Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study

Meierhofer, Christian; Schneider, Eike Philipp; Lyko, Christine; Hutter, Andrea; Martinoff, Stefan; Markl, Michael; Hager, Alfred; Hess, John; Stern, Heiko; Fratz, Sohrab

doi:10.1093/ehjci/jes273

Cited by 150 publications

(151 citation statements)

References 37 publications

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“…Increased and asymmetric aortic wall shear stress is the most prevalent flow anomaly in BAV patients with dilated ascending aorta [7,8]. The abnormal force parallel to the aortic wall exerted by shear stress acts upon endothelial surface in terms of friction, which may activate cellular signaling cascades and result in over-expression of extracellular matrix degenerating substances including matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) [9,10].…”

Section: Introductionmentioning

confidence: 99%

Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis

Wang

Dong

et al. 2014

Heart Vessels

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Bicuspid aortic valve (BAV) exhibits a clinical incline toward aortopathy, in which aberrant tensile and shear stress generated by BAV can induce differential expression of matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs). Whether stenotic BAV, which exhibits additional eccentric high-velocity flow jet upon ascending aorta and further worsens circumferential systolic wall shear stress than BAV with echocardiographically normal aortic valve, can lead to unique plasma MMP/TIMP patterns is still unknown. According to their valvulopathy and aortic dilatation status, 93 BAV patients were included in the present study. Group A (n = 37) and B (n = 28) comprised severely stenotic patients with or without ascending aorta dilatation; Group C (n = 12) and D (n = 16) comprised echocardiographically normal BAV patients with or without ascending aorta dilatation. Plasma MMP/TIMP levels (MMP-1, -2, -3, -8, -9, -10, -13 and TIMP-1, -2, -4) were determined via a multiplex ELISA detection system in a single procedure. Among patients with isolated severe aortic stenosis, plasma levels of MMP-2 and -9 were significantly elevated when ascending aortic dilatation was present (p = 0.001 and p = 0.002, respectively). MMP-2, however, remained as the single elevated plasma component among echocardiographically normal BAV patients with dilated ascending aorta (p = 0.027). Multivariate analysis revealed that MMP-2 and MMP-9 could both serve as independent risk factor for aortic dilatation in the case of isolated severe stenosis (p = 0.003 and p = 0.001, respectively), and MMP-2 in echocardiographically normal patients (p = 0.002). In conclusion, BAV patients with isolated severe aortic stenosis demonstrated a distinct plasma MMP/TIMP pattern, which might be utilized as circulating biomarkers for early detection of aortic dilatation.

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Section: Introductionmentioning

confidence: 99%

Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis

Wang

Dong

et al. 2014

Heart Vessels

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“…Previous studies have investigated the relationship between BAV, aortic dilatation 15 , helical and eccentric flow in the ascending aorta 4,16 , flow jet angle at the valve plane 11 , wall shear stress 2-4,17,19,24,26 , and aortic aneurysms 23 . Large cohort studies have also been carried out to identify standard and advanced predictors of aortic dilatation and growth 9,10,25 .…”

Section: Introductionmentioning

confidence: 99%

MRI-based Protocol to Characterize the Relationship Between Bicuspid Aortic Valve Morphology and Hemodynamics

et al. 2014

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Bicuspid aortic valve (BAV) is the most common congenital heart defect and can lead to severe complications. Many studies have been conducted to evaluate the potential of geometric and hemodynamic biomarkers to predict BAV-related aortopathy. This work proposes a novel semi-automatic protocol to characterize geometry and hemodynamics of aorta and aortic valve based on 2D cine and 4D Flow MRI data. The protocol was applied to 12 BAV and 12 control subjects. Statistical differences between the groups were identified and linear regression models were investigated to elucidate the potential of this protocol to investigate the risk of disease progression. Statistical differences between the groups were found for orifice eccentricity, aorta diameter, velocity, jet angle and flow displacement. Key findings of the regression analysis include the association in the proximal ascending aorta between aorta diameter and mean velocity (negative), jet angle (positive) and flow displacement (positive), in the combined cohort. Positive association between flow displacement in the proximal aorta and orifice jet angle in TAV subjects was found. This study represents a pilot application of a protocol for standardized assessment of aortic geometry and hemodynamics associated with BAV disease. Its limited need for user input is advantageous for large cohort studies.

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“…Moreover, although the exact mechanism of proximal aortic dilatation has not been clarified, the significantly higher shear forces might have an impact on the development of aortic dilation in patients with BAV. 26 Our original aortic valve reconstruction using glutaraldehydetreated autologous pericardium is pure tricuspidization, which is basically a tricuspid replacement using autologous pericardium. We believe that tricuspidization is the ideal reconstructive technique rather than bicuspidization.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Bicuspid Aortic Valve With Autologous Pericardium

Ozaki

Kawase

Yamashita

et al. 2014

Circ J

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Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study

Abstract: WSS and flow patterns in the ascending aorta in patients with BAVs without concomitant valve or vessel disease are significantly different compared with TAV. The significantly higher shear forces may have an impact on the development of aortic dilation in patients with BAVs.

Cited by 150 publications

References 37 publications

Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis

Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis

MRI-based Protocol to Characterize the Relationship Between Bicuspid Aortic Valve Morphology and Hemodynamics

Reconstruction of Bicuspid Aortic Valve With Autologous Pericardium

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