Kocabay Gonene, Karabay Can Yucel, Kalkan Sedat, Kalayci Arzu, Efe Suleyman Cagan, Akgun Taylan, Bakal Ruken Bengi, Demir Serdar, Izgi Akin, Kirma Cevat
J Heart Valve Dis. 2014 May;23(3):279-88.
Bicuspid aortic valve (BAV), one of the most common congenital cardiac abnormalities, is the result of abnormal aortic leaflet formation during valvulogenesis. Recent studies have reported BAV to be associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The study aim was to investigate the relationship between LV diastolic function, as measured with two-dimensional speckle tracking echocardiography (2D-STE), and arterial stiffness.
A total of 38 patients with isolated BAV, and 18 age- and gender-matched healthy controls were enrolled prospectively. Patients with aortic valve velocity > 1.7 m/s, more than mild aortic regurgitation (AR) and ascending aorta diameter > 3.6 cm (indexed diameter > 2.1 cm/m2) were excluded. BAV was classified as either anterior-posterior (AP) orientation or right-left (RL) orientation. The LV diastolic function (E/A and E/Em ratio), left atrial (LA) volume index (LAVI), LA systolic strain and strain rate (SR) was assessed using echocardiography. Strain measurements were reported as longitudinal LA strain during ventricular systole (LA-Res), strain during late diastole (LA-Pump), and also as SR during ventricular contraction (LA-SR(s)), during passive ventricular filling (LA-SR(E)), and during active atrial contraction (LA-SR(A)) from four-chamber views. Arterial stiffness was evaluated by measuring the aortic pulse wave velocity (PWV), wave reflection was assessed by measuring the central systolic blood pressure (cSBP), central pulse pressure (cPP) and augmentation index (AIx) with applanation tonometry.
The aortic diameter at the proximal ascending aorta was larger in patients with BAV than in controls. Compared to controls, the E/Em ratio and LAVI were significantly higher in BAV patients. Although PWV was higher in BAV patients than in controls, no differences were found between the groups in terms of cSBP, cPP and AIx. The BAV group was observed to have significant lower LA-Res and LA-Pump strain values compared to controls. Significant correlations were identified between the PWV and echocardiographic parameters of LV diastolic function determinants, such as LA-Res and LA-Pump. However, there were no significant differences between BAV subgroups in terms of LV diastolic parameters and PWV.
Patients with isolated BAV have early features of subclinical LV diastolic dysfunction, as measured with 2D-STE. In addition, aortic stiffness assessed by PWV was impaired. The LV diastolic parameters were related to aortic stiffness.
二叶式主动脉瓣（BAV）是最常见的先天性心脏异常之一，是瓣膜形成过程中主动脉瓣叶异常形成的结果。最近的研究报道BAV与主动脉僵硬度异常有关，这对左心室（LV）舒张功能有负面影响。本研究的目的是探讨二维斑点追踪超声心动图（2D-STE）测量的LV舒张功能与动脉僵硬度之间的关系。
前瞻性纳入38例孤立性BAV患者和18例年龄及性别匹配的健康对照者。排除主动脉瓣流速>1.7m/s、中重度以上主动脉反流（AR）及升主动脉直径>3.6cm（指数直径>2.1cm/m²）的患者。BAV分为前后（AP）型或左右（RL）型。采用超声心动图评估LV舒张功能（E/A和E/Em比值）、左心房（LA）容积指数（LAVI）、LA收缩期应变及应变率（SR）。应变测量结果报告为心室收缩期纵向LA应变（LA-Res）、舒张晚期应变（LA-Pump），以及四腔心切面心室收缩期（LA-SR(s)）、心室被动充盈期（LA-SR(E)）和心房主动收缩期（LA-SR(A)）的SR。通过测量主动脉脉搏波速度（PWV）评估动脉僵硬度，采用压平式眼压计测量中心收缩压（cSBP）、中心脉压（cPP）和增强指数（AIx）评估波反射。
BAV患者升主动脉近端直径大于对照组。与对照组相比，BAV患者的E/Em比值和LAVI显著更高。虽然BAV患者的PWV高于对照组，但两组在cSBP、cPP和AIx方面无差异。观察发现BAV组的LA-Res和LA-Pump应变值显著低于对照组。PWV与LV舒张功能决定因素的超声心动图参数（如LA-Res和LA-Pump）之间存在显著相关性。然而，BAV亚组在LV舒张参数和PWV方面无显著差异。
二维斑点追踪超声心动图测量显示，孤立性BAV患者具有亚临床LV舒张功能障碍的早期特征。此外，通过PWV评估的主动脉僵硬度受损。LV舒张参数与主动脉僵硬度相关。
