Aortic Dilation in Bicuspid Aortic Valve Disease Flow Pattern Is a Major Contributor and Differs With Valve Fusion Type

被引：321

作者：

Bissell, Malenka M. ^{[1
]}

Hess, Aaron T. ^{[1
]}

Biasiolli, Luca ^{[1
]}

Glaze, Steffan J. ^{[1
]}

Loudon, Margaret ^{[1
]}

Pitcher, Alex ^{[1
]}

Davis, Anne ^{[1
]}

Prendergast, Bernard ^{[2
]}

Markl, Michael ^{[3
]}

Barker, Alex J. ^{[3
]}

Neubauer, Stefan ^{[1
]}

Myerson, Saul G. ^{[1
,2
]}

机构：

[1] Univ Oxford, Radcliffe Dept Med, Div Cardiovasc Med, Ctr Clin Magnet Resonance Res OCMR, Oxford OX3 9DU, England

[2] John Radcliffe Hosp, Dept Cardiol, Oxford OX3 9DU, England

[3] Northwestern Univ, Feinberg Sch Med, Dept Radiol, Chicago, IL 60611 USA

来源：

CIRCULATION-CARDIOVASCULAR IMAGING | 2013年 / 6卷 / 04期

基金：

英国工程与自然科学研究理事会; 英国医学研究理事会; 美国国家卫生研究院;

关键词：

aorta; bicuspid aortic valve; cardiac MRI; vascular function; wall shear stress; WALL SHEAR-STRESS; ELASTIC PROPERTIES; NATURAL-HISTORY; BLOOD-FLOW;

D O I：

10.1161/CIRCIMAGING.113.000528

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Ascending aortic dilation is important in bicuspid aortic valve (BAV) disease, with increased risk of aortic dissection. We used cardiovascular MR to understand the pathophysiology better by examining the links between 3-dimensional flow abnormalities, aortic function, and aortic dilation. Methods and Results A total of 142 subjects underwent cardiovascular MR (mean age, 40 years; 95 with BAV, 47 healthy volunteers). Patients with BAV had predominantly abnormal right-handed helical flow in the ascending aorta, larger ascending aortas (18.3 +/- 3.3 versus 15.2 +/- 2.2 mm/m(2); P<0.001), and higher rotational (helical) flow (31.7 +/- 15.8 versus 2.9 +/- 3.9 mm(2)/s; P<0.001), systolic flow angle (23.1 degrees +/- 12.5 degrees versus 7.0 degrees +/- 4.6 degrees; P<0.001), and systolic wall shear stress (0.85 +/- 0.28 versus 0.59 +/- 0.17 N/m(2); P<0.001) compared with healthy volunteers. BAV with right-handed flow and right-non coronary cusp fusion (n=31) showed more severe flow abnormalities (rotational flow, 38.5 +/- 16.5 versus 27.8 +/- 12.4 mm(2)/s; P<0.001; systolic flow angle, 29.4 degrees +/- 10.9 degrees versus 19.4 degrees +/- 11.4 degrees; P<0.001; in-plane wall shear stress, 0.64 +/- 0.23 versus 0.47 +/- 0.22 N/m(2); P<0.001) and larger aortas (19.5 +/- 3.4 versus 17.5 +/- 3.1 mm/m(2); P<0.05) than right-left cusp fusion (n=55). Patients with BAV with normal flow patterns had similar aortic dimensions and wall shear stress to healthy volunteers and younger patients with BAV showed abnormal flow patterns but no aortic dilation, both further supporting the importance of flow pattern in the pathogenesis of aortic dilation. Aortic function measures (distensibility, aortic strain, and pulse wave velocity) were similar across all groups. Conclusions Flow abnormalities may be a major contributor to aortic dilation in BAV. Fusion type affects the severity of flow abnormalities and may allow better risk prediction and selection of patients for earlier surgical intervention.

引用

页码：499 / 507

页数：9

共 37 条

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