Insights into degenerative aortic valve disease
Insights into degenerative aortic valve disease
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DOI：
10.1016/j.jacc.2007.06.024
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发表时间：
2007-09-25
影响因子：
24
通讯作者：
Fuster, Valentin
中科院分区：
文献类型：
--
作者：
Goldbarg, Seth H.;Elmariah, Sammy;Fuster, Valentin
尽管在过去的50年里风湿性心脏病的发病率急剧下降，但瓣膜性心脏病的患病率并没有一致的下降。退行性主动脉瓣疾病（DAVD）已成为西方世界心脏瓣膜病的最常见原因，导致显著的发病率和死亡率。瓣膜钙化不再被认为是衰老的良性后果，而是一种活跃过程的结果，与动脉粥样硬化性血管疾病非常相似，在基底膜破坏、炎性细胞浸润和脂质沉积之前，瓣膜钙化与糖尿病、高胆固醇血症、高血压和吸烟有关。这些认识，除了从新兴的成像方式获得的病理学见解，导致了各种治疗干预措施的探索，以延迟或防止DAVD的进展。3-羟基-3-甲基戊二酰辅酶A还原酶、血管紧张素转换酶和基质金属蛋白酶的抑制剂都被研究为潜在的疾病调节剂。此外，组织工程，辅助新兴的干细胞技术，具有巨大的潜力，为治疗心脏瓣膜病的手术干预的替代品。在这里，我们回顾DAVD的流行病学和病理生理学，除了强调这个日益严重的问题的新兴治疗干预措施。
Despite the dramatic decline of rheumatic heart disease over the past 5 decades, there has not been a concordant decline in the prevalence of valvular heart disease. Degenerative aortic valve disease (DAVD) has become the most common cause of valvular heart disease in the Western world, causing significant morbidity and mortality. No longer considered a benign consequence of aging, valve calcification is the result of an active process that, much like atherosclerotic vascular disease, is preceded by basement membrane disruption, inflammatory cell infiltration, and lipid deposition and is associated with diabetes, hypercholesterolemia, hypertension, and tobacco use. These realizations, in addition to pathological insights gained from emerging imaging modalities, have lead to the exploration of a variety of therapeutic interventions to delay or prevent the progression of DAVD. Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, angiotensin-converting enzyme, and matrix metalloproteinase have all been studied as potential disease modifiers. Moreover, tissue engineering, aided by emerging stem cell technology, holds immense potential for the treatment of valvular heart disease as adjuncts to surgical interventions. Here we review the epidemiology and pathophysiology of DAVD, in addition to highlighting emerging therapeutic interventions for this growing problem.