| ObjectiveTo investigate the prevalence of heart valve calcification and the relativity between pathological changes and clinical factors in elderly autopsied patients.MethodsPathology data of 1047 autopsied patients with age from 60 to 106 years in Bejing Hospital from Novermber 1954 to March 2016 were retrospectively reviewed.We investigated the prevalence of heart valve calcification and its relativity with age,clinical disease and coronary atherosclerosis.Results1.Aortic valve calcification(AVC)was present in 15.2%(n=159),mitral valve calcification(MVC)in 9.6%(n=101),both AVC and MVC calcification in 5.4%(n=57)and heart valve calcification in 19.4%(n=203)of 1047 autopsied patients.2.The prevalence of calcification was increased in elderly patients as the rate was 6.4%(15/234),12.8%(37/289),22.5%(70/311)and 38.0%(81/213)in age subgroup 60-69,70-79,80-89 and 90-106 years old respectively(X2=82.523,p<0.01).3.The prevalence of calcification was significantly increased in pathological coronary artery stenosis,hypertension,coronary artery disease(CAD),diabetes and chronic kidney disease(CKD).According to multivariate regression analysis,age and CAD independently increased the risk of heart valve calcification respectively(OR=1.066,95%CI:1.048-1.086,p<0.01;OR=2.238,95%CI:1.396-3.589,p<0.01),while hypertension,diabetes and CKD were not independent factors(OR=1.223,95%CI:0.859-1.741,p>0.05;OR=1.053,95%CI:0.700-1.586,p>0.05;OR=0.924,95%CI:0.610-1.399,p>0.05).4.As compared with patients with non-calcification heart valves,patients with heart valve calcification had increased risk of coronary atherosclerosis(OR=2.983,95%CI:1.868-4.765,p<0.01).ConclusionPrevalence of heart valve calcification is increased in elderly patients with increasing age.Prevalence of heart valve calcification is high in CAD patients,heart valve calcification is significantly associated with coronary atherosclerosis.ObjectiveTo investigate the accuracy of transthoracic echocardiography(TTE)in the diagnosis of left cardiac valve calcification in elderly patients.MethodsIn this retrospective study,we studied 410 elderly patients died in Beijing Hospital from 1982 to 2015,They all had the full cardiac valve examination data in the postmortem examination and full antemortem TTE data.The study population was classified in three tertiles according to the year of death:Group 1982-1995,Group 1996-2005 and Group 2006-2015,also classified in three tertiles according to the age of death:Group 60-75,Group76-90 and Group 91-106.Results1.Compared with pathological findings(taken as a golden standard),the sensitivity,specificity,diagnostic coincidence rate,positive likelihood ratio(PLR),negative likelihood ratio(NLR),Positive predictive value(PPV)and negative predictive value(NPV)of TTE for the diagnosis of elder left cardiac valve calcification were 88.6%、28.2%、43.7%、1.234、0.405、0.298 and 0.878.2.Compared with Group 1982-1995,the sensitivity、PPV of TTE for the diagnosis of elderly left cardiac valve calcification in Group 1996-2005 and Group 2006-2015 was increased;but the specificity、PLR、NLR、and NPV was decreased.3.Compared with Group 60-75,the sensitivity、PPV of TTE for the diagnosis of elderly left cardiac valve calcification in Group 76-90 and Group 91-106 was increased;but the specificity、diagnostic coincidence rate was decreased.4.Compared with pathological findings(taken as a golden standard),the sensitivity,specificity,diagnostic coincidence rate,PLR,NLR,PPV,NPV of TTE for the diagnosis of elderly aortic valve calcification and mitral valve calcification were 88.2%and 44.0%、30.8%and 75.3%、42.7%and 71.5%、1.275 and 1,780、0.382 and 0.744、0.250 and 0.198、0.909 and 0.906,respectively.ConclusionTTE provides high sensitivity for the diagnosis of elderly left cardiac valve calcification,especially the aortic valve calcification,but low specificity.ObjectiveTo study the pathological features of valvular calcification in patients with rheumatic and non-rheumatic heart valvular disease.MethodsThe valves specimen with pathological calcification positive,stored at Specimen bank of the department of pathology in Beijing Hospital,from patients underwent valve replacement in cardiac surgery department from 2002 to 2016,were retrospectively reviewed.According to the etiology,patients were divided into rheumatic or non-rheumatic heart valvular calcification group.Hematoxylin-eosin(HE)staining performances were observed and compared between the two groups.Electron microscopy and energy dispersive analysis were done in 3 different patients selected from Specimen bank of the department of pathology(one with rheumatic aortic valve calcification,one with rheumatic mitral valve calcification,and one with non-rheumatic aortic valve calcification,respectively).Results1.HE staining showed that both rheumatic and non-rheumatic heart valvular calcification can have different degrees of calcification of the valve,severe cases with bone like changes,calcification was patchy and punctate distribution;In rheumatic heart valvular calcification group,hyaline degeneration was heavy,thick walled muscular vessels were more common,and calcification was generally heavier.But in non-rheumatic heart valvular calcification group,mucoid degeneration was obvious,thick walled muscular vessel was rare.2.The electron microscope showed that the calcification has two kinds of aggregates-dots and slices,the central area of calcification was patchy distribution,and the surrounding area was scattering,the diameter of the calcified granules was 0.3-5μm with different shape.There was no significant difference in electron microscopy features of the valve calcification among rheumatic aortic valve,rheumatic mitral valve and non-rheumatic aortic valve.3.The energy spectrum analysis showed that calcification components were basically the same in different etiology and different valves,mainly contains C,O,P,Ca elements,and also Na,Mg;There was no significant difference in the percentage of Ca/P atom percentage within 1.29-1.48 in different cases(p>0.05),which suggested that the calcified phases mainly were calcium phosphates.Conclusions:Although the pathogenesis is different,there is no significant difference in the pathological manifestations of rheumatic and non-rheumatic heart valvular calcification using HE staining and electron microscope in this study.The components of calcification mainly are calcium phosphates. |
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