Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve

Guala, Andrea; Dux-Santoy, Lydia; Teixidó-Turà, Gisela; Ruiz-Muñoz, Aroa; Galián-Gay, Laura; Servato, María Luz; Valente, Filipa; Gutiérrez, Laura; González‐Alujas, Teresa; Johnson, Kevin M.; Wieben, Oliver; Casas-Masnou, G; Avilés, Augusto Sao; Fernandez-Galera, R; Ferreira‐González, Ignacio; Evangelista, Arturo; Rodríguez-Palomares, José F.

doi:10.1016/j.jcmg.2021.09.023

Cited by 50 publications

(31 citation statements)

References 37 publications

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“…Although wall shear stress has been shown to affect aortic dilation in bicuspid aortic valve and Marfan syndrome patients [ 24 , 27 , 34 , 35 ], no previous study investigated its potential role in chronic descending AD. A pathological wall shear stress in the false lumen may play a similar role to that found in the other pathologies confined to the ascending aorta [ 35 , 36 ]. In this study a positive, nearly-statistical significant association was found between WSS and aortic growth rate (p = 0.060), but this relationship was not sustained in multivariate analysis.…”

Section: Discussionmentioning

confidence: 84%

False lumen rotational flow and aortic stiffness are associated with aortic growth rate in patients with chronic aortic dissection of the descending aorta: a 4D flow cardiovascular magnetic resonance study

Ruiz-Muñoz

Guala

Dux-Santoy

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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Background Patency of the false lumen in chronic aortic dissection (AD) is associated with aortic dilation and long-term aortic events. However, predictors of adverse outcomes in this population are limited. The aim of this study was to evaluate the relationship between aortic growth rate and false lumen flow dynamics and biomechanics in patients with chronic, patent AD. Methods Patients with a chronic AD with patent false lumen in the descending aorta and no genetic connective tissue disorder underwent an imaging follow-up including a contrast-enhanced 4D flow cardiovascular magnetic resonance (CMR) protocol and two consecutive computed tomography angiograms (CTA) acquired at least 1 year apart. A comprehensive analysis of anatomical features (including thrombus quantification), and false lumen flow dynamics and biomechanics (pulse wave velocity) was performed. Results Fifty-four consecutive patients with a chronic, patent false lumen in the descending aorta were included (35 surgically-treated type A AD with residual tear and 19 medically-treated type B AD). Median follow-up was 40 months. The in-plane rotational flow, pulse wave velocity and the percentage of thrombus in the false lumen were positively related to aortic growth rate (p = 0.006, 0.017, and 0.037, respectively), whereas wall shear stress showed a trend for a positive association (p = 0.060). These results were found irrespectively of the type of AD. Conclusions In patients with chronic AD and patent false lumen of the descending aorta, rotational flow, pulse wave velocity and wall shear stress are positively related to aortic growth rate, and should be implemented in the follow-up algorithm of these patients. Further prospective studies are needed to confirm if the assessment of these parameters helps to identify patients at higher risk of adverse clinical events.

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Section: Discussionmentioning

confidence: 84%

False lumen rotational flow and aortic stiffness are associated with aortic growth rate in patients with chronic aortic dissection of the descending aorta: a 4D flow cardiovascular magnetic resonance study

Ruiz-Muñoz

Guala

Dux-Santoy

et al. 2022

Journal of Cardiovascular Magnetic Resonance

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“…The correlations of velocity and wall shear stress (WSS) with vascular disease progression have been recognized since 1995 108 . Although WSS is not yet established in clinical practice as a marker of intervention success, several recent clinical studies raised attention to it specifically towards the correlation of WSS with ascending aorta dilation and rupture 109 – 114 . All these studies 109 – 114 addressed (in large population data) the importance of WSS assessment in order to predict disease progression, such as for the prediction of aortic dilation rate.…”

Section: Discussionmentioning

confidence: 99%

“…Although WSS is not yet established in clinical practice as a marker of intervention success, several recent clinical studies raised attention to it specifically towards the correlation of WSS with ascending aorta dilation and rupture 109 – 114 . All these studies 109 – 114 addressed (in large population data) the importance of WSS assessment in order to predict disease progression, such as for the prediction of aortic dilation rate. According to one recent clinical study 114 , WSS was assessed in for 47 patients in their follow ups.…”

Section: Discussionmentioning

confidence: 99%

Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling

Sadeghi

Tomka

Khodaei

et al. 2022

Sci Rep

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Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn’t change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.

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“…In a longitudinal study, our group proved that in patients with BAV without significant valvular dysfunction, circumferential wall shear stress component independently predicted progressive dilation of the ascending aorta. Notably, mapping of WSS further allowed for establishing ascending aorta regions with the fastest dilation rates [66].…”

Section: Aortic Flow Hemodynamic Parametersmentioning

confidence: 99%

Unraveling Bicuspid Aortic Valve Enigmas by Multimodality Imaging: Clinical Implications

Masip

Galián-Gay

Guala

et al. 2022

JCM

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Multimodality imaging is the basis of the diagnosis, follow-up, and surgical management of bicuspid aortic valve (BAV) patients. Transthoracic echocardiography (TTE) is used in our clinical routine practice as a first line imaging for BAV diagnosis, valvular phenotyping and function, measurement of thoracic aorta, exclusion of other aortic malformations, and for the assessment of complications such are infective endocarditis and aortic. Nevertheless, TTE is less useful if we want to assess accurately other aortic segments such as mid-distal ascending aorta, where computed tomography (CT) and magnetic resonance (CMR) could improve the precision of aorta size measurement by multiplanar reconstructions. A major advantage of CT is its superior spatial resolution, which affords a better definition of valve morphology and calcification, accuracy, and reproducibility of ascending aorta size, and allows for coronary artery assessment. Moreover, CMR offers the opportunity of being able to evaluate aortic functional properties and blood flow patterns. In this setting, new developed sequences such as 4D-flow may provide new parameters to predict events during follow up. The integration of all multimodality information facilitates a comprehensive evaluation of morphologic and dynamic features, stratification of the risk, and therapy guidance of this cohort of patients.

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Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve

Cited by 50 publications

References 37 publications

False lumen rotational flow and aortic stiffness are associated with aortic growth rate in patients with chronic aortic dissection of the descending aorta: a 4D flow cardiovascular magnetic resonance study

False lumen rotational flow and aortic stiffness are associated with aortic growth rate in patients with chronic aortic dissection of the descending aorta: a 4D flow cardiovascular magnetic resonance study

Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling

Unraveling Bicuspid Aortic Valve Enigmas by Multimodality Imaging: Clinical Implications

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