P=0.011) and serum phosphorus (OR=7.433,95％ CI 1.558-35.470,P=0.012) were two independent risk factors for cardiac valve calcification in CAPD patients,and the decrease of sKL (OR=0.310,95％ CI 0.108-0.891,P=0.030) was another independent risk factor as well.Receiver operator characteristic curves (ROC) indicated that to predict cardiac valve calcification in patients with CAPD,the optimal cut off points of FGF-23 and sKL were 2 172.64 pg/mL (sensitivity was 91.3％,specificity was 91％) and 231.88 pg/mL (sensitivity was 88.8％,specificity was 92.5％),respectively.Conclusion· The high level of FGF-23 and low level of sKL are two independent risk factors for cardiac valve calcification in CAPD patients.FGF-23 and sKL can be used to diagnose cardiac valve calcification in CAPD patients.

Research on relationship of FGF-23 and sKL with cardiac valve calcification in CAPD patients / 上海交通大学学报（医学版）

Objective: To explore the relationship of fibroblast growth factor-23 (FGF-23) and soluble klotho (sKL) with cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods: 147 CAPD patients from the dialysis center of the First Affiliated Hospital of Soochow University were enrolled. The concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assays (ELISA). Echocardiography was applied to evaluate cardiac valve calcification. The patients were divided into normal cardiac valve group (group A) and cardiac valve calcification group (group B). SPSS 23.0 software was used for data analysis. Results: The incidence of cardiac valve calcification in CAPD patients was 54.42%. The risk of cardiac valve calcification showed positive correlation with age, dialysis age, serum creatinine, corrected calcium, serum phosphorus, serum alkaline phosphatase, parathyroid hormone, and the level of FGF-23 (P=0.045, P=0.022, P=0.006, P=0.024, P=0.000, P=0.017, P=0.022, P=0.000), and negative correlation with urea clearance index, the level of sKL and residual renal function (P=0.045, P=0.000, P=0.011). Multivariate Logistic regression analysis showed that the increase of FGF-23 (OR=5.007, 95% CI 1.446-17.339, P=0.011) and serum phosphorus (OR=7.433, 95% CI 1.558-35.470, P=0.012) were two independent risk factors for cardiac valve calcification in CAPD patients, and the decrease of sKL (OR=0.310, 95% CI 0.108-0.891, P=0.030) was another independent risk factor as well. Receiver operator characteristic curves (ROC) indicated that to predict cardiac valve calcification in patients with CAPD, the optimal cut off points of FGF-23 and sKL were 2 172.64 pg/mL (sensitivity was 91.3%, specificity was 91%) and 231.88 pg/mL (sensitivity was 88.8%, specificity was 92.5%), respectively. Conclusion: The high level of FGF-23 and low level of sKL are two independent risk factors for cardiac valve calcification in CAPD patients. FGF-23 and sKL can be used to diagnose cardiac valve calcification in CAPD patients.

Prevalencia y asociación de la calcificación valvular aórtica con factores de riesgo y aterosclerosis coronaria en población mexicana / Aortic valve calcification prevalence and association with coronary risk factors and atherosclerosis in Mexican population

Resumen: Objetivo: La prevalencia de calcificación valvular aórtica (CVA) tiene influencia importante de la etnia y se desconoce en población mexicana. Nuestro objetivo fue investigar la prevalencia de CVA y sus asociaciones con factores de riesgo cardiovascular y calcificación arterial coronaria (CAC). Método: En 1,267 sujetos (53% mujeres) sin enfermedad coronaria conocida y con edad de 35 a 75 años, la CVA y la CAC se evaluaron mediante tomografía computada multidetector, utilizando el método de Agatston. Los factores de riesgo cardiovascular se documentaron en todos los participantes. Las asociaciones de CVA con CAC y factores de riesgo se estimaron usando el análisis de regresión logística múltiple. Resultados: La prevalencia global de CVA y CAC fue del 19.89% y del 26.5%, respectivamente. Ambas condiciones aumentaron con la edad y se encontraron con mayor frecuencia en hombres (25.5 y 37.1%, respectivamente) que en mujeres (14.9 y 13%, respectivamente). La CVA se observó en únicamente el 8.5% de los sujetos sin CAC, mientras que en aquellos con CAC 1-99, 100-399 y > 400 unidades Agatston, las prevalencias fueron del 36.8, 56.8 y 84%, respectivamente. El análisis de regresión logística múltiple ajustado por edad, género, obesidad, inactividad física, hipertensión, dislipidemia y valores altos de insulina, mostró que la presencia de CAC (RM [IC95%]: 3.23 [2.26-4.60]), obesidad (1.94 [1.35-2.79]), género masculino (1.44 [1.01-2.05]) y edad (1.08 [1.03-1.10]), fueron predictores independientes y significativos de la CVA. Conclusiones: La prevalencia de CVA es alta y se asocia significativamente con factores de riesgo aterosclerótico y CAC en población mexicana.

