Author + information
- Received January 3, 2018
- Revision received March 8, 2018
- Accepted March 20, 2018
- Published online June 3, 2019.
- Andrea Guala, PhDa,∗∗ (, )
- Jose Rodriguez-Palomares, MD, PhDa,∗,
- Lydia Dux-Santoy, MSca,
- Gisela Teixido-Tura, MD, PhDa,
- Giuliana Maldonado, MDa,
- Laura Galian, MDa,
- Marina Huguet, MDa,
- Filipa Valente, MDa,
- Laura Gutiérrez, MDa,
- Teresa González-Alujas, MD, PhDa,
- Kevin M. Johnson, PhDb,
- Oliver Wieben, PhDb,
- Augusto Sao Avilés, MD, PhDa,
- David Garcia-Dorado, MD, PhDa and
- Arturo Evangelista, MD, PhDa
- aHospital Universitari Vall d’Hebron, Department of Cardiology, CIBER-CV, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- bDepartments of Medical Physics and Radiology, University of Wisconsin–Madison, Madison, Wisconsin
- ↵∗Address for correspondence:
Dr. Andrea Guala, Department of Cardiology, Hospital Universitari Vall d’Hebron, Paseo Vall d’Hebron 119-129, 08035, Barcelona, Spain.
Objectives This study sought to ascertain whether patients with a bicuspid aortic valve (BAV) have an intrinsic alteration in regional aortic stiffness compared with patients with tricuspid aortic valve (TAV) and Marfan syndrome (MFS) patients with similar aortic sizes, as well as to assess the influence of ascending aorta (AAo) dilation on regional stiffness parameters in BAV patients.
Background Imaging biomarkers as predictors of BAV, MFS, and degenerative AAo aneurysms in TAV patients (DA-TAV) are lacking. Biomechanical characterization has been proposed as a possible tool for further aneurysm stratification.
Methods A total 234 subjects (136 BAV, 44 MFS, and 18 DA-TAV patients and 36 healthy control subjects) were included. The cardiac magnetic resonance protocol comprised 4-dimensional flow to assess AAo and descending aorta (DAo) pulse wave velocities (PWVs) and double-oblique, 2-dimensional, steady-state free-precession cine cardiac magnetic resonance to compute aortic distensibility (AD).
Results On adjusted analysis, nondilated BAV patients had similar PWV and AD as healthy control subjects in both AAo and DAo, whereas dilated BAV did not differ from DA-TAV. In contrast, AAo and DAo stiffness in MFS patients was markedly greater than in BAV patients, increasing slightly with dilation severity. AAo PWV showed a biphasic pattern in BAV patients: it first decreased and then increased throughout AAo dilation, with a clear turning point at 50 mm, whereas distensibility did not discern mildly dilated aorta. In multivariate analysis adjusted for clinical and demographic characteristics, only PWV was related to AAo dilation in BAV patients.
Conclusions The mechanical properties of AAo aneurysms are similar in BAV and TAV patients, whereas MFS patients have a stiffer aorta. Aortic stiffness strongly depends on dilation severity. AAo PWV resulted in a potentially clinically useful biphasic trend with respect to aneurysm diameter, whereas distensibility did not discern mildly dilated aorta. Beyond clinical risk factors, PWV but not AD was independently related to AAo dilation in BAV patients.
- ascending aorta aneurysm
- bicuspid aortic valve
- 4D flow CMR
- Marfan syndrome
- pulse wave velocity
↵∗ Drs. Guala and Rodriguez-Palomares contributed equally to this work and are joint first authors.
This study was funded by Instituto de Salud Carlos III through the projects PI11/01081 and PI14/0106 (co-funded by ERDF/ESF), La Marató de TV3 (project number 20151330), and Ministerio de Economía y Competitividad through Retos-Colaboración 2016 (RTC-2016-5152-1) and Beca Philips de la Societat Catalana de Cardiologia 2017. Dr. Guala has received funding from the European Union Seventh Framework Programme FP7/People under grant agreement number 267128. Dr. Johnson has received a research grant from GE Healthcare through The University of Wisconsin-Madison (no personal compensation); has received research grant support from Myocardial Solutions; and holds a consulting agreement with Vertex Pharmaceuticals. Dr. Wieben has received a research grant from GE Healthcare through The University of Wisconsin-Madison (no personal compensation). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 3, 2018.
- Revision received March 8, 2018.
- Accepted March 20, 2018.
- 2019 American College of Cardiology Foundation
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