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Neurohormonal and inflammatory markers in valvular heart disease
Includes bibliographical references (leaves 147-180).
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| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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Division of Cardiology
2014
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| _version_ | 1867614377069248512 |
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| access_status_str | Open Access |
| author | Gerber, Ivor Leslie |
| author2 | Stewart Ralph |
| author_browse | Gerber, Ivor Leslie Stewart Ralph |
| author_facet | Stewart Ralph Gerber, Ivor Leslie |
| author_sort | Gerber, Ivor Leslie |
| collection | Thesis |
| description | Includes bibliographical references (leaves 147-180). |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/8624 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:51:04.362Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2014 |
| publishDateRange | 2014 |
| publishDateSort | 2014 |
| publisher | Division of Cardiology |
| publisherStr | Division of Cardiology |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/8624 Neurohormonal and inflammatory markers in valvular heart disease Gerber, Ivor Leslie Stewart Ralph Sack, Michael N Cardiology Includes bibliographical references (leaves 147-180). Chronic valvular heart disease is characterised by compensatory mechanisms that result in a long asymptomatic phase associated with variable disease progression. After the development of symptoms or left ventricular dysfunction, mortality is high without surgical intervention. Currently there is no known medical therapy that influences disease progression or clinical outcome. While the development of symptoms or left ventricular dysfunction are the cardinal indications for valve surgery, routine echocardiography may not detect early left ventricular dysfunction and the development of early symptoms may not be appreciated. Numerous studies demonstrate that increased natriuretic peptide plasma levels, including atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and amino-terminal BNP (N-BNP) reflect left ventricular dysfunction, correlate with symptoms of cardiac failure and are independent prognostic markers for clinical outcomes in diverse cardiac conditions, but very few studies address natriuretic peptides in patients with valvular heart disease. The aims of this thesis are firstly, to determine the clinical utility of measuring natriuretic peptide plasma levels in patients with valvular heart disease, and secondly, to provide supportive biochemical evidence to established histological evidence that aortic stenosis is an inflammatory disease. One hundred and sixty three patients with chronic valvular heart disease, including aortic stenosis (n=74), aortic regurgitation (n=40) and mitral regurgitation (n=49) underwent independent assessment of symptoms, transthoracic echocardiography and measurement of plasma levels of ANP, BNP and N-BNP. Natriuretic peptide levels were significantly higher in symptomatic compared with asymptomatic patients after adjustment for echocardiographic measures of disease severity and left ventricular function. Of 29 asymptomatic patients with aortic stenosis followed for a mean of 18 months, patients with an N-BNF level above the normal range or with a greater increase in N-BNP/year were at increased risk of symptomatic deterioration. In 33 patients with aortic stenosis who underwent aortic valve replacement, N-BNP levels decreased and symptoms consistently improved by 6 months postoperatively in patients with a preoperative N-BNP level above the normal range, but N-BNP levels did not decrease and symptoms less reliably improved in patients with a preoperative N-BNP level within normal limits. In contrast to the established theory that aortic stenosis is a degenerative process not amenable to medical therapy, recent histological studies suggest that aortic stenosis may be an inflammatory disease with similarities to coronary atherosclerosis. To further address this issue, high sensitivity C-reactive protein (CRP) was measured in 20 patients with non-rheumatic aortic stenosis, 19 patients with non-rheumatic aortic regurgitation and 31 healthy controls, as well as 6 months after valve replacement in aortic stenosis. CRP was significantly increased in aortic stenosis, but not aortic regurgitation compared with controls and decreased after valve replacement in aortic stenosis. These observations are consistent with histological evidence that the aortic valve is the site of active inflammation. In conclusion, measurement of plasma natriuretic peptide levels complement clinical and echocardiographic evaluation of patients with valvular heart disease and may assist with the timing of valve surgery. Novel evidence that aortic stenosis may be an inflammatory disease is presented and suggests further studies are required to determine whether agents with anti-inflammatory actions may have a role in delaying disease progression. Following on the studies presented in this thesis, a large multicentre study has commenced in New Zealand to confirm these findings that has the potential to change clinical practice. 2014-10-20T07:16:42Z 2014-10-20T07:16:42Z 2004 Master Thesis Masters MD http://hdl.handle.net/11427/8624 eng application/pdf Division of Cardiology Faculty of Health Sciences University of Cape Town |
| spellingShingle | Cardiology Gerber, Ivor Leslie Neurohormonal and inflammatory markers in valvular heart disease |
| thesis_degree_str | Master's |
| title | Neurohormonal and inflammatory markers in valvular heart disease |
| title_full | Neurohormonal and inflammatory markers in valvular heart disease |
| title_fullStr | Neurohormonal and inflammatory markers in valvular heart disease |
| title_full_unstemmed | Neurohormonal and inflammatory markers in valvular heart disease |
| title_short | Neurohormonal and inflammatory markers in valvular heart disease |
| title_sort | neurohormonal and inflammatory markers in valvular heart disease |
| topic | Cardiology |
| url | http://hdl.handle.net/11427/8624 |
| work_keys_str_mv | AT gerberivorleslie neurohormonalandinflammatorymarkersinvalvularheartdisease |