Journal
JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH
Volume 9, Issue 2, Pages 102-118Publisher
SPRINGER
DOI: 10.1007/s12265-016-9679-z
Keywords
Hemodynamics; Aortic valvular stenosis (AVS); Genomics of calcific aortic valve disease (CAVD); Bicuspid aortic valve disease (BAVD); Aortic valve inflammation; fibrosis and calcific nodule buildup; Aortic transvalvular
Funding
- National Heart, Lung, and Blood Institute [R01 HL 050446]
- National Science Foundation [CDR 8622201]
- North Carolina Supercomputing Center
- Cray Research
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Aortic valvular stenosis (AVS), produced by calcific aortic valve disease (CAVD) causing reduced cusp opening, afflicts mostly older persons eventually requiring valve replacement. CAVD had been considered degenerative, but newer investigations implicate active mechanisms similar to atherogenesis-genetic predisposition and signaling pathways, lipoprotein deposits, chronic inflammation, and calcification/osteogenesis. Consequently, CAVD may eventually be controlled/reversed by lifestyle and pharmacogenomics remedies. Its management should be comprehensive, embracing not only the valve but also the left ventricle and the arterial system with their interdependent morphomechanics/hemodynamics, which underlie the ensuing diastolic and systolic LV dysfunction. Compared to even a couple of decades ago, we now have an increased appreciation of genomic and cytomolecular pathogenetic mechanisms underlying CAVD. Future pluridisciplinary studies will characterize better and more completely its pathobiology, evolution, and overall dynamics, encompassing intricate feedback processes involving specific signaling molecules and gene network cascades. They will herald more effective, personalized medicine treatments of CAVD/AVS.
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