Chongthammakun Vasutakarn, Pan Amy Y, Earing Michael G, Damluji Abdulla A, Goot Benjamin H, Cava Joseph R, Gerardin Jennifer F
Adult Congenital Heart Disease Program, Division of Cardiology, Virginia Commonwealth University, Richmond, VA, United States of America.
Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI, United States of America.
Am Heart J Plus. 2022 Aug 11;20:100194. doi: 10.1016/j.ahjo.2022.100194. eCollection 2022 Aug.
Bicuspid aortic valve (BAV) is associated with progressive aortic dilation. Studies in aortopathies have shown a correlation between increased aortic stiffness and aortic dilation. We aimed to evaluate aortic stiffness measures as predictors of progressive aortic dilation by cardiac magnetic resonance (CMR) in BAV patients.
This is a retrospective study of 49 patients with BAV (median age 21.1 years at first CMR visit) with ≥2 CMR at the Wisconsin Adult Congenital Heart Disease Program (WAtCH). Circumferential aortic strain, distensibility, and -stiffness index were obtained from CMR-derived aortic root cine imaging, and aortic dimensions were measured at aortic root and ascending aorta. A linear mixed-model and logistic regression were used to identify important predictors of progressive aortic dilation.
Over a median of 3.8 years follow-up, the annual growth rates of aortic root and ascending aorta dimensions were 0.25 and 0.16 mm/year, respectively. Aortic strain and distensibility decreased while -stiffness index increased with age. Aortic root strain and distensibility were associated with progressive dilation of the ascending aorta. Baseline aortic root diameter was an independent predictor of >1 mm/year growth rate of the aortic root (adjusted OR 1.34, 95 % CI 1.03-1.74, = 0.028). Most patients (61 %) had coexisting coarctation of aorta. Despite the higher prevalence of hypertension in patients with aortic coarctation, hypertension or coarctation had no effect on baseline aorta dimensions, stiffness, or progressive aortic dilation.
Some CMR-derived aortic stiffness parameters correlated with progressive aortic dilation in BAV and should be further investigated in larger and older BAV cohorts.
二叶式主动脉瓣（BAV）与主动脉进行性扩张有关。主动脉病变的研究表明，主动脉僵硬度增加与主动脉扩张之间存在相关性。我们旨在通过心脏磁共振成像（CMR）评估主动脉僵硬度指标，作为BAV患者主动脉进行性扩张的预测指标。
这是一项对威斯康星成人先天性心脏病项目（WAtCH）中49例BAV患者（首次CMR检查时的中位年龄为21.1岁）进行的回顾性研究，这些患者至少接受过2次CMR检查。从CMR获得的主动脉根部电影成像中获取主动脉圆周应变、扩张性和僵硬度指数，并在主动脉根部和升主动脉测量主动脉尺寸。使用线性混合模型和逻辑回归来确定主动脉进行性扩张的重要预测指标。
在中位随访3.8年期间，主动脉根部和升主动脉尺寸的年增长率分别为0.25和0.16毫米/年。随着年龄的增长，主动脉应变和扩张性降低，而僵硬度指数增加。主动脉根部应变和扩张性与升主动脉的进行性扩张有关。基线主动脉根部直径是主动脉根部年增长率>1毫米/年的独立预测指标（调整后的比值比为1.34，95%可信区间为1.03-1.74，P = 0.028）。大多数患者（61%）合并主动脉缩窄。尽管主动脉缩窄患者中高血压的患病率较高，但高血压或主动脉缩窄对基线主动脉尺寸、僵硬度或主动脉进行性扩张没有影响。
一些CMR衍生的主动脉僵硬度参数与BAV患者的主动脉进行性扩张相关，应在更大规模和年龄更大的BAV队列中进一步研究。
