Qin Jiaxing Jason, Obeidy Peyman, Gok Mustafa, Gholipour Alireza, Grieve Stuart M
Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.
Sydney Medical School and School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Front Cardiovasc Med. 2023 Jan 9;9:1075833. doi: 10.3389/fcvm.2022.1075833. eCollection 2022.
Current intervention guidelines for bicuspid aortic valve (BAV) associated ascending aorta (AAo) dilatation are suboptimal predictors of clinical outcome. There is growing interest in identifying better biomarkers such as wall shear stress (WSS) to help risk stratify BAV aortopathy. The aim of the systematic review is to synthesize existing evidence of the relationship between WSS and aortopathy in the BAV population.
A comprehensive literature search of available major databases was performed in May 2022 to include studies that used four-dimensional flow cardiac magnetic resonance (4D-flow) MRI to quantify WSS in the AAo in adult BAV populations. Summary results and statistical analysis were provided for key numerical results. A narrative summary was provided to assess similarities between studies.
A total of 26 studies that satisfied selection criteria and quality assessment were included in the review. The presence of BAV resulted in significantly elevated WSS magnitude and circumferential WSS, but not axial WSS. The presence of aortic stenosis had additional impact on WSS and flow alterations. BAV phenotypes were associated with different WSS distributions and flow profiles. Altered protein expression in the AAo wall associated with WSS supported the contribution of altered hemodynamics to aortopathy in addition to genetic factors.
WSS has the potential to be a valid biomarker for BAV aortopathy. Future work would benefit from larger study cohorts with longitudinal evaluations to further characterize WSS association with aortopathy, mortality, and morbidities.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077, identifier CRD42022337077.
目前针对二叶式主动脉瓣（BAV）相关升主动脉（AAo）扩张的干预指南对临床结局的预测效果欠佳。人们越来越关注识别更好的生物标志物，如壁面剪应力（WSS），以帮助对BAV主动脉病变进行风险分层。本系统评价的目的是综合现有证据，阐明BAV人群中WSS与主动脉病变之间的关系。
2022年5月对主要可用数据库进行了全面的文献检索，纳入了使用四维血流心脏磁共振成像（4D-flow MRI）对成年BAV人群的AAo中WSS进行量化的研究。提供了关键数值结果的汇总结果和统计分析。进行了叙述性总结以评估各研究之间的相似性。
共有26项符合选择标准和质量评估的研究纳入本评价。BAV的存在导致WSS大小和周向WSS显著升高，但轴向WSS未升高。主动脉狭窄的存在对WSS和血流改变有额外影响。BAV表型与不同的WSS分布和血流模式相关。AAo壁中与WSS相关的蛋白质表达改变支持了除遗传因素外，血流动力学改变对主动脉病变的影响。
WSS有可能成为BAV主动脉病变的有效生物标志物。未来的研究若纳入更大的队列并进行纵向评估，将有助于进一步明确WSS与主动脉病变、死亡率和发病率之间的关联。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337077，标识符CRD42022337077 。
