Association of Regional Wall Shear Stress and Progressive Ascending Aorta Dilation in Bicuspid Aortic Valve

JACC-CARDIOVASCULAR IMAGING

卷:15

Article

Soulat, Gilles¹  Scott, Michael B.^1,2  Allen, Bradley D.¹  Avery, Ryan¹  Bonow, Robert O.³  Malaisrie, S. Chris⁴  McCarthy, Patrick⁴  Fedak, Paul W. M.^4,5  Barker, Alex J.⁶  Markl, Michael^1,2 

[1] Northwestern Univ, Feinberg Sch Med, Dept Radiol, Chicago, IL 60611 USA

[2] Northwestern Univ, McCormick Sch Engn, Dept Biomed Engn, Evanston, IL 60208 USA

[3] Northwestern Univ, Bluhm Cardiovasc Inst, Dept Med, Div Cardiol, Chicago, IL 60611 USA

[4] Northwestern Univ, Bluhm Cardiovasc Inst, Dept Surg, Div Cardiac Surg, Chicago, IL 60611 USA

[5] Univ Calgary, Cumming Sch Med, Libin Cardiovasc Inst, Dept Cardiac Sci,Sect Cardiac Surg, Calgary, AB, Canada

[6] Univ Colorado, Dept Radiol & Bioengn, Anschutz Med Campus, Aurora, CO USA

关键词: 4-dimensional flow;    aortic;    dilation;    bicuspid aortic valve;    wall shear;    stress;   

DOI  :  10.1016/j.jcmg.2021.06.020

来源: Elsevier

【 摘 要 】

OBJECTIVES The aim of this study was to evaluate the role of wall shear stress (WSS) as a predictor of ascending aorta (AAo) growth at 5 years or greater follow-up. BACKGROUND Aortic 4-dimensional flow cardiac magnetic resonance (CMR) can quantify regions exposed to high WSS, a known stimulus for arterial wall dysfunction. However, its association with longitudinal changes in aortic dilation in patients with bicuspid aortic valve (BAV) is unknown. METHODS This retrospective study identified 72 patients with BAV (age 45 +/- 12 years) who underwent CMR for surveillance of aortic dilation at baseline and $5 years of follow-up. Four-dimensional flow CMR analysis included the calculation of WSS heat maps to compare regional WSS in individual patients with population averages of healthy age and sex-matched subjects (database of 136 controls). The relative areas of the AAo and aorta (in %) exposed to elevated WSS (outside the 95% CI of healthy population averages) were quantified. RESULTS At a median follow-up duration of 6.0 years, the mean AAo growth rate was 0.24 +/- 0.20 mm/y. The fraction of the AAo exposed to elevated WSS at baseline was increased for patients with higher growth rates ( 0.24 mm/y (19.9% [IQR: 10.2%-25.5%] vs 5.7% [IQR: 1.5%-21.3%]; P = 0.008). Larger areas of elevated WSS in the AAo and entire aorta were associated with higher rates of AAo dilation 0.24 mm/y (odds ratio: 1.51; 95% CI: 1.05-2.17; P = 0.026 and odds ratio: 1.70; 95% CI: 1.01-3.15; P = 0.046, respectively). CONCLUSIONS The area of elevated AAo WSS as assessed by 4-dimensional flow CMR identified BAV patients with higher rates of aortic dilation and thus might determine which patients require closer follow-up. (J Am Coll Cardiol Img 2022;15:33-42) (c) 2022 by the American College of Cardiology Foundation.

【 授权许可】

Free