Abstract: Objetive: The prevalence of aortic valve calcification (AVC), strongly influenced by ethnicity, is unknown in Mexican population. The aim of this study was to investigate the prevalence of AVC and its associations with cardiovascular risk factors and coronary artery calcification (CAC), in Mexican subjects. Methods: In 1,267 subjects (53% women) without known coronary heart disease, aged 35 to 75 years, AVC and CAC were assessed by multidetector-computed tomography using the Agatston score. Cardiovascular risk factors were documented in all participants. The associations of AVC with CAC and risk factors were assessed by multivariable logistic regression analyses. Results: The overall prevalence of AVC and CAC was 19.89% and 26.5%, respectively. AVC and CAC increased with age and were found more frequently in men (25.5% and 37.1%, respectively) than in women (14.9% and 13.0%, respectively). AVC was observed in only 8.5% of subjects wit-hout CAC, while those with CAC 1-99, 100-399, and > 400 Agatston units had AVC prevalences of 36.8%, 56.8%, and 84.0%, respectively. The multivariable logistic regression analyses, adjusted for age, gender, obesity, physical inactivity, hypertension, dyslipidemia and high insulin levels, showed that the presence of CAC (OR [CI95%]: 3.23 [2.26-4.60]), obesity (1.94 [1.35-2.79]), male gender (1.44 [1.01-2.05]) and age (1.08 [1.03-1.10]), were significant independent predictors of AVC. Conclusion: Prevalence of AVC is high and significantly associated with atherosclerotic risk factors and CAC in this Mexican population.

Assessing whether aortic valve calcification and mitral annual calcification is the independent predictors for coronary artery disease / 实用放射学杂志

Objective To assess whether aortic valve calcification (AVC) and mitral annual calcification (MAC) is independent predictors for coronary artery disease (CAD).Methods Coronary CT angiography(CCTA) data in a total of 263 patients were included in this study,including 30 patients with MAC, 82 patients with AVC and 31 patients with MAC+AVC;meanwhile other 120 patients without valvular calcification were regarded as a control group.Five indicators were used to evaluate the extent and severity of CAD, namely, the prevalence of coronary plaque, multi-coronary vessels lesions, degrees of coronary artery narrowing, incidence of moderate to severe coronary artery calcification score and mean number of affected coronary artery segments.The correlations of MAC,AVC,MAC+AVC with CAD were analyzed by Logistic regression analysis.Results The presence and severity of CAD were significantly greater in patients with MAC, AVC and MAC+AVC than those in control group.After adjustment for CAD conventional risk factors,Logistic regression analysis revealed that AVC,MAC and MAC+AVC were independently associated with the presence and severity of CAD.Conclusion AVC and MAC are independent predictors for CAD and often predict the more presence and greater severity of CAD.

Effect of Rosuvastatin on Bovine Pericardial Aortic Tissue Valve Calcification in a Rat Subdermal Implantation Model

