Whole-blood transcriptome unveils altered immune response in acute myocardial infarction patients with aortic valve sclerosis

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fondazione Umberto Veronesi (Research Grant 2011-12 to GIC) Fondazione Gigi e Pupa Ferrari ONLUS (FPF-14 to PP) Background Aortic valve sclerosis (AVSc) presents similar pathogenetic mechanisms to coronary artery disease (CAD) and is associated with short- and long-term mortality in CAD patients. Evidence of AVSc-specific pathophysiological traits in acute myocardial infarction (AMI) is currently lacking. Purpose We aimed to identify a blood-based transcriptional signature that could differentiate AVSc from non-AVSc patients during AMI. Methods Whole-blood transcriptome of AVSc (n = 44) and no-AVSc (n = 66) patients with AMI was assessed by RNA-sequencing on hospital admission. Feature selection, differential expression, and enrichment analyses were performed to identify gene expression patterns discriminating AVSc from no-AVSc and infer functional associations. Multivariable Cox regression analysis was used to estimate the hazard ratios of cardiovascular events in AVSc versus no-AVSc patients. Results This cross-sectional study identified a panel of 100 informative genes capable of distinguishing AVSc from no-AVSc patients with 94% accuracy. Further analysis revealed significant mean differences in 143 genes, of which 30 genes withstood correction for age and previous AMI or coronary interventions. Functional inference unveiled a significant association between AVSc and key biological processes, including acute inflammatory responses, type I interferons (IFN) response, platelet activation, and hemostasis. Notably, AMI patients with AVSc exhibited a significantly higher incidence of adverse cardiovascular events during a 10-year follow-up period, with a full adjusted hazard ratio of 2.4 (95% CI: 1.3–4.5). Conclusions Our findings shed light on the molecular mechanisms underlying AVSc and provide potential prognostic insights for AMI patients with AVSc. During AMI, AVSc patients showed increased type I IFN response and earlier adverse cardiovascular outcomes. Novel pharmacological therapies aiming at limiting type I IFN response during or immediately after AMI might improve poor cardiovascular outcomes of AMI patients with AVSc.