Lymphocyte and monocyte subpopulations in severe aortic stenosis at the time of surgical intervention

Cardiovasc Pathol. 2018 Jul-Aug;35:1-7. doi: 10.1016/j.carpath.2018.03.004. Epub 2018 Apr 7.


Introduction: Aortic stenosis (AS) is the most common acquired valvular heart disease in adults. Immune system involvement becomes evident during AS development. We sought to investigate the role of different circulating lymphocyte and monocyte subpopulations, with focus on CD4+CD8+ and natural killer T (NKT) cells, in AS.

Material and methods: Blood samples and aortic valves were obtained from patients undergoing elective aortic valve surgery. Valves were dissected and underwent genetic analyses and calcium content assessment. Lymphocytes and monocytes subsets were assessed by flow cytometry.

Results: Thirty-eight AS patients were studied. Maximal transvalvular pressure gradient (PGmax) as well as mean transvalvular pressure gradient (PGmean) correlated with the CD4+CD8+ lymphocyte count (r=0.35, P=.03 and r=0.43, P=.006, respectively) and fraction (r=0.43, P=.007 and r=0.48, P=.002, respectively). PGmax and PGmean correlated with CD16+CD56+CD3+ NKT cell count (r=0.39, P=.01 and r=0.43, P=.007, respectively) and fraction (r=0.49, P=.002 and r=0.47, P=.003, respectively). The classical monocyte subpopulation increased after the surgery by 68% (P<.0001). Patients after mini-sternotomy surgery had 47% lower nonclassical monocyte counts than those with full-sternotomy (P=.03). Patients treated with statins had significantly lower postoperative levels of both classical (-25%, P=.04) and nonclassical monocytes (-37%, P=.004) than nontreated individuals.

Conclusions: In patients with severe isolated AS, CD4+CD8+ T cells and CD16+CD56+CD3+ NKT cells are associated with AV pressure gradients. Postoperative monocyte levels are affected by procedure invasiveness and use of statins.

Keywords: Aortic stenosis; CD4; CD4CD8; CD8; Lymphocytes; Monocytes; NKT.

MeSH terms

  • Aged
  • Aortic Valve / immunology*
  • Aortic Valve / pathology*
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / immunology*
  • Aortic Valve Stenosis / pathology
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery
  • CD4-Positive T-Lymphocytes / immunology
  • CD4-Positive T-Lymphocytes / pathology
  • CD8-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / pathology
  • Calcinosis / immunology*
  • Calcinosis / pathology
  • Calcinosis / physiopathology
  • Calcinosis / surgery
  • Cardiac Surgical Procedures
  • Female
  • Flow Cytometry
  • Hemodynamics
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Immunophenotyping / methods
  • Male
  • Middle Aged
  • Monocytes / classification
  • Monocytes / immunology*
  • Monocytes / pathology
  • Natural Killer T-Cells / immunology
  • Natural Killer T-Cells / pathology
  • Phenotype
  • Severity of Illness Index
  • Sternotomy
  • T-Lymphocyte Subsets / classification
  • T-Lymphocyte Subsets / immunology*
  • T-Lymphocyte Subsets / pathology
  • Treatment Outcome


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors

Supplementary concepts

  • Aortic Valve, Calcification of