Aortic sclerosis overview: Difference between revisions
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==Overview== | ==Overview== | ||
Aortic sclerosis commonly affects elderly population. Microscopic changes reveal lipoprotein accumulation, cellular infiltration and extracellular matrix formation that cause progressive thickening of the aortic valve.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref> Aortic sclerosis is defined based on [[transthoracic echocardiography|transthoracic echocardiographic]] findings which include irregular leaflet thickening and focal valve thickening with associated increase in echogenicity.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref><ref name="pmid10403851">{{cite journal |author=Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS |title=Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly |journal=[[The New England Journal of Medicine]] |volume=341 |issue=3 |pages=142–7 |year=1999 |month=July |pmid=10403851 |doi=10.1056/NEJM199907153410302 |url=http://dx.doi.org/10.1056/NEJM199907153410302 |accessdate=2012-04-10}}</ref><ref name="pmid9060903">{{cite journal |author=Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM |title=Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study |journal=[[Journal of the American College of Cardiology]] |volume=29 |issue=3 |pages=630–4 |year=1997 |month=March |pmid=9060903 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109796005633 |accessdate=2012-04-10}}</ref><ref name="pmid21295189">{{cite journal |author=Gharacholou SM, Karon BL, Shub C, Pellikka PA |title=Aortic valve sclerosis and clinical outcomes: moving toward a definition |journal=[[The American Journal of Medicine]] |volume=124 |issue=2 |pages=103–10 |year=2011 |month=February |pmid=21295189 |doi=10.1016/j.amjmed.2010.10.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(10)00913-7 |accessdate=2012-04-10}}</ref> | Aortic sclerosis commonly affects elderly population. Microscopic changes reveal lipoprotein accumulation, cellular infiltration and extracellular matrix formation that cause progressive thickening of the aortic valve.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref> Aortic sclerosis is defined based on [[transthoracic echocardiography|transthoracic echocardiographic]] findings which include irregular leaflet thickening and focal valve thickening with associated increase in echogenicity.<ref name="pmid15967862">{{cite journal |author=Freeman RV, Otto CM |title=Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies |journal=[[Circulation]] |volume=111 |issue=24 |pages=3316–26 |year=2005 |month=June |pmid=15967862 |doi=10.1161/CIRCULATIONAHA.104.486738 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15967862 |accessdate=2012-04-10}}</ref><ref name="pmid10403851">{{cite journal |author=Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS |title=Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly |journal=[[The New England Journal of Medicine]] |volume=341 |issue=3 |pages=142–7 |year=1999 |month=July |pmid=10403851 |doi=10.1056/NEJM199907153410302 |url=http://dx.doi.org/10.1056/NEJM199907153410302 |accessdate=2012-04-10}}</ref><ref name="pmid9060903">{{cite journal |author=Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM |title=Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study |journal=[[Journal of the American College of Cardiology]] |volume=29 |issue=3 |pages=630–4 |year=1997 |month=March |pmid=9060903 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109796005633 |accessdate=2012-04-10}}</ref><ref name="pmid21295189">{{cite journal |author=Gharacholou SM, Karon BL, Shub C, Pellikka PA |title=Aortic valve sclerosis and clinical outcomes: moving toward a definition |journal=[[The American Journal of Medicine]] |volume=124 |issue=2 |pages=103–10 |year=2011 |month=February |pmid=21295189 |doi=10.1016/j.amjmed.2010.10.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(10)00913-7 |accessdate=2012-04-10}}</ref> | ||
==Epidemiology== | ==Epidemiology== | ||
Majority of the patients with aortic sclerosis are aged beyond 65 years and are associated with a significant increase in the risk of cardiovascular death, [[myocardial infarction]] even in the absence of hemodynamically significant [[LVOT|left ventricular outflow tract obstruction]].<ref name="pmid8459080">{{cite journal |author=Lindroos M, Kupari M, Heikkilä J, Tilvis R |title=Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample |journal=[[Journal of the American College of Cardiology]] |volume=21 |issue=5 |pages=1220–5 |year=1993 |month=April |pmid=8459080 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(93)90249-Z |accessdate=2012-04-10}}</ref><ref name="pmid9060903">{{cite journal |author=Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM |title=Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study |journal=[[Journal of the American College of Cardiology]] |volume=29 |issue=3 |pages=630–4 |year=1997 |month=March |pmid=9060903 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109796005633 |accessdate=2012-04-10}}</ref><ref name="pmid10403851">{{cite journal |author=Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS |title=Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly |journal=[[The New England Journal of Medicine]] |volume=341 |issue=3 |pages=142–7 |year=1999 |month=July |pmid=10403851 |doi=10.1056/NEJM199907153410302 |url=http://dx.doi.org/10.1056/NEJM199907153410302 |accessdate=2012-04-10}}</ref> | Majority of the patients with aortic sclerosis are aged beyond 65 years and are associated with a significant increase in the risk of cardiovascular death, [[myocardial infarction]] even in the absence of hemodynamically significant [[LVOT|left ventricular outflow tract obstruction]].