High prevalence of amyloid in 150 surgically removed heart valves—a comparison of histological and clinical data reveals a correlation to atheroinflammatory conditions

Kristen, Arnt V.; Schnabel, Philipp A.; Winter, Bettina; Helmke, Burkhard M.; Longerich, Thomas; Hardt, Stefan; Koch, Achim; Sack, Falk-Udo; Katus, Hugo A.; Linke, Reinhold P.; Dengler, Thomas J.

doi:10.1016/j.carpath.2009.04.005

« Previous Next »Cardiovascular Pathology
Volume 19, Issue 4 , Pages 228-235, July 2010

High prevalence of amyloid in 150 surgically removed heart valves—a comparison of histological and clinical data reveals a correlation to atheroinflammatory conditions

Arnt V. Kristen
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
- Corresponding author. Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Tel.: +49 6221 568611; fax: +49 6221 564105.
Philipp A. Schnabel
- Department of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Bettina Winter
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Burkhard M. Helmke
- Department of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Thomas Longerich
- Department of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Stefan Hardt
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Achim Koch
- Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Falk-Udo Sack
- Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Hugo A. Katus
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
Reinhold P. Linke
- Reference Center of Amyloid Diseases, amYmed, Am Klopferspitz 19, D-82152 Martinsried, Germany
- These authors contributed equally to this work.
Thomas J. Dengler
- Department of Cardiology, Angiology, and Respiratory Medicine, University Hospital Heidelberg, Im Neuenheimer Feld, D-69120 Heidelberg, Germany
- These authors contributed equally to this work.

Received 1 August 2008; received in revised form 3 April 2009; accepted 14 April 2009. published online 08 June 2009.

Abstract

Introduction

The prevalence, pathophysiology, and clinical indicators of valvular amyloid deposition have not been clarified yet.

Methods

One hundred fifty surgically resected heart valve specimens [67.4±1.0 years; aortic stenosis (AS), n=100; aortic regurgitation, n=19; mitral stenosis, n=7; mitral regurgitation, n=24] were qualitatively, semiquantitatively, and immunohistochemically analyzed and correlated with clinical data.

Results

Amyloid was found in 83/150 specimens with highest prevalence in AS (74/100), intermediate prevalence in mitral stenosis (2/7) and regurgitation (7/24), and lowest prevalence in aortic regurgitation (2/19). Severe and polymorphic amyloid deposits were almost exclusively found in AS (35/100). Filamentous cloudy amyloid patterns occurred with the same frequency in AS (29/100). A combination of both was found only in AS (n=7/100). By immunohistochemistry, none of the most common amyloid proteins was identified except for a weak staining by the apolipoprotein AI antibody, but more intense adjacent to amyloid deposits. Amyloid correlated with valvular thickening (P<.05), hyperlipidemia (P=.07), coronary artery disease (P=.084), and obesity (P=.082).

Conclusions

Localized valvular amyloid is predominantly found in stenotic aortic valves. It appears to depend on atheroinflammatory conditions and high shear-stress hemodynamics. Further studies are needed to identify the underlying protein.

Keywords: Amyloid, Atherosclerosis, Heart valves, Hyperlipidemia, Immunohistochemistry, Apolipoprotein AI