在无狭窄的二叶式主动脉瓣患者中，主动脉弹性降低和扩张与主动脉反流及左心室肥厚相关。
Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients.
作者信息
Grotenhuis Heynric B, Ottenkamp Jaap, Westenberg Jos J M, Bax Jeroen J, Kroft Lucia J M, de Roos Albert
机构信息
Department of Radiology, Center for Congenital Anomalies of the Heart, Leiden, the Netherlands; Department of Paediatric Cardiology, Center for Congenital Anomalies of the Heart, Leiden, the Netherlands; Emma Children's Hospital/AMC, Amsterdam, the Netherlands; VU Medical Center, Amsterdam, the Netherlands.
Department of Paediatric Cardiology, Center for Congenital Anomalies of the Heart, Leiden, the Netherlands; Emma Children's Hospital/AMC, Amsterdam, the Netherlands; VU Medical Center, Amsterdam, the Netherlands.
出版信息
J Am Coll Cardiol. 2007 Apr 17;49(15):1660-1665. doi: 10.1016/j.jacc.2006.12.044. Epub 2007 Apr 2.
OBJECTIVES
This study sought to assess elasticity and dimensions of the aorta and their impact on aortic valve competence and left ventricular (LV) function in patients with a nonstenotic bicuspid aortic valve (BAV).
BACKGROUND
Intrinsic pathology of the aortic wall is a possible explanation for reduced aortic elasticity and aortic dilatation in patients with BAVs, even in the absence of a stenotic aortic valve. The relationship between aortic wall elasticity, aortic dimensions, aortic valve competence, and LV function in patients with BAVs has not previously been studied with magnetic resonance imaging.
METHODS
Magnetic resonance imaging was performed in 20 patients with nonstenotic BAVs (mean +/- SD, age 27 +/- 11 years) and 20 matched control patients.
RESULTS
The BAV patients showed reduced aortic elasticity as indicated by increased pulse wave velocity in the aortic arch and descending aorta (5.6 +/- 1.3 m/s vs. 4.5 +/- 1.1 m/s, p = 0.01; and 5.2 +/- 1.8 m/s vs. 4.3 +/- 0.9 m/s, p = 0.03, respectively), and reduced aortic root distensibility (3.1 +/- 1.2 x 10(-3) mm Hg(-1) vs. 5.6 +/- 3.2 x 10(-3) mm Hg(-1), p < 0.01). In addition, BAV patients showed aortic root dilatation as compared with control patients (mean difference 3.6 to 4.2 mm, p < or = 0.04 at all 4 predefined levels). Minor degrees of aortic regurgitation (AR) were present in 11 patients (AR fraction 6 +/- 8% vs. 1 +/- 1%, p < 0.01). The LV ejection fraction was normal (55 +/- 8% vs. 56 +/- 6%, p = 0.61), whereas LV mass was significantly increased in patients (54 +/- 12 g/m2 vs. 46 +/- 12 g/m2, p = 0.04). Dilatation at the level of the aortic annulus (r = 0.45, p = 0.044) and reduced aortic root distensibility (r = 0.37, p = 0.041) correlated with AR fraction. Increased pulse wave velocity in the aortic arch correlated with increased LV mass (r = 0.42, p = 0.041).
CONCLUSIONS
Reduced aortic elasticity and aortic root dilatation were frequently present in patients with nonstenotic BAVs. In addition, reduced aortic wall elasticity was associated with severity of AR and LV hypertrophy.
目的
本研究旨在评估非狭窄性二叶式主动脉瓣（BAV）患者的主动脉弹性和尺寸及其对主动脉瓣功能和左心室（LV）功能的影响。
背景
主动脉壁的内在病变可能是BAV患者主动脉弹性降低和主动脉扩张的原因，即使在没有主动脉瓣狭窄的情况下也是如此。此前尚未通过磁共振成像研究BAV患者的主动脉壁弹性、主动脉尺寸、主动脉瓣功能和LV功能之间的关系。
方法
对20例非狭窄性BAV患者（平均±标准差，年龄27±11岁）和20例匹配的对照患者进行磁共振成像检查。
结果
BAV患者的主动脉弹性降低，表现为主动脉弓和降主动脉的脉搏波速度增加（分别为5.6±1.3 m/s对4.5±1.1 m/s，p = 0.01；以及5.2±1.8 m/s对4.3±0.9 m/s，p = 0.03），主动脉根部扩张性降低（3.1±1.2×10⁻³ mmHg⁻¹对5.6±3.2×10⁻³ mmHg⁻¹，p < 0.01）。此外，与对照患者相比，BAV患者表现出主动脉根部扩张（在所有4个预定义水平上，平均差异为3.6至4.2 mm，p≤0.04）。11例患者存在轻度主动脉反流（AR）（AR分数6±8%对1±1%，p < 0.01）。LV射血分数正常（55±8%对56±6%，p = 0.61），而患者的LV质量显著增加（54±12 g/m²对46±12 g/m²，p = 0.04）。主动脉瓣环水平的扩张（r = 0.45，p = 0.044）和主动脉根部扩张性降低（r = 0.37，p = 0.041）与AR分数相关。主动脉弓中脉搏波速度增加与LV质量增加相关（r = 0.42，p = 0.041）。
结论
非狭窄性BAV患者经常出现主动脉弹性降低和主动脉根部扩张。此外，主动脉壁弹性降低与AR的严重程度和LV肥厚有关。
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