Department of Cardiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.
INSERM U1148, Bichat Hospital, Paris, France.
Eur Heart J Cardiovasc Imaging. 2018 Jul 1;19(7):792-799. doi: 10.1093/ehjci/jex176.
Ascending aorta (AA) dilatation is common in aortic valve stenosis (AS) but data regarding AA progression, its determinants and impact of valve anatomy [bicuspid (BAV), or tricuspid (TAV)] are scarce.
Asymptomatic AS patients enrolled in a prospective cohort (COFRASA/GENERAC) with at least 2 years of follow-up were considered in the present analysis. A transthoracic echocardiography (TTE) and a computed tomography (CT) scan were performed at inclusion and yearly thereafter. We enrolled 195 patients [mean gradient 22 ± 11 mmHg, 42 BAV patients (22%)]. Mean aorta diameters assessed using TTE were 35 ± 4 and 36 ± 5 mm at the sinuses of Valsalva and tubular level, respectively. Ascending aorta diameter was >40 mm in 29% of patients (24% in TAV vs. 52% in BAV, P < 0.01). Determinants of AA diameters were age, sex, BSA, and BAV, but not AS severity. After a mean follow-up of 3.8 ± 1.5years, AA enlargement rate assessed using TTE was +0.18 ± 0.34 mm/year and +0.36 ± 0.54 mm/year at the Valsalva and tubular level, respectively. Determinants of the progression of AA size were smaller AA diameter (P < 0.01) but not baseline AS severity or valve anatomy (all P > 0.05). Only four patients presented an AA progression ≥2 mm/year. Correlations between TTE and CT scan were excellent (all r >0.74) and similar results were obtained using CT. During follow-up, two BAV patients underwent a combined AA surgery; no surgery was primarily performed for AA aneurysm and no dissection was observed.
In this prospective cohort of AS patients determinants of AA diameters were age, sex, BSA, and valve anatomy but not AS severity. AA progression rates were low and not influenced by AS severity or valve anatomy.
升主动脉（AA）扩张在主动脉瓣狭窄（AS）中很常见，但关于 AA 进展、其决定因素以及瓣膜解剖结构[二叶式（BAV）或三叶式（TAV）]的影响的数据很少。
本分析纳入了前瞻性队列（COFRASA/GENERAC）中至少随访 2 年的无症状 AS 患者。在纳入时和之后每年进行一次经胸超声心动图（TTE）和计算机断层扫描（CT）检查。我们共纳入了 195 名患者[平均梯度 22±11mmHg，42 名 BAV 患者（22%）]。使用 TTE 评估的主动脉直径在窦部和管状水平分别为 35±4mm 和 36±5mm。29%的患者升主动脉直径>40mm（TAV 为 24%，BAV 为 52%，P<0.01）。AA 直径的决定因素是年龄、性别、BSA 和 BAV，但与 AS 严重程度无关。在平均 3.8±1.5 年的随访后，使用 TTE 评估的 AA 增大率分别为+0.18±0.34mm/年和+0.36±0.54mm/年，分别在窦部和管状水平。AA 大小进展的决定因素是 AA 直径较小（P<0.01），但基线 AS 严重程度或瓣膜解剖结构均不是（所有 P>0.05）。只有 4 名患者的 AA 进展速度≥2mm/年。TTE 和 CT 扫描之间的相关性很好（所有 r>0.74），使用 CT 也得到了相似的结果。在随访期间，2 名 BAV 患者接受了联合 AA 手术；没有因 AA 瘤而进行原发性手术，也没有观察到夹层。
在这项 AS 患者的前瞻性队列研究中，AA 直径的决定因素是年龄、性别、BSA 和瓣膜解剖结构，但不是 AS 严重程度。AA 进展速度较低，不受 AS 严重程度或瓣膜解剖结构的影响。
