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Sex-dependent aortic valve pathology in patients with rheumatic heart disease

Feng Xiao1,2, Rui Zheng3, Di Yang1

  • 1Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.

Plos One
|June 30, 2017
PubMed

Insights

Female patients with rheumatic heart disease show more inflammation and severe aortic valve pathology. This sex difference in inflammation may lead to worse outcomes in women with this autoimmune condition.

Area of Science:

  • Cardiovascular Pathology
  • Immunology
  • Rheumatology

Background:

  • Rheumatic heart disease (RHD) is an autoimmune condition triggered by group A streptococci, often impacting the aortic valve.
  • While sex differences in RHD progression and outcomes are known, specific sex-based differences in aortic valve pathology remain understudied.

Purpose of the Study:

  • To investigate sex-dependent differences in the pathology and molecular changes of end-stage calcific aortic valves in patients with RHD requiring valve replacement.

Main Methods:

  • Comparative analysis of aortic valves from 39 RHD patients (19 males, 20 females) undergoing valve replacement.
  • Utilized pathology, immunohistochemistry, and gene expression analyses, alongside clinical data comparison.

Main Results:

  • Female RHD patients exhibited increased collagen expression, monocyte/macrophage infiltration, and neovascularization in aortic valves.
  • Elevated expression of inflammatory genes (NF-κB pathway, Th1 cytokines) and higher anti-streptolysin O antibody levels were observed in females.
  • Severe valve pathology in females correlated with increased inflammation markers.

Conclusions:

  • Inflammation is significantly more pronounced in the aortic valves of female RHD patients.
  • These sex-based inflammatory differences may underlie the more severe valve pathology and poorer outcomes observed in female patients.
Abstract

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