Adhesion molecules in nonrheumatic aortic valve disease: Endothelial expression, serum levels and effects of valve replacement

OBJECTIVES We studied the expression of intercellular adhesion molecule 1 ( ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and endothelial selecti n (E-selectin) on aortic valve endothelium in patients undergoing valve rep lacement. We also assessed the relation between serum levels and endothelia l expression and also the changes in serum levels following surgery. BACKGROUND Nonrheumatic aortic valve disease is believed to be a degenerati ve condition. Increased tissue and soluble adhesion molecule levels are des cribed in inflammatory conditions. METHODS Aortic valves from 22 surgical (16 bicuspid, 6 tricuspid) and 6 aut opsy (LC normal, 2 thickened) cases were studied by immunohistochemistry. S oluble adhesion molecules were measured in peripheral blood preoperatively, and at 6 and 18 months postoperatively, and compared with controls. RESULTS The majority of the surgically removed tricuspid and bicuspid valve s expressed adhesion molecules (E-selectin, 75% and 100%; ICAM-1, 75% and 8 0%; VCAM-1, 69% and 60%, respectively). The normal postmortem valves did no t express these, while the diseased ones did. Endothelial expression of E-s electin correlated strongly with serum levels (r = 0.695, p = 0.004). Solub le E-selectin levels were significantly higher at baseline compared with co ntrols (p = 0.017) and fell significantly at 18 months postoperatively (p = 0.005). CONCLUSIONS Adhesion molecule expression on diseased valves supports an inf lammatory component in "degenerative" aortic valve disease. The diseased va lves may be the main source of elevated soluble E-selectin in this conditio n as blood levels correlate with endothelial expression and blood levels fa ll at 18 months postoperatively. (C) 2000 by the American College of Cardio logy.