Goudot Guillaume, Mirault Tristan, Bruneval Patrick, Soulat Gilles, Pernot Mathieu, Messas Emmanuel
INSERM U1273, ESPCI Paris, CNRS FRE 2031, Physics for Medicine Paris, PSL Research University, Paris, France.
Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.
Front Physiol. 2019 Apr 10;10:299. doi: 10.3389/fphys.2019.00299. eCollection 2019.
Bicuspid aortic valve (BAV) is associated with a significant risk of development of aneurysm and dissection of the ascending thoracic aorta. Development of what is called BAV associated aortopathy is particularly heterogeneous with an uncertain prognosis and with no prognostic biomarkers except for the aortic diameter. This situation leads to an important variability of the therapeutic strategy of this aortopathy. By reviewing the literature on aortic stiffness in the case of BAV, we aimed at evaluating its potential prognostic role in the development of aortic dilatation.
Studies evaluating aortic stiffness, with ultrasound or magnetic resonance imaging, converge toward the description of an increased segmental aortic stiffness in BAV patients regardless of age, diameter or aortic level, from the root to the arch. Even though there is a lack of longitudinal studies evaluating the progression of aortic dilatation, new data have recently shown the potential prognostic role of the maximal rate of systolic distension of the aortic wall with magnetic resonance imaging.
Although the use of aortic distensibility calculation is a simple evaluation of stiffness that could be easily transposed in daily practice, its interpretation remains uncertain. New arterial stiffening indicators seem more promising but need a stronger validation.
二叶式主动脉瓣（BAV）与升主动脉瘤和夹层形成的显著风险相关。所谓的BAV相关性主动脉病变的发展具有特别的异质性，预后不确定，除了主动脉直径外没有预后生物标志物。这种情况导致了这种主动脉病变治疗策略的重要变异性。通过回顾关于BAV病例中主动脉僵硬度的文献，我们旨在评估其在主动脉扩张发展中的潜在预后作用。
使用超声或磁共振成像评估主动脉僵硬度的研究一致表明，无论年龄、直径或主动脉水平如何，BAV患者从主动脉根部到弓部的节段性主动脉僵硬度均增加。尽管缺乏评估主动脉扩张进展的纵向研究，但最近的新数据显示了磁共振成像测量的主动脉壁收缩期最大扩张率的潜在预后作用。
尽管使用主动脉扩张性计算是对僵硬度的一种简单评估，可在日常实践中轻松应用，但其解读仍不确定。新的动脉僵硬度指标似乎更有前景，但需要更强有力的验证。
