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. 2015 Oct 16;4(10):e002156. doi: 10.1161/JAHA.115.002156

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© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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eLDL is present in all of the 4 grades of aortic valve calcification and structural damage. A, Left panels, apolipoprotein B staining demonstrating presence of LDL in general. The fibrosa with the aortic side of the valve is to the top. Right panels, adjacent sections stained with monoclonal antibody AIL‐3 for eLDL demonstrating extensive enzymatic modification of LDL. First panel, grade 1 (adjacent sections stained for eLDL with monoclonal antibody AIL‐3 and connective tissue by van Gieson's staining (inset), respectively. Note the extracellular matrix of the fibrosa suffused with aggregates of the modified lipoprotein). Second panel, grade 2. Third panel, grade 3. Fourth panel, grade 4. B, Analysis of lipid composition in early valvular cusp lesions (grade 1, dark gray) and internal control tissue (nondiseased areas, white) by GC‐MS for free cholesterol (left, n=12) and LC‐MS‐MS for linoleic acid (right, n=11). Note the higher concentrations of both constituents compared with the internal control tissue. ***P < 0.001. eLDL indicates enzymatically modified low‐density lipoprotein; EvG, Elastica van Gieson; GC, gas chromatography; MS, mass spectrometry; LC, liquid chromatography.