Association of inflammation, myocardial fibrosis and cardiac remodelling in patients with mild aortic stenosis as assessed by biomarkers and echocardiography

The aim of the present study was to investigate the relationships among inflammation, myocardial fibrosis and cardiac remodelling in patients with mild aortic stenosis (AS), as assessed by biomarkers and echocardiography. We evaluated 32 consecutive patients with mild AS, as well as 30 age- and gender-matched healthy individuals with normal aortic valves as control subjects. Baseline echocardiography showed that the left ventricular (LV) mass index (111.326.9 vs 94.518.2g/m(2); P=0.006) and left atrial (LA) volume index (LAVI 27.59.0 vs xx.x +/- 5.2mm(3)/mm(2); P=0.005) were significantly higher in patients with mild AS. Furthermore, LA enlargement (LAVI >33mm(3)/mm(2); 32.4% vs 3.3%;P=0.003) and elevated LV filling pressure (E/e>15; 50.0% vs 23.3%; P=0.036) were higher in patients with mild AS. In patients with mild AS, stepwise, multivariate linear regression analysis revealed that the LV end-diastolic volume index was independently associated with matrix metalloproteinase (MMP)-1 (=0.371; P=0.015), that the aortic valve mean pressure gradient was independently associated with MMP-2 (=0.19; P=0.019), that MMP-2 was independently associated with transforming growth factor- (=0.95; P<0.001) and interleukin (IL)-1 (=0.17; P=0.019) and that IL-1 was independently associated with tissue inhibitor of matrix metalloproteinase-1 (=0.68; P=0.001). Myocardial fibrosis in mild AS is independently associated with three factors: LV volume overload, aortic valve pressure overload and inflammation.