在二叶式主动脉瓣患者中，局部主动脉壁剪切应力随时间增加。
Regional aortic wall shear stress increases over time in patients with a bicuspid aortic valve.
作者信息
Minderhoud Savine C S, Arrouby Aïmane, van den Hoven Allard T, Bons Lidia R, Chelu Raluca G, Kardys Isabella, Rizopoulos Dimitris, Korteland Suze-Anne, van den Bosch Annemien E, Budde Ricardo P J, Roos-Hesselink Jolien W, Wentzel Jolanda J, Hirsch Alexander
机构信息
Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
出版信息
J Cardiovasc Magn Reson. 2024;26(2):101070. doi: 10.1016/j.jocmr.2024.101070. Epub 2024 Aug 2.
BACKGROUND
Aortic wall shear stress (WSS) is a known predictor of ascending aortic growth in patients with a bicuspid aortic valve (BAV). The aim of this study was to study regional WSS and changes over time in BAV patients.
METHODS
BAV patients and age-matched healthy controls underwent four-dimensional (4D) flow cardiovascular magnetic resonance (CMR). Regional, peak systolic ascending aortic WSS, aortic valve function, aortic stiffness measures, and aortic dimensions were assessed. In BAV patients, 4D flow CMR was repeated after 3 years of follow-up and both at baseline and follow-up computed tomography angiography (CTA) were acquired. Aortic growth (volume increase of ≥5%) was measured on CTA. Regional WSS differences within patients' aorta and WSS changes over time were analyzed using linear mixed-effect models and were associated with clinical parameters.
RESULTS
Thirty BAV patients (aged 34 years [interquartile range (IQR) 25-41]) were included in the follow-up analysis. Additionally, another 16 BAV patients and 32 healthy controls (aged 33 years [IQR 28-48]) were included for other regional analyses. Magnitude, axial, and circumferential WSS increased over time (all p < 0.001) irrespective of aortic growth. The percentage of regions exposed to a magnitude WSS >95th percentile of healthy controls increased from 21% (baseline 506/2400 regions) to 31% (follow-up 734/2400 regions) (p < 0.001). WSS angle, a measure of helicity near the aortic wall, decreased during follow-up. Magnitude WSS changes over time were associated with systolic blood pressure, peak aortic valve velocity, aortic valve regurgitation fraction, aortic stiffness indexes, and normalized flow displacement (all p < 0.05).
CONCLUSION
An increase in regional WSS over time was observed in BAV patients, irrespective of aortic growth. The increasing WSSs, comprising a larger area of the aorta, warrant further research to investigate the possible predictive value for aortic dissection.
背景
主动脉壁剪切应力（WSS）是二叶式主动脉瓣（BAV）患者升主动脉生长的已知预测指标。本研究的目的是研究BAV患者的局部WSS及其随时间的变化。
方法
BAV患者和年龄匹配的健康对照者接受了四维（4D）血流心血管磁共振成像（CMR）检查。评估了局部、收缩期峰值升主动脉WSS、主动脉瓣功能、主动脉僵硬度指标和主动脉尺寸。在BAV患者中，随访3年后重复进行4D血流CMR检查，并在基线和随访时均进行计算机断层扫描血管造影（CTA）检查。在CTA上测量主动脉生长（体积增加≥5%）。使用线性混合效应模型分析患者主动脉内的局部WSS差异以及WSS随时间的变化，并将其与临床参数相关联。
结果
30例BAV患者（年龄34岁[四分位间距（IQR）25 - 41]）纳入随访分析。另外，又纳入了16例BAV患者和32例健康对照者（年龄33岁[IQR 28 - 48]）进行其他局部分析。无论主动脉生长情况如何，WSS的大小、轴向和周向值均随时间增加（所有p < 0.001）。暴露于大于健康对照者第95百分位数大小的WSS区域的百分比从21%（基线时2400个区域中的506个）增加到31%（随访时2400个区域中的734个）（p < 0.001）。WSS角度是主动脉壁附近螺旋度的一种测量指标，在随访期间下降。WSS大小随时间的变化与收缩压、主动脉瓣峰值速度、主动脉瓣反流分数、主动脉僵硬度指数和归一化血流位移均相关（所有p < 0.05）。
结论
在BAV患者中观察到局部WSS随时间增加，与主动脉生长无关。不断增加的WSS覆盖了主动脉的更大区域，有必要进一步研究以探讨其对主动脉夹层的可能预测价值。
Zotero 插件