二叶式主动脉瓣患者瓣叶间血流动力学与升主动脉远端直径的相关性研究。
Valve mediated hemodynamics and their association with distal ascending aortic diameter in bicuspid aortic valve subjects.
机构信息
Georgia Institute of Technology, Atlanta, Georgia, USA.
Auburn University, Auburn, Alabama, USA.
出版信息
J Magn Reson Imaging. 2018 Jan;47(1):246-254. doi: 10.1002/jmri.25719. Epub 2017 Apr 8.
PURPOSE
Valve mediated hemodynamics have been postulated to contribute to pathology of the ascending aorta (AAo). The objective of this study is to assess the association of aortic valve morphology and hemodynamics with downstream AAo size in subjects with bicuspid aortic valve (BAV) disease.
MATERIALS AND METHODS
Four-dimensional flow MRI at 1.5 or 3 Tesla was used to evaluate the hemodynamics in the proximal AAo of 52 subjects: size-matched controls with tricuspid aortic valves (n = 24, mid ascending aorta [MAA] diameter = 38.0 ± 4.9 mm) and BAV patients with aortic dilatation (n = 14 right and left coronary leaflet fusion [RL]-BAV, MAA diameter = 38.1 ± 5.3 mm; n = 14 right and noncoronary leaflet fusion [RN]-BAV, MAA diameter = 36.5 ± 6.6 mm). A validated semi-automated technique was used to evaluate hemodynamic metrics (flow angle, flow displacement, and jet quadrant) and valve morphology (orifice circularity) for all subjects. Regression analysis of these metrics to AAo diameter was performed.
RESULTS
RN-BAV subjects displayed a stronger correlation between hemodynamic metrics in the proximal AAo with diameter in the distal AAo compared with size-matched tricuspid aortic valve (TAV) controls and RL-BAV subjects. The distal AAo diameter was found to be strongly correlated to the upstream flow displacement (R = 0.75) and flow angle (R = 0.66) measured at the sino-tubular junction (STJ). Orifice circularity was also strongly correlated (R = 0.53) to the distal AAo diameter in RN-BAV subjects. For TAV controls and RL-BAV subjects, correlations were weaker (R < 0.2).
CONCLUSION
Hemodynamics in the STJ were strongly correlated to the distal AAo diameter for the RN-BAV subjects. Hemodynamic metrics were more strongly correlated to the downstream aortic size when compared with valve morphology metrics.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:246-254.
目的
已有研究提出，瓣叶介导的血流动力学改变可能导致升主动脉（AAo）病变。本研究旨在评估二叶主动脉瓣（BAV）病变患者的主动脉瓣形态和血流动力学与近端 AAo 下游 AAo 大小的相关性。
材料与方法
使用 1.5 或 3.0T 磁共振 4 维血流成像评估 52 例患者的近端 AAo 血流动力学：与三叶主动脉瓣（n = 24，升主动脉中段[MAA]直径 38.0 ± 4.9mm）大小匹配的对照组和主动脉扩张的 BAV 患者（n = 14 右冠状动脉和无冠状动脉瓣叶融合[RL]-BAV，MAA 直径 38.1 ± 5.3mm；n = 14 右冠状动脉和非冠状动脉瓣叶融合[RN]-BAV，MAA 直径 36.5 ± 6.6mm）。使用一种经过验证的半自动技术评估所有患者的血流动力学指标（流量角、流量位移和射流象限）和瓣叶形态（瓣口圆度）。对这些指标与 AAo 直径进行回归分析。
结果
与大小匹配的三叶主动脉瓣（TAV）对照组和 RL-BAV 患者相比，RN-BAV 患者近端 AAo 的血流动力学指标与远端 AAo 直径之间的相关性更强。远端 AAo 直径与窦管交界处（STJ）处上游流量位移（R = 0.75）和流量角（R = 0.66）呈强相关性。RN-BAV 患者瓣口圆度与远端 AAo 直径也呈强相关性（R = 0.53）。而 TAV 对照组和 RL-BAV 患者的相关性较弱（R < 0.2）。
结论
对于 RN-BAV 患者，STJ 的血流动力学与远端 AAo 直径密切相关。与瓣叶形态学指标相比，血流动力学指标与下游主动脉大小的相关性更强。
证据水平
3 级 技术功效：2 级 J. 磁共振成像 2018；47：246-254
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