Krasic Stasa, Zec Boris, Topic Vesna, Popovic Sasa, Nesic Dejan, Zdravkovic Marija, Vukomanovic Vladislav
Cardiology Department, Mother and Child Health Institute of Serbia, Belgrade, Serbia.
School of Medicine, University of Belgrade, Belgrade, Serbia.
Front Cardiovasc Med. 2024 Nov 26;11:1384707. doi: 10.3389/fcvm.2024.1384707. eCollection 2024.
The bicuspid aortic valve (BAV) is the most common congenital heart defect. Patients with BAV frequently develop aortopathy, which depends on the dysfunction and morphotype of the BAV.
The aim of our study was to compare the echocardiography and cardiac magnetic resonance (CMR) findings in BAV patients, and to define the risks of BAV dysfunction and aortopathy.
The retrospective study included 50 patients (68% male) with BAV, with an average age of 13.6 ± 3.9 years, who underwent a transthoracic echocardiographic examination and CMR at our institute from 2012 to 2020.
The BAV types were evaluated significantly differently by echocardiography and CMR ( = 0.013). 54% of patients had BAV insufficiency on echo and 70% on echo CMR. It was more prevalent in males, older patients, and patients with a higher body surface area. By comparing the degree of insufficiency measured by echo (1+, IQR 0-1), and CMR (0, IQR 0-1), a significant difference was observed ( = 0.04), while a moderate positive correlation was proved ( = 0.4; = 0.004). Stenosis was registered in 44% of patients by echo, while 58% had stenosis on CMR. The peak pressure gradient measured by echo was significantly higher than the velocity on CMR (41, IQR 22.7-52.5 mmHg vs. 23, IQR 15.5-35.0 mmHg; = 0.002). Aortopathy was registered in 76% of patients on echo and 78% on CMR; 38% of patients had severe aortic dilatation on echo and 54% on CMR ( = 0.003). Patients with BAV stenosis on echo had more frequent dilatation of the tubular ascending aorta (15/24 pts; = 0.02). All patients with BAV insufficiency on CMR had aortopathy ( = 0.04) and had enlargement of the sinus of Valsalva and sinotubular junction. In patients with associated coarctation, the development of aortopathy occurred less frequently than those without coarctation (7/39 vs. 32/39; = 0.003). The Bland-Altman method, a specific type of scatterplot that is used to visualize the results of comparing two measures, demonstrated the existence of agreement between the two methods, and a level of agreement between the methods of 95% was demonstrated.
Our study indicated significant differences in the measured BAV morphotype and dysfunction when comparing the two diagnostic methods. On the other hand, moderate to strong correlations were found in the evaluated parameters, which indicates the importance of performing noninvasive diagnostic procedures in the follow-up of these patients.
二叶式主动脉瓣（BAV）是最常见的先天性心脏缺陷。BAV患者常发生主动脉病变，这取决于BAV的功能障碍和形态类型。
本研究的目的是比较BAV患者的超声心动图和心脏磁共振（CMR）检查结果，并确定BAV功能障碍和主动脉病变的风险。
这项回顾性研究纳入了50例BAV患者（68%为男性），平均年龄13.6±3.9岁，于2012年至2020年在我院接受了经胸超声心动图检查和CMR检查。
超声心动图和CMR对BAV类型的评估存在显著差异（P=0.013）。54%的患者超声心动图显示BAV关闭不全，CMR显示为70%。在男性、年龄较大的患者和体表面积较高的患者中更为常见。通过比较超声心动图（1+，四分位间距0-1）和CMR（0，四分位间距0-1）测量的关闭不全程度，观察到显著差异（P=0.04），同时证明存在中度正相关（r=0.4；P=0.004）。超声心动图显示44%的患者有狭窄，而CMR显示58%的患者有狭窄。超声心动图测量的峰值压力梯度显著高于CMR测量的速度（41，四分位间距22.7-52.5 mmHg对23，四分位间距15.5-35.0 mmHg；P=0.002）。超声心动图显示76%的患者有主动脉病变，CMR显示为78%；38%的患者超声心动图显示严重主动脉扩张，CMR显示为54%（P=0.003）。超声心动图显示BAV狭窄的患者管状升主动脉扩张更常见（15/24例患者；P=0.02）。CMR显示BAV关闭不全的所有患者均有主动脉病变（P=0.04），且主动脉瓣窦和窦管交界处扩大。在合并主动脉缩窄的患者中，主动脉病变的发生率低于无主动脉缩窄的患者（7/39对32/39；P=0.003）。Bland-Altman方法是一种特殊类型的散点图，用于直观显示两种测量方法比较的结果，证明了两种方法之间存在一致性，并显示两种方法之间的一致性水平为95%。
我们的研究表明，比较两种诊断方法时，所测量的BAV形态类型和功能障碍存在显著差异。另一方面，在评估参数中发现了中度至强的相关性，这表明在这些患者的随访中进行无创诊断程序的重要性。