BACKGROUND AND OBJECTIVES: There are pathophysiologic similarities between calcification and atherosclerosis because both are the product of an active inflammatory process. The aim of this study was to examine the effects of statin treatment on calcification in bovine pericardial tissue valves. MATERIALS AND METHODS: Forty Sprague-Dawley rats were randomly divided into 4 groups according to hypercholesterolemia induction and statin intake (Group 1, n=10: normal diet without statin treatment, Group 2, n=10: normal diet with statin treatment, Group 3, n=10: high fat diet without statin treatment, Group 4, n=10: high fat diet with statin treatment). Serum lipid levels were measured just before the experiment and after 4 and 12 weeks. Bovine pericardial tissue valve cusps were surgically implanted in rat dorsal subcutis at 4 weeks. After the surgery, statin was administered daily to Groups 2 and 4. Serum interleukin-6 (IL-6) level was measured at 5 weeks. Cusps were explanted at 12 weeks and calcium levels were determined by atomic absorption spectroscopy. RESULTS: Mean IL-6 was significantly higher in Group 3 at 5 weeks (7.14, 2.03, 31.70, and 6.90 pg/dL for each group, respectively). Mean calcium level in Group 3 was significantly higher among groups but Group 4 was significantly lower compared to Group 3 and was similar to Group 1, 2 (1.86, 1.92, 2.55, and 1.80 mg/g for each group, respectively, p<0.01). CONCLUSION: Hypercholesterolemia may be a significant risk factor for bovine pericardial valve calcification. Statin treatment significantly attenuated calcification of bovine pericardial valve tissue in a rat subdermal implantation model and might prolong the durability of bioprostheses.

Clinical study on risk factors correlated with senile degenerative aortic valve calcification by color Doppler echocardiograph / 国际生物医学工程杂志

Objective To investigate the value of the senile degenerative aortic valve calcification (AVC) and to analyze the correlative risk factors by color Doppler echocardiograph.Methods Aortic valves of 110 cases with AVC (study group) and 110 cases without AVC (control group) were observed by color Doppler echocardiograph.All the patients with AVC have been excluded of congenital and other acquired valves' diseases.The aortic valve' s shape and the diameters of aortic root were measured.At the same time,the peak systolic and diastolic velocities of aorta were detected.The different features were compared between the two groups.Results Test results showed significant differences in study group:Anteroposterior diameter of aortic annulus and the area of aortic valve were decreased by calcification; The anteroposterior diameter of aortic sinus increased and aorta transvalvular pressure gradient augmented; Detection rate of atherosclerosis (AS) of aorta and the peripheral artery stenosis of the study group were higher than that of control group; The AS increased pulse pressure and aggravated AVC; Correlative risk factors,in addition to age,included hypertension,hypercholesterolemia,osteoporosis,and so on.The correct diagnosis of the correlated diseases were on the basis of clinical examines.The rate of AVC with multi-factor was higher than that with single-factor.In addition,gender difference and the diameters of ascending aortic showed no significant difference in two groups.Relationship between diabetes of correlative factors and the rate of AVC showed no significant difference in two groups.Conclusion Morphologic abnormality and malfunction of aortic valve and the large artery in elder patients were caused by senile degenerative AVC.The more correlative risk factors,the worse showed.

The expression and significance of metalloproteinase in the calciflc aortic valve / 中国综合临床

Objective To study the expression and significance of metalloproteinase 2(MMP-2)and tisse inhibitor of metalloproteinase(TIMP-2 ) in the degenerative calcific aortic valve.Methods 15 calcific and 10 non-calcific aortic valve acquired through aortic valve replacement.were studied by immunohistochemistry for MMP-2 and TIMP-2.Morphologic changes were observed by light and transmission electron microscopic.Results The expression of MMP-2 and TIMP-2 in calcific group were significantly higher than in non-calcific group(P<0.01).Positive cells were mostly localized subendothelial and the extracellular matrix.Control valves exhibited very weak staining of MMP-2 and TIMP-2 mostly localized in the extracelluar matrix.Various degree of endothelial damage and interstitial calcification were observed.Conculsion The expression of MMP-2 and TIMP-2 may play an important role in the calcific aortic valve.They may be involved not only in matrix degradation but also in matrix remodeling.The mecha-nism of regulation and activation remain to be elucidated.

Valvular and perivalvular involvement in patients with chronic kidney disease / 老年心脏病学杂志（英文版）

Abstract Mitral annular calcification (MAC) and aortic valve alcification (AVC) are the most common valvular and perivalvular bnormalities in patients with chronic kidney disease (CKD). Both MAC and AVC occur at a younger age in CKD patients than in the general population. AVC progresses to aortic stenosis and mild aortic stenosis progresses to severe aortic stenosis at a more rapid rate in patients with CKD than in the general population. The use of calcium-free phosphate binders in such patients may reduce the calcium burden in valvular and perivalvular tructures and retard the rate of progression of aortic stenosis. Despite high rates of morbidity and mortality, the prognosis associated with valve surgery in patients with CKD is better than without valve surgery. Infective endocarditis remains an important complication of CKD, particularly in those treated with hemodialysis.