Regional aortic wall shear stress increases over time in patients with a bicuspid aortic valve.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-08-02 DOI:10.1016/j.jocmr.2024.101070

Savine C S Minderhoud, Aïmane Arrouby, Allard T van den Hoven, Lidia R Bons, Raluca G Chelu, Isabella Kardys, Dimitris Rizopoulos, Suze-Anne Korteland, Annemien E van den Bosch, Ricardo P J Budde, Jolien W Roos-Hesselink, Jolanda J Wentzel, Alexander Hirsch

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Abstract

Background: Aortic wall shear stress (WSS) is a known predictor of ascending aortic growth in patients with a bicuspid aortic valve (BAV). The aim of this study was to study regional WSS and changes over time in BAV patients.

Methods: BAV patients and age-matched healthy controls underwent four-dimensional (4D) flow cardiovascular magnetic resonance (CMR). Regional, peak systolic ascending aortic WSS, aortic valve function, aortic stiffness measures, and aortic dimensions were assessed. In BAV patients, 4D flow CMR was repeated after 3 years of follow-up and both at baseline and follow-up computed tomography angiography (CTA) were acquired. Aortic growth (volume increase of ≥5%) was measured on CTA. Regional WSS differences within patients' aorta and WSS changes over time were analyzed using linear mixed-effect models and were associated with clinical parameters.

Results: Thirty BAV patients (aged 34 years [interquartile range (IQR) 25-41]) were included in the follow-up analysis. Additionally, another 16 BAV patients and 32 healthy controls (aged 33 years [IQR 28-48]) were included for other regional analyses. Magnitude, axial, and circumferential WSS increased over time (all p < 0.001) irrespective of aortic growth. The percentage of regions exposed to a magnitude WSS >95th percentile of healthy controls increased from 21% (baseline 506/2400 regions) to 31% (follow-up 734/2400 regions) (p < 0.001). WSS angle, a measure of helicity near the aortic wall, decreased during follow-up. Magnitude WSS changes over time were associated with systolic blood pressure, peak aortic valve velocity, aortic valve regurgitation fraction, aortic stiffness indexes, and normalized flow displacement (all p < 0.05).

Conclusion: An increase in regional WSS over time was observed in BAV patients, irrespective of aortic growth. The increasing WSSs, comprising a larger area of the aorta, warrant further research to investigate the possible predictive value for aortic dissection.

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主动脉瓣二尖瓣患者的区域主动脉壁剪切应力随时间增加。

背景：主动脉壁剪切应力（WSS）是已知的二尖瓣主动脉（BAV）患者升主动脉生长的预测因子。本研究旨在研究 BAV 患者的区域 WSS 及其随时间的变化：方法：BAV 患者和年龄匹配的健康对照组接受 4D 血流 CMR 检查。方法：对 BAV 患者和年龄相匹配的健康对照组进行了四维血流 CMR 检查，评估了区域性、收缩期峰值升主动脉 WSS、主动脉瓣功能、主动脉僵硬度测量和主动脉尺寸。对于 BAV 患者，在随访三年后再次进行四维血流 CMR 检查，并在基线和随访时进行计算机断层扫描（CTA）。CTA 测量了主动脉的生长（体积增加≥5%）。采用线性混合效应模型分析了患者主动脉内的区域WSS差异和WSS随时间的变化，并将其与临床参数联系起来：30 名 BAV 患者（年龄 34 岁 [IQR 25-41]）被纳入随访分析。此外，另有 16 名 BAV 患者和 32 名健康对照者（年龄为 33 岁 [IQR：28-48]）被纳入其他区域分析。随着时间的推移，幅值、轴向和周向 WSS 均有所增加（健康对照组的所有 p95 百分位数从 21%（基线 506/2400 个区域）增至 31%（随访 734/2400 个区域）（p 结论：在 BAV 患者中观察到区域 WSS 随时间推移而增加，与主动脉生长无关。主动脉面积越大，WSS 越高，这就需要进一步研究主动脉夹层的可能预测价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.