Boonyasirinant Thananya, Rajiah Prabhakar, Flamm Scott D
Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland, OH, USA.
Division of Cardiology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Int J Cardiovasc Imaging. 2019 Jan;35(1):133-141. doi: 10.1007/s10554-018-1433-y. Epub 2018 Sep 5.
The aim of this study was to assess aortic stiffness in patients with bicuspid aortic valve (BAV), and to determine if differences exist among the BAV phenotypes. Stiffness was measured by pulse wave velocity (PWV) determined using velocity-encoded magnetic resonance imaging (VENC-MRI). VENC-MRI was performed in 100 BAV patients and 45 normal controls. PWV was determined between the mid ascending and mid descending aorta. The BAV phenotypes were characterized using steady-state free precession (SSFP) images acquired across the face of the aortic valve, and classified as follows: right-left cusp (R-L) fusion, right and non-coronary cusp (R-NC) fusion, and left and non-coronary cusp (L-NC) fusion. The following BAV phenotypes were identified: 76 R-L, 23 R-NC, and 1 L-NC fusion. BAV patients demonstrated significantly greater PWV compared to normal controls, after adjusting for age (9.16 vs. 3.83 m/s; p < 0.0001). Furthermore, PWV was significantly greater in patients with R-NC fusion than those with R-L fusion phenotype (12.27 vs. 7.97 m/s; p < 0.001). There was significantly increased PWV from VENC-MRI in BAV patients compared to normal controls. Thisis the first to demonstrate the association of different BAV phenotypes and aortic stiffness. VENC-MRI PWV assessment potentially represents a novel parameter for enhanced surveillance and may alter surgical triage of aorta in this high risk group.
本研究的目的是评估二叶式主动脉瓣（BAV）患者的主动脉僵硬度，并确定BAV各表型之间是否存在差异。通过使用速度编码磁共振成像（VENC-MRI）测定的脉搏波速度（PWV）来测量僵硬度。对100例BAV患者和45例正常对照者进行了VENC-MRI检查。在升主动脉中部和降主动脉中部之间测定PWV。使用在主动脉瓣平面采集的稳态自由进动（SSFP）图像对BAV表型进行特征描述，并分类如下：右-左瓣叶融合（R-L）、右瓣叶与无冠瓣叶融合（R-NC）以及左瓣叶与无冠瓣叶融合（L-NC）。识别出以下BAV表型：76例R-L融合、23例R-NC融合和1例L-NC融合。在调整年龄后，BAV患者的PWV显著高于正常对照者（9.16 vs. 3.83 m/s；p < 0.0001）。此外，R-NC融合患者的PWV显著高于R-L融合表型患者（12.27 vs. 7.97 m/s；p < 0.001）。与正常对照者相比，BAV患者VENC-MRI测定的PWV显著升高。这是首次证明不同BAV表型与主动脉僵硬度之间的关联。VENC-MRI PWV评估可能代表一种用于加强监测的新参数，并可能改变这一高风险组中主动脉的手术分类。
