In this presentation Dr. Skowasch talks about valvular heart disease, in particular aortic stenosis.

Patients with aortic stenosis can have a long asymptomatic period, however once symptoms develop the prognosis is poor (1). According to the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease, surgery is recommended in the symptomatic patients with aortic stenosis (2). There are no medical therapies currently approved for the prevention or treatment of aortic stenosis. Of the substitute valves implanted each year, about half are mechanical valves and the other half are bioprostheses. "Twenty to thirty percent of implanted bioprostheses show dysfunction about 10 years post-implantation," says Dr. Skowasch.

In addition to histological studies suggesting that inflammation plays an important role in valve degeneration, several groups have reported the presence of increased serum levels of C-reactive protein (CRP) in patients with aortic stenosis. In addition, CRP levels decrease 6 months after aortic valve replacement, suggesting that aortic stenosis is an inflammatory disease (3). In the present study reported by Dr. Skowasch and colleagues, the aim was to compare degenerative aortic native valves versus degenerative aortic bioprostheses, to assess the presence of CRP in these valves, the relationship between valvular and serum CRP levels, and a possible modulation of CRP levels with statin therapy. Dr. Skowasch presents the findings of the study, which support an important role for inflammation in valve degeneration, and show reduced valvar and CRP concentrations with statin therapy (4).

Copyright © 2006 E-MedHosting.com Inc.

After viewing this presentation the participant will be able to discuss:

- The natural history of aortic valve stenosis (AS)
- ACC/AHA 2006 practice guidelines relating to severe AS
- Evidence for an important role of inflammation in aortic valve degeneration
- Effect of aortic valve replacement on serum C-reactive protein (CRP) concentrations
- A comparison of degenerative aortic native valves versus degenerative aortic bioprostheses:
--- valvular tissue-resident CRP
--- the relationship between valvular and serum CRP concentrations
--- modification of CRP by statins

1. Blase A. Carabello, M.D., and Fred A. Crawford, M.D. Valvular Heart Disease N Engl J Med. 1997 Jul 3;337(1):32-41.

2. Bonow RO et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J Am Coll Cardiol. 2006 Aug 1;48(3):e1-148.

3. Gerber IL, Stewart RA, Hammett CJ, Legget ME, Oxenham H, West TM, French JK,White HD. Effect of aortic valve replacement on c-reactive protein in nonrheumatic aortic stenosis Am J Cardiol. 2003 Nov 1;92(9):1129-32.

4. D Skowasch, S Schrempf, C J Preusse, J A Likungu, A Welz, B Lüderitz and G Bauriedel Tissue resident C reactive protein in degenerative aortic valves: correlation with serum C reactive protein concentrations and modification by statins Heart 2006;92:495-498.