Ahmad Hamza M, Iskandar Zaid, Lang Chim C, Huang Jeffrey T J, Choy Anna-Maria
Department of Molecular & Clinical Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK.
Cardiology Department, Raigmore Hospital, Inverness IV2 3UJ, UK.
Int J Cardiol Heart Vasc. 2025 Mar 6;58:101640. doi: 10.1016/j.ijcha.2025.101640. eCollection 2025 Jun.
Bicuspid Aortic Valve (BAV) is the most prevalent congenital heart defect with an autosomal dominant inheritance. With up to 2% of the general population affected by the condition, mortality remains high likely due to the development of aortopathy which pre-disposes to the development of aortic dissection. Current guidelines focus on surgical management, once a threshold of aorta diameter is surpassed, via routine image surveillance. However, it is recognised that some will develop aortic dissection without meeting these requirements for surgical intervention. Recent literature has begun to address the need for potential biomarkers specific to aortopathy in the BAV population to aid in risk stratification. Four-dimensional cardiovascular magnetic resonance flow imaging has paved the way to the development of imaging measurements such as wall shear stress and reverse flow which aid in the assessment of aberrant blood flow contributing to aortopathy in the BAV group. Differing levels of plasma biomarkers such as matrix metalloproteinases and microRNA have also been associated with aortopathy development furthering insight into the cellular mechanisms involved in aortic vascular matrix remodelling. This article will provide an overview of the recent research into prospective 4-D imaging and circulating biomarkers that have been studied and potential areas of future work.
二叶式主动脉瓣（BAV）是最常见的常染色体显性遗传先天性心脏缺陷。该疾病在普通人群中的发病率高达2%，死亡率仍然很高，这可能是由于主动脉病变的发展，而主动脉病变易引发主动脉夹层。目前的指南侧重于一旦主动脉直径超过阈值，通过常规影像监测进行手术管理。然而，人们认识到，有些人在未达到手术干预的这些要求时就会发生主动脉夹层。最近的文献已开始探讨BAV人群中针对主动脉病变的潜在生物标志物的需求，以帮助进行风险分层。四维心血管磁共振血流成像为诸如壁面剪应力和反流等成像测量的发展铺平了道路，这些测量有助于评估导致BAV组主动脉病变的异常血流。血浆生物标志物如基质金属蛋白酶和微小RNA的不同水平也与主动脉病变的发展相关，这进一步加深了对主动脉血管基质重塑所涉及的细胞机制的了解。本文将概述对前瞻性四维成像和循环生物标志物最近的研究情况，这些研究已经开展，以及未来可能的工作领域。
