Bench to bedside defining calcific aortic valve disease: osteocardiology

ABSTRACT

Introduction

For years, calcific aortic valve disease (CAVD) was thought to be due to a degenerative process, but recent scientific discoveries have proven it to be an active process. Understanding the cellular mechanisms for the development of disease and translating the cellular changes critical in the development of calcific phenotypes. The use of multimodality imaging has been the gold standard to define the development of calcification to determine the timing of therapy.

Areas covered

This review will discuss the scientific literature in a new and evolving field known as osteocardiology, which specifically defines the cellular mechanisms involved in the development of the osteogenic phenotype in the heart and vasculature. The work in this field has been highlighted by the calcific aortic valve disease working group at the NIH. This review will discuss the appropriate use criteria for multimodality imaging techniques to identify early cellular and hemodynamic disease progression in the aortic valve to help determine the timing of therapy, the osteocardiology theory.

Expert opinion

The authors will provide their background in basic science and clinical medicine to support the opinions in this paper.

KEYWORDS:

• Calcific aortic valve disease
• medical therapy
• diagnosis
• valve risk factors
• valve genetics
• multimodality imaging

Article highlights

1. Understanding the biology of calcification and disease progression is critical in the future of developing therapies for calcific aortic valve disease.

2. Understanding the mechanisms of atherosclerotic initiation of osteogenic differentiation in the heart valve which causes bone formation in the heart.

3. Understanding the role of anatomic location of the disease and how it affects the coronary artery versus the aortic valve.

4. The field of valvular heart disease is rapidly progressing in the diagnostic imaging options to improve the timing of therapy for patients.

5. Large scales clinical trials are around the corner targeting calcification mechanism with the initiation of therapies early in the disease process. The field of valvular heart disease is rapidly progressing in the diagnostic imaging options to improve the timing of therapy for patients.

Declaration of interest

N Rajamannan is the inventor on patents for bioprosthetic valve degeneration and native valve calcification, which are owned by Mayo Clinic and/or herself, she does not receive royalties from this intellectual property. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.