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Published on: July 14, 2021
Association of myocardial angiogenesis with structural and functional ventricular remodeling in aortic stenosis
Seung-Pyo Lee1, Hyung-Kwan Kim1, Yong-Jin Kim1
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Myocardial angiogenesis increases with left ventricular (LV) hypertrophy in patients with aortic stenosis (AS) and normal ejection fraction (EF). This study investigated the link between blood vessel density and LV remodeling in AS patients.
Area of Science:
- Cardiovascular Biology
- Vascular Biology
- Cardiac Pathophysiology
Background:
- Myocardial angiogenesis, the formation of new blood vessels in the heart muscle, is crucial for cardiac health.
- Reduced angiogenesis is linked to left ventricular (LV) systolic dysfunction in animal models of hypertrophy.
- The relationship between angiogenesis and LV remodeling in human aortic stenosis (AS) patients with preserved ejection fraction (EF) remains under-investigated.
Purpose of the Study:
- To investigate the relationship between myocardial angiogenesis and functional/structural LV remodeling parameters.
- To analyze angiogenesis in patients with moderate to severe AS and normal LV ejection fraction (LVEF).
Main Methods:
- 38 patients with moderate/severe AS and LVEF > 50% were included.
- LV endomyocardial biopsies were obtained during aortic valve replacement.
- Myocardial blood vessel density was assessed using CD31 staining.
Main Results:
- Myocardial angiogenesis increased with worsening LV systolic function (LVEF), elevated LV filling pressure (E/e'), and progressive LV hypertrophy (LV mass index).
- Angiogenesis correlated with the severity of aortic stenosis and differed significantly across LV geometry patterns.
- LV mass index and LVEF were significant predictors of myocardial blood vessel density.
Conclusions:
- A strong association exists between myocardial angiogenesis and LV remodeling in AS patients with normal LVEF.
- Increased angiogenesis correlates with LV hypertrophy in this patient group.
- Further research is needed to elucidate the underlying mechanisms.
Background:
Although rarefaction of myocardial angiogenesis has been shown to be associated with left ventricular (LV) systolic dysfunction in animal models of ventricular hypertrophy, this relationship has not been investigated in depth nor validated in humans. We aimed to analyze the relationship of myocardial angiogenesis with various functional and structural ventricular remodeling parameters in moderate to severe aortic stenosis (AS) patients with normal LV ejection fraction (LVEF).
Methods:
A total of 38 moderate or severe AS patients with LVEF > 50% were enrolled for the current study and all patients underwent LV endomyocardial biopsy at the septum during aortic valve replacement. The biopsy specimens were stained for platelet endothelial cell adhesion molecule-1 (CD31) to analyze the density of blood vessels in the myocardium.
Results:
The degree of myocardial angiogenesis tended to increase with worse myocardial systolic function, LV filling pressure and progressed ventricular hypertrophy (Spearman's ρ = -0.388, p = 0.016 for LVEF; Spearman's ρ = 0.442, p = 0.007 for E/e'; Spearman's ρ = 0.424, p = 0.008 for LV mass index). The degree of myocardial angiogenesis was also significantly associated with the degree of aortic valve stenosis (Spearman's ρ = -0.368, p = 0.023). There was significant difference in the degree of myocardial angiogenesis according to the LV geometry (p = 0.016 for mean difference between different LV geometry groups by analysis of variance). Significant predictors of myocardial blood vessel density were LV mass index (β = 0.398, p = 0.010) and LVEF (β = -0.313, p = 0.028).
Conclusion:
There is a close relationship between myocardial angiogenesis and LV remodeling in moderate to severe AS patients with normal LVEF, with angiogenesis increasing with LV hypertrophy. Further studies to demonstrate the mechanism underlying this phenomenon is warranted.
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