Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina.
Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France; ESME Sudria Research Lab, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
Int J Cardiol. 2021 Mar 1;326:206-212. doi: 10.1016/j.ijcard.2020.11.046. Epub 2020 Nov 28.
We aimed to provide a comprehensive aortic stiffness description using magnetic resonance imaging (MRI) in patients with ascending thoracic aorta aneurysm and tricuspid (TAV-ATAA) or bicuspid (BAV) aortic valve.
This case-control study included 18 TAV-ATAA and 19 BAV patients, with no aortic valve stenosis/severe regurgitation, who were 1:1 age-, gender- and central blood pressures (BP)-matched to healthy volunteers. Each underwent simultaneous aortic MRI and BP measurements. 3D anatomical MRI provided aortic diameters. Stiffness indices included: regional ascending (AA) and descending (DA) aorta pulse wave velocity (PWV) from 4D flow MRI; local AA and DA strain, distensibility and theoretical Bramwell-Hill (BH) model-based PWV, as well as regional arch PWV from 2D flow MRI.
Patient groups had significantly higher maximal AA diameter (median[interquartile range], TAV-ATAA: 47.5[42.0-51.3]mm, BAV: 45.0[41.0-47.0]mm) than their respective controls (29.1[26.8-31.8] and 28.1[26.0-32.0]mm, p < 0.0001), while BP were similar (p ≥ 0.25). Stiffness indices were significantly associated with age (ρ ≥ 0.33), mean BP (arch PWV: ρ = 0.25, p = 0.05; DA distensibility: ρ = -0.30, p = 0.02) or AA diameter (arch PWV: ρ = 0.28, p = 0.03; DA PWV: ρ = 0.32, p = 0.009). None of them, however, was significantly different between TAV-ATAA or BAV patients and their matched controls. Finally, while direct PWV measures were significantly correlated to BH-PWV estimates in controls (ρ ≥ 0.40), associations were non-significant in TAV-ATAA and BAV groups (p ≥ 0.18).
The overlap of MRI-derived aortic stiffness indices between patients with TAV or BAV aortopathy and matched controls highlights another heterogeneous feature of aortopathy, and suggests the urgent need for more sensitive indices which might help better discriminate such diseases.
我们旨在使用磁共振成像（MRI）全面描述升主动脉瘤伴三尖瓣（TAV-ATAA）或二叶式主动脉瓣（BAV）主动脉瓣患者的主动脉僵硬度。
本病例对照研究纳入了 18 例 TAV-ATAA 患者和 19 例 BAV 患者，这些患者均无主动脉瓣狭窄/重度反流，年龄、性别和中心血压（BP）与健康志愿者 1:1 匹配。所有患者均接受了主动脉 MRI 和 BP 同步测量。3D 解剖学 MRI 提供了主动脉直径。僵硬度指数包括：4D 流 MRI 得出的区域性升主动脉（AA）和降主动脉（DA）脉搏波速度（PWV）；局部 AA 和 DA 应变、可扩张性和理论 Bramwell-Hill（BH）模型基础上的 PWV，以及 2D 流 MRI 得出的区域性弓部 PWV。
患者组的最大 AA 直径（中位数[四分位数范围]，TAV-ATAA：47.5[42.0-51.3]mm，BAV：45.0[41.0-47.0]mm）明显高于各自的对照组（29.1[26.8-31.8]和 28.1[26.0-32.0]mm，p<0.0001），而 BP 相似（p≥0.25）。僵硬度指数与年龄（ρ≥0.33）、平均 BP（弓部 PWV：ρ=0.25，p=0.05；DA 可扩张性：ρ=-0.30，p=0.02）或 AA 直径（弓部 PWV：ρ=0.28，p=0.03；DA PWV：ρ=0.32，p=0.009）显著相关。然而，它们均与 TAV-ATAA 或 BAV 患者及其匹配对照组无显著差异。最后，尽管直接 PWV 测量与对照组的 BH-PWV 估计值显著相关（ρ≥0.40），但 TAV-ATAA 和 BAV 组的相关性无统计学意义（p≥0.18）。
TAV 或 BAV 主动脉瓣病变患者与匹配对照组之间 MRI 得出的主动脉僵硬度指数重叠，突出了主动脉病变的另一个异质性特征，并提示迫切需要更敏感的指数，以帮助更好地区分这些疾病。
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