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2016 ; 11
(4
): 1184-1188
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Pathophysiology of valvular heart disease
#MMPMID27073420
Zeng YI
; Sun R
; Li X
; Liu M
; Chen S
; Zhang P
Exp Ther Med
2016[Apr]; 11
(4
): 1184-1188
PMID27073420
show ga
Valvular heart disease (VHD) is caused by either damage or defect in one of the
four heart valves, aortic, mitral, tricuspid or pulmonary. Defects in these
valves can be congenital or acquired. Age, gender, tobacco use,
hypercholesterolemia, hypertension, and type II diabetes contribute to the risk
of disease. VHD is an escalating health issue with a prevalence of 2.5% in the
United States alone. Considering the likely increase of the aging population
worldwide, the incidence of acquired VHD is expected to increase. Technological
advances are instrumental in identifying congenital heart defects in infants,
thereby adding to the growing VHD population. Almost one-third of elderly
individuals have echocardiographic or radiological evidence of calcific aortic
valve (CAV) sclerosis, an early and subclinical form of CAV disease (CAVD). Of
individuals ages >60, ~2% suffer from disease progression to its most severe
form, calcific aortic stenosis. Surgical intervention is therefore required in
these patients as no effective pharmacotherapies exist. Valvular calcium load and
valve biomineralization are orchestrated by the concerted action of diverse
cell-dependent mechanisms. Signaling pathways important in skeletal morphogenesis
are also involved in the regulation of cardiac valve morphogenesis, CAVD and the
pathobiology of cardiovascular calcification. CAVD usually occurs without any
obvious symptoms in early stages over a long period of time and symptoms are
identified at advanced stages of the disease, leading to a high rate of
mortality. Aortic valve replacement is the only primary treatment of choice.
Biomarkers such as asymmetric dimethylarginine, fetuin-A, calcium phosphate
product, natriuretic peptides and osteopontin have been useful in improving
outcomes among various disease states. This review, highlights the current
understanding of the biology of VHD, with particular reference to molecular and
cellular aspects of its regulation. Current clinical questions and the
development of new strategies to treat various forms of VHD medically were
addressed.