The online version of this article (https://doi.org/10.1007/s00330-018-5775-6) contains supplementary material, which is available to authorized users.
To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).
MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.
The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.
In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.
• Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV).
• We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness.
• Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.
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Ward C (2000) Clinical significance of the bicuspid aortic valve. Heart 83:81–85 CrossRef
Ferencik M, Pape LA (2003) Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves. Am J Cardiol 92:43–46 CrossRef
Michelena HI, Desjardins VA, Avierinos JF et al (2008) Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation 117:2776–2784 CrossRef
Guntheroth WG (2008) A critical review of the American College of Cardiology/American Heart Association practice guidelines on bicuspid aortic valve with dilated ascending aorta. Am J Cardiol 102:107–110 CrossRef
Bonderman D, Gharehbaghi-Schnell E, Wollenek G, Maurer G, Baumgartner H, Lang IM (1999) Mechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation 99:2138–2143 CrossRef
Cecconi M, Nistri S, Quarti A et al (2006) Aortic dilatation in patients with bicuspid aortic valve. J Cardiovasc Med (Hagerstown) 7:11–20 CrossRef
Robicsek F, Thubrikar MJ, Cook JW, Fowler B (2004) The congenitally bicuspid aortic valve: how does it function? Why does it fail? Ann Thorac Surg 77:177–185 CrossRef
Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605 CrossRef
Grotenhuis HB, Westenberg JJ, Steendijk P et al (2009) Validation and reproducibility of aortic pulse wave velocity as assessed with velocity-encoded MRI. J Magn Reson Imaging 30:521–526 CrossRef
Nistri S, Sorbo MD, Basso C, Thiene G (2002) Bicuspid aortic valve: abnormal aortic elastic properties. J Heart Valve Dis 11:369–373 PubMed
Yap SC, Nemes A, Meijboom FJ et al (2008) Abnormal aortic elastic properties in adults with congenital valvular aortic stenosis. Int J Cardiol 128:336–341 CrossRef
Nistri S, Grande-Allen J, Noale M et al (2008) Aortic elasticity and size in bicuspid aortic valve syndrome. Eur Heart J 29:472–479 CrossRef
Grotenhuis HB, Ottenkamp J, Westenberg JJ, Bax JJ, Kroft LJ, de Roos A (2007) Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients. J Am Coll Cardiol 49:1660–1665 CrossRef
Singh A, Greenwood JP, Berry C et al (2017) Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) Study. Eur Heart J 38:1222–1229 CrossRef
Singh A, Ford I, Greenwood JP et al (2013) Rationale and design of the PRognostic Importance of MIcrovascular Dysfunction in asymptomatic patients with Aortic Stenosis (PRIMID-AS): a multicentre observational study with blinded investigations. BMJ Open 3:e004348 CrossRef
Voges I, Jerosch-Herold M, Hedderich J et al (2012) Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study. J Cardiovasc Magn Reson 14:77 CrossRef
Singh A, Horsfield MA, Bekele S, Khan JN, Greiser A, McCann GP (2015) Myocardial T1 and extracellular volume fraction measurement in asymptomatic patients with aortic stenosis: reproducibility and comparison with age-matched controls. Eur Heart J Cardiovasc Imaging 16:763–770 CrossRef
Papavassiliu T, Kühl HP, Schröder M et al (2005) Effect of endocardial trabeculae on left ventricular measurements and measurement reproducibility at cardiovascular MR imaging. Radiology 236:57–64 CrossRef
Schaefer BM, Lewin MB, Stout KK et al (2008) The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart 94:1634–1638 CrossRef
Nkomo VT, Enriquez-Sarano M, Ammash NM et al (2003) Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol 23:351–356 CrossRef
Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, Sutton MG (2000) Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 102:III35–III39 CrossRef
Novaro GM, Tiong IY, Pearce GL, Grimm RA, Smedira N, Griffin BP (2003) Features and predictors of ascending aortic dilatation in association with a congenital bicuspid aortic valve. Am J Cardiol 92:99–101 CrossRef
Cecconi M, Manfrin M, Moraca A et al (2005) Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction. Am J Cardiol 95:292–294 CrossRef
Skaluba SJ, Litwin SE (2004) Mechanisms of exercise intolerance: insights from tissue Doppler imaging. Circulation 109:972–977 CrossRef
Ibrahim el-SH, Johnson KR, Miller AB, Shaffer JM, White RD (2010) Measuring aortic pulse wave velocity using high-field cardiovascular magnetic resonance: comparison of techniques. J Cardiovasc Magn Reson 12:26 CrossRef
Mohiaddin RH, Firmin DN, Longmore DB (1993) Age-related changes of human aortic flow wave velocity measured noninvasively by magnetic resonance imaging. J Appl Physiol (1985) 74:492–497 CrossRef
Nemes A, Galema TW, Geleijnse ML et al (2007) Aortic valve replacement for aortic stenosis is associated with improved aortic distensibility at long-term follow-up. Am Heart J 153:147–151 CrossRef
Dalsgaard M, Kjaergaard J, Pecini R et al (2010) Predictors of exercise capacity and symptoms in severe aortic stenosis. Eur J Echocardiogr 11:482–487 CrossRef
Dalsgaard M, Kjaergaard J, Pecini R et al (2009) Left ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements. J Am Soc Echocardiogr 22:343–349 CrossRef
Hope MD, Hope TA, Meadows AK et al (2010) Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology 255:53–61 CrossRef
den Reijer PM, Sallee D 3rd, van der Velden P et al (2010) Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12:4 CrossRef
Wilson KA, Lee AJ, Lee AJ et al (2003) The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg 37:112–117 CrossRef
Molacek J, Baxa J, Houdek K, Treska V, Ferda J (2011) Assessment of abdominal aortic aneurysm wall distensibility with electrocardiography-gated computed tomography. Ann Vasc Surg 25:1036–1042 CrossRef
Khan JN, Wilmot EG, Leggate M et al (2014) Subclinical diastolic dysfunction in young adults with Type 2 diabetes mellitus: a multiparametric contrast-enhanced cardiovascular magnetic resonance pilot study assessing potential mechanisms. Eur Heart J Cardiovasc Imaging 15:1263–1269 CrossRef
Schaefer BM, Lewin MB, Stout KK, Byers PH, Otto CM (2007) Usefulness of bicuspid aortic valve phenotype to predict elastic properties of the ascending aorta. Am J Cardiol 99:686–690 CrossRef
- Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves
Mark A. Horsfield
John P. Greenwood
Dana K. Dawson
Damian J. Kelly
John G. Houston
Prasad Guntur Ramkumar
Gerry P. McCann
- Springer Berlin Heidelberg
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
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