Aortic valve calcification and outcomes in severe aortic stenosis

Calcification of the valve leaflets is generally regarded to be a core feature of degenerative aortic stenosis (AS). Indeed, such is the importance of calcium deposition, the condition is commonly referred to as calcific AS. Historically, the process by which stenosis progressed was considered to be passive. It is, however, now well established that the evolution of AS is an active, inflammatory, process.1 Initial valvular endothelial injury, through mechanical shear stress and other risk factors, results in lipid infiltration and oxidisation. This leads to an inflammatory cascade and pathological activation of valvular interstitial cells, which subsequently differentiate into osteoblast-like cells and myofibroblasts (figure 1). The osteoblast-like cells cause ossification and calcification. The myofibroblasts lay down a collagen scaffolding, which causes fibrosis and provides a further foundation for developing calcification. The relative contribution of osteoblast-like cells and myofibroblasts to this process is unknown and likely variable...

Source: Heart - September 13, 2023 Category: Cardiology Authors: Courtney, W. A., Schultz, C. J., Hillis, G. S. Tags: Editorials Source Type: research