<ref name="pmid8459080">{{cite journal |author=Lindroos M, Kupari M, Heikkilä J, Tilvis R |title=Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample |journal=[[Journal of the American College of Cardiology]] |volume=21 |issue=5 |pages=1220–5 |year=1993 |month=April |pmid=8459080 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0735-1097(93)90249-Z |accessdate=2012-04-10}}</ref><ref name="pmid9060903">{{cite journal |author=Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM |title=Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study |journal=[[Journal of the American College of Cardiology]] |volume=29 |issue=3 |pages=630–4 |year=1997 |month=March |pmid=9060903 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109796005633 |accessdate=2012-04-10}}</ref><ref name="pmid10403851">{{cite journal |author=Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS |title=Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly |journal=[[The New England Journal of Medicine]] |volume=341 |issue=3 |pages=142–7 |year=1999 |month=July |pmid=10403851 |doi=10.1056/NEJM199907153410302 |url=http://dx.doi.org/10.1056/NEJM199907153410302 |accessdate=2012-04-10}}</ref> | ||
==Risk Factors== | |||
The presence of aortic sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality. However, it remains unclear whether aortic sclerosis is independently associated with risk or merely a marker of coexistent cardiovascular risk factors.<ref name="pmid21295189">{{cite journal |author=Gharacholou SM, Karon BL, Shub C, Pellikka PA |title=Aortic valve sclerosis and clinical outcomes: moving toward a definition |journal=[[The American Journal of Medicine]] |volume=124 |issue=2 |pages=103–10 |year=2011 |month=February |pmid=21295189 |doi=10.1016/j.amjmed.2010.10.012 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(10)00913-7 |accessdate=2012-04-10}}</ref> | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 21:48, 10 April 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Aortic sclerosis commonly affects elderly population. Microscopic changes reveal lipoprotein accumulation, cellular infiltration and extracellular matrix formation that cause progressive thickening of the aortic valve.[1] Aortic sclerosis is defined based on transthoracic echocardiographic findings which include irregular leaflet thickening and focal valve thickening with associated increase in echogenicity.[1][2][3][4]
Epidemiology
Majority of the patients with aortic sclerosis are aged beyond 65 years and are associated with a significant increase in the risk of cardiovascular death, myocardial infarction even in the absence of hemodynamically significant left ventricular outflow tract obstruction.[5][3][2]
Risk Factors
The presence of aortic sclerosis has been suggested as a marker of increased cardiovascular risk, including increased mortality. However, it remains unclear whether aortic sclerosis is independently associated with risk or merely a marker of coexistent cardiovascular risk factors.[4]
Diagnosis
History and Symptoms
- Mostly asymptomatic
- Aortic sclerosis is an incidental echocardiographic finding
Physical Examination
Echocardiography
- Focal areas of valve thickening with associated increase in echogenicity is the hallmark of aortic sclerosis,[1][2][3][4] as opposed to the diffuse thickening observed as a part of normal aging
- Aortic side of the valve in the center of the valve cusp is commonly affected
- Commissural areas are spared
- Irregular leaflet thickening
- Leaflet mobility is normal
- Valvular hemodynamic parameters are normal with a jet flow velocity of less than 2.5 m per sec across the valve
References
- ↑ 1.0 1.1 1.2 Freeman RV, Otto CM (2005). "Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies". Circulation. 111 (24): 3316–26. doi:10.1161/CIRCULATIONAHA.104.486738. PMID 15967862. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999). "Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly". The New England Journal of Medicine. 341 (3): 142–7. doi:10.1056/NEJM199907153410302. PMID 10403851. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM (1997). "Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study". Journal of the American College of Cardiology. 29 (3): 630–4. PMID 9060903. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 4.2 Gharacholou SM, Karon BL, Shub C, Pellikka PA (2011). "Aortic valve sclerosis and clinical outcomes: moving toward a definition". The American Journal of Medicine. 124 (2): 103–10. doi:10.1016/j.amjmed.2010.10.012. PMID 21295189. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help) - ↑ Lindroos M, Kupari M, Heikkilä J, Tilvis R (1993). "Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample". Journal of the American College of Cardiology. 21 (5): 1220–5. PMID 8459080. Retrieved 2012-04-10. Unknown parameter
|month=ignored (help)