Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

Singh, A. et al. (2019) Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves. European Radiology, 29, pp. 2340-2349. (doi: 10.1007/s00330-018-5775-6) (PMID:30488106) (PMCID:PMC6443917)

Abstract

Objectives: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS). Methods: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated. Results: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area. Conclusions: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.

• Item Type: Articles
• Additional Information: The study was funded by a Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011-04-51 Gerald P McCann). Support was also received from NIHR Leicester Cardiovascular Biomedical Research Unit, the NIHR Comprehensive Local Research Networks, and the Leeds and Leicester NIHR Clinical Research Facilities.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Berry, Professor Colin
• Authors: Singh, A., Horsfield, M. A., Bekele, S., Greenwood, J. P., Dawson, D. K., Berry, C., Hogrefe, K., Kelly, D. J., Houston, J. G., Guntur Ramkumar, P., Uddin, A., Suzuki, T., and McCann, G. P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Radiology
• Publisher: Springer
• ISSN: 0938-7994
• ISSN (Online): 1432-1084
• Published Online: 28 November 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in European Radiology 29:2340-2349
• Publisher Policy: Reproduced under a Creative Commons License