Aortic stenosis, atherosclerosis, and skeletal bone: is there a common link with calcification and inflammation?

The pathophysiology of aortic stenosis shares many similarities with atherosclerosis and skeletal bone formation. Using non-invasive imaging, we compared aortic valve calcification and inflammation activity with that measured in atherosclerosis and bone. Positron emission and computed tomography was performed using 18F-sodium fluoride (18F-NaF, calcification) and 18F-fluorodeoxyglucose (18F-FDG, inflammation) in 101 patients with calcific aortic valve disease (81 aortic stenosis and 20 aortic sclerosis). Calcium scores and positron emission tomography tracer activity (tissue-to-background ratio; TBR) were measured in the aortic valve, coronary arteries, thoracic aorta, and bone. Over 90 of the cohort had coexistent calcific atheroma, yet correlations between calcium scores were weak or absent (valve vs. aorta r(2) 0.015, P 0.222; valve vs. coronaries r(2) 0.039, P 0.049) as were associations between calcium scores and bone mineral density (BMD vs. valve r(2) 0.000, P 0.766; vs. aorta r(2) 0.052, P 0.025; vs. coronaries r(2) 0.016, P 0.210). 18F-NaF activity in the valve was 28 higher than in the aorta (TBR: 2.66 0.84 vs. 2.11 0.31, respectively, P 0.001) and correlated more strongly with the severity of aortic stenosis (r(2) 0.419, P 0.001) than 18F-NaF activity outwith the valve (valve vs. aorta r(2) 0.167, P 0.001; valve vs. coronary arteries r(2) 0.174, P 0.001; valve vs. bone r(2) 0.001, P 0.806). In contrast, 18F-FDG activity was lower in the aortic valve than the aortic atheroma (TBR: 1.56 0.21 vs. 1.81 0.24, respectively, P 0.001) and more closely associated with uptake outwith the valve (valve vs. aorta r(2) 0.327, P 0.001). In patients with aortic stenosis, disease activity appears to be determined by local calcific processes within the valve that are distinct from atherosclerosis and skeletal bone metabolism. Trial Registration: ClinicalTrials.gov number: NCT01358513.