Fat cells and membranous fat necrosis of aortic valves: a clinicopathological study

We examined 152 aortic valves (AVs), which included 82 postmortem non-dysfunctional AVs (nd-AVs) and 70 surgically removed dysfunctional AVs showing aortic stenosis (AS), aortic regurgitation (AR), or combined AS and AR (AS-R). Fat cells, membranous fat necrosis (MFN), and fat-MFN-related lesions composed of fat cells and/or MFN were found in 127 (83.6%), 110 (72.4%), and 140 (92.1%) of 152 AVs, respectively, and all were associated with older age (P = 0.010, P = 0.022, and P = 0.003, respectively). MFN was associated with fibrous thickening and calcification (both, P = 0.001). Nd-AV fat cells and fat-MFN-related lesions were not correlated with body mass index. Compared with age- and sex-matched control cases, MFN in AS and AS-R cases was more frequent (P = 0.030 and P = 0.045, respectively), but MFN in AR cases showed no significant differences. Fat-MFN-related lesions, possibly representing true preceding fat cells, showed no differences in AVs with and without dysfunction or in dysfunctional types. These data suggest that AV fat cells are age-related, obesity-independent, and AV dysfunction-unrelated common phenomenon. MFN is also age-dependent and could be caused by AS and AS-R, which is probably concerned with AV thickening and calcification.