Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Am Soc Echocardiogr. 2011 Aug;24(8):847-52. doi: 10.1016/j.echo.2011.04.017. Epub 2011 Jun 11.
Reduced elasticity and dilatation of the proximal aorta are highly prevalent in patients with bicuspid aortic valves (BAVs), even in the absence of valvular dysfunction. The aim of this study was to examine central aortic stiffness and its association with ascending aortic dilation in subjects with BAVs compared with controls.
Fifty subjects with BAVs (39 men; mean age, 52 ± 14 years) without significant valve dysfunction and 50 age-matched and gender-matched controls with normal trileaflet aortic valves were studied. Aortic diameter was measured using two-dimensional echocardiography, and central hemodynamics were assessed simultaneously using radial artery tonometry. Subjects with BAVs were divided into two groups on the basis of the median value of the aortic diameter.
Subjects with BAVs had larger ascending aortic diameters (20.6 ± 4.0 vs 17.9 ± 2.4 mm/m(2), P < .001), higher augmentation indexes normalized for a heart rate of 75 beats/min (25.3 ± 9.7% vs 16.7 ± 8.6%, P < .001), higher pulse-wave velocities (7.8 ± 1.5 vs 7.2 ± 1.0 m/sec, P = .013), and lower pulse pressure amplification (1.24 ± 0.27 vs 1.35 ± 0.18, P = .022) than control subjects. The higher augmentation indexes were significant even in subjects with BAVs with relatively normal sized aortas. The diameter of the ascending aorta was correlated with augmentation index (r = 0.48, P < .001), pulse-wave velocity (r = 0.27, P = .063), and pulse pressure amplification (r = -0.46, P = .001) in subjects with BAVs.
Subjects with BAVs had stiffer central hemodynamics than controls with tricuspid aortic valves, even in the absence of significant aortic dilation. Central aortic stiffness was positively correlated with the degree of aortic dilation in subjects with BAV. Thus, the evaluation of central aortic stiffness could be useful for the early detection and risk stratification of aortopathy in subjects with BAVs.
即使没有瓣叶功能障碍，二叶式主动脉瓣（BAV）患者的近端主动脉弹性和扩张性也明显降低。本研究旨在比较 BAV 患者与对照组之间的中心主动脉僵硬度及其与升主动脉扩张的关系。
研究了 50 名无明显瓣叶功能障碍的 BAV 患者（39 名男性；平均年龄 52±14 岁）和 50 名年龄和性别匹配的三叶式主动脉瓣正常对照者。使用二维超声心动图测量主动脉直径，同时使用桡动脉张力测定法评估中心血流动力学。根据主动脉直径的中位数将 BAV 患者分为两组。
BAV 患者的升主动脉直径较大（20.6±4.0 比 17.9±2.4mm/m2，P＜0.001），心率为 75 次/分时校正的增强指数较高（25.3±9.7%比 16.7±8.6%，P＜0.001），脉搏波速度较高（7.8±1.5 比 7.2±1.0m/sec，P=0.013），脉搏压放大率较低（1.24±0.27 比 1.35±0.18，P=0.022）。即使在主动脉直径相对正常的 BAV 患者中，增强指数升高也具有显著意义。BAV 患者的升主动脉直径与增强指数（r=0.48，P＜0.001）、脉搏波速度（r=0.27，P=0.063）和脉搏压放大率（r=-0.46，P=0.001）相关。
即使无明显主动脉扩张，BAV 患者的中心血流动力学也比三叶式主动脉瓣患者更僵硬。BAV 患者的中心主动脉僵硬度与主动脉扩张程度呈正相关。因此，评估中心主动脉僵硬度可能有助于早期发现和分层 BAV 患者的主动脉病变。
