Baykiz D, Demirtakan Z G, Govdeli E A, Kaytaz M, Yavuz M L, Emet S, Elitok A, Ademoglu E, Umman S, Umman B, Bugra Z
Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(6):2358-2376. doi: 10.26355/eurrev_202303_31771.
Bicuspid aortic valve (BAV) is the most common congenital heart defect. Ascending aorta dilatation is related to BAV- and hypertension (HTN)-associated aortopathy. The aim of this study was to investigate aortic elasticity, as well as aortic deformation of the ascending aorta, using strain imaging, and to evaluate the possible relationship of biomarkers, such as endotrophin and matrix metalloproteinase-2 (MMP-2), with ascending aorta dilatation in patients with BAV- or HTN-associated aortopathy.
This prospective study included patients with ascending aorta dilatation with BAV (n = 33), or normal tricuspid aortic valve with HTN (n = 33), and 20 control subjects. The mean age of the total patients was 42.76 ± 10.4 years (67% male, 33% female). We calculated aortic elasticity parameters using the relevant formula by M-mode echocardiography and determined layer-specific longitudinal and transverse strains of the proximal aorta by speckle-tracking echocardiography. Blood samples of the participants were drawn for the analysis of endotrophin and MMP-2.
Aortic strain and aortic distensibility were significantly decreased, whereas the aortic stiffness index was significantly increased in patient groups with BAV or HTN compared to the control group (p < 0.001). Moreover, longitudinal strain of both the anterior and posterior aortic walls of the proximal aorta were significantly impaired in BAV and HTN patients (p < 0.001). Serum endotrophin levels were significantly reduced in the patient cohort compared to the controls (p = 0.001). Endotrophin was noted to be significantly positively correlated with aortic strain and aortic distensibility (r = 0.37, p = 0.001; r = 0.45, p < 0.001, respectively), whereas inversely associated with aortic stiffness index (r = -0.402, p < 0.001). Furthermore, endotrophin was the single independent predictor of ascending aorta dilatation (OR = 0.986, p < 0.001). A cut-off value of endotrophin ≤ 82.38 ng/mL predicted ascending aorta dilatation with a sensitivity of 80.3% and specificity of 78.5% (p < 0.0001).
The present study showed that aortic deformation parameters and elasticity are impaired in BAV and HTN patients, and strain imaging allows for a good analysis of ascending aorta deformation. Endotrophin could be a predictive biomarker of ascending aorta dilatation in BAV and HTN aortopathy.
二叶式主动脉瓣（BAV）是最常见的先天性心脏缺陷。升主动脉扩张与BAV和高血压（HTN）相关的主动脉病变有关。本研究的目的是使用应变成像技术研究主动脉弹性以及升主动脉的主动脉变形，并评估内毒素和基质金属蛋白酶-2（MMP-2）等生物标志物与BAV或HTN相关主动脉病变患者升主动脉扩张之间的可能关系。
这项前瞻性研究纳入了升主动脉扩张的BAV患者（n = 33）、正常三尖瓣主动脉瓣合并HTN的患者（n = 33）以及20名对照受试者。所有患者的平均年龄为42.76±10.4岁（男性67%，女性33%）。我们通过M型超声心动图使用相关公式计算主动脉弹性参数，并通过斑点追踪超声心动图确定近端主动脉的各层特定纵向和横向应变。采集参与者的血样用于分析内毒素和MMP-2。
与对照组相比，BAV或HTN患者组的主动脉应变和主动脉扩张性显著降低，而主动脉僵硬度指数显著升高（p < 0.001）。此外，BAV和HTN患者近端主动脉前后壁的纵向应变均显著受损（p < 0.001）。与对照组相比，患者队列中的血清内毒素水平显著降低（p = 0.001）。内毒素与主动脉应变和主动脉扩张性显著正相关（r = 0.37，p = 0.001；r = 0.45，p < 0.001），而与主动脉僵硬度指数呈负相关（r = -0.402，p < 0.001）。此外，内毒素是升主动脉扩张的单一独立预测因子（OR = 0.986，p < 0.001）。内毒素≤82.38 ng/mL的临界值预测升主动脉扩张的敏感性为80.3%，特异性为78.5%（p < 0.0001）。
本研究表明，BAV和HTN患者的主动脉变形参数和弹性受损，应变成像能够很好地分析升主动脉变形。内毒素可能是BAV和HTN主动脉病变中升主动脉扩张的预测生物标志物。
