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Brückner A, Brandtner A, Rieck S, Matthey M, Geisen C, Fels B, Stei M, Kusche-Vihrog K, Fleischmann BK, Wenzel D. Site-specific genetic and functional signatures of aortic endothelial cells at aneurysm predilection sites in healthy and AngII ApoE -/- mice. Angiogenesis 2024:10.1007/s10456-024-09933-9. [PMID: 38965173 DOI: 10.1007/s10456-024-09933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
Aortic aneurysm is characterized by a pathological dilation at specific predilection sites of the vessel and potentially results in life-threatening vascular rupture. Herein, we established a modified "Häutchen method" for the local isolation of endothelial cells (ECs) from mouse aorta to analyze their spatial heterogeneity and potential role in site-specific disease development. When we compared ECs from aneurysm predilection sites of healthy mice with adjacent control segments we found regulation of genes related to extracellular matrix remodeling, angiogenesis and inflammation, all pathways playing a critical role in aneurysm development. We also detected enhanced cortical stiffness of the endothelium at these sites. Gene expression of ECs from aneurysms of the AngII ApoE-/- model when compared to sham animals mimicked expression patterns from predilection sites of healthy animals. Thus, this work highlights a striking genetic and functional regional heterogeneity in aortic ECs of healthy mice, which defines the location of aortic aneurysm formation in disease.
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Affiliation(s)
- Alexander Brückner
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Adrian Brandtner
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Sarah Rieck
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Michaela Matthey
- Department of Systems Physiology, Medical Faculty, Institute of Physiology, Ruhr University of Bochum, Universitätsstr. 150, 44801, Bochum, Germany
| | - Caroline Geisen
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Benedikt Fels
- Institute of Physiology, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner SiteHamburg/Luebeck/Kiel, Luebeck, Germany
| | - Marta Stei
- Heart Center Bonn, Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Kristina Kusche-Vihrog
- Institute of Physiology, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner SiteHamburg/Luebeck/Kiel, Luebeck, Germany
| | - Bernd K Fleischmann
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany
| | - Daniela Wenzel
- Life&Brain Center, Medical Faculty, Institute of Physiology I, University of Bonn, Bonn, Germany.
- Department of Systems Physiology, Medical Faculty, Institute of Physiology, Ruhr University of Bochum, Universitätsstr. 150, 44801, Bochum, Germany.
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2
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Terriaca S, Ferlosio A, Scioli MG, Coppa F, Bertoldo F, Pisano C, Belmonte B, Balistreri CR, Orlandi A. miRNA Regulation of Cell Phenotype and Parietal Remodeling in Atherosclerotic and Non-Atherosclerotic Aortic Aneurysms: Differences and Similarities. Int J Mol Sci 2024; 25:2641. [PMID: 38473887 DOI: 10.3390/ijms25052641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Aortic aneurysms are a serious health concern as their rupture leads to high morbidity and mortality. Abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) exhibit differences and similarities in their pathophysiological and pathogenetic features. AAA is a multifactorial disease, mainly associated with atherosclerosis, characterized by a relevant inflammatory response and calcification. TAA is rarely associated with atherosclerosis and in some cases is associated with genetic mutations such as Marfan syndrome (MFS) and bicuspid aortic valve (BAV). MFS-related and non-genetic or sporadic TAA share aortic degeneration with endothelial-to-mesenchymal transition (End-Mt) and fibrosis, whereas in BAV TAA, aortic degeneration with calcification prevails. microRNA (miRNAs) contribute to the regulation of aneurysmatic aortic remodeling. miRNAs are a class of non-coding RNAs, which post-transcriptionally regulate gene expression. In this review, we report the involvement of deregulated miRNAs in the different aortic remodeling characterizing AAAs and TAAs. In AAA, miRNA deregulation appears to be involved in parietal inflammatory response, smooth muscle cell (SMC) apoptosis and aortic wall calcification. In sporadic and MFS-related TAA, miRNA deregulation promotes End-Mt, SMC myofibroblastic phenotypic switching and fibrosis with glycosaminoglycan accumulation. In BAV TAA, miRNA deregulation sustains aortic calcification. Those differences may support the development of more personalized therapeutic approaches.
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Affiliation(s)
- Sonia Terriaca
- Anatomic Pathology, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Maria Giovanna Scioli
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Francesca Coppa
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
| | - Fabio Bertoldo
- Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy
| | - Calogera Pisano
- Cardiac Surgery Unit, Department of Surgery, Tor Vergata University, 00133 Rome, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, 90134 Palermo, Italy
- Azienda sanitaria Provinciale di Catania (ASP), 95124 Catania, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, Tor Vergata University, 00133 Rome, Italy
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3
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Ajmone Marsan N, Graziani F, Meucci MC, Wu HW, Lillo R, Bax JJ, Burzotta F, Massetti M, Jukema JW, Crea F. Valvular heart disease and cardiomyopathy: reappraisal of their interplay. Nat Rev Cardiol 2024; 21:37-50. [PMID: 37563454 DOI: 10.1038/s41569-023-00911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
Cardiomyopathies and valvular heart diseases are typically considered distinct diagnostic categories with dedicated guidelines for their management. However, the interplay between these conditions is increasingly being recognized and they frequently coexist, as in the paradigmatic examples of dilated cardiomyopathy and hypertrophic cardiomyopathy, which are often complicated by the occurrence of mitral regurgitation. Moreover, cardiomyopathies and valvular heart diseases can have a shared aetiology because several genetic or acquired diseases can affect both the cardiac valves and the myocardium. In addition, the association between cardiomyopathies and valvular heart diseases has important prognostic and therapeutic implications. Therefore, a better understanding of their shared pathophysiological mechanisms, as well as of the prevalence and predisposing factors to their association, might lead to a different approach in the risk stratification and management of these diseases. In this Review, we discuss the different scenarios in which valvular heart diseases and cardiomyopathies coexist, highlighting the need for an improved classification and clustering of these diseases with potential repercussions in the clinical management and, particularly, personalized therapeutic approaches.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Francesca Graziani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Lillo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Francesco Burzotta
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Filippo Crea
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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4
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Kanagala SG, Sawhney A, Parikh K, Gupta V, Mahmood T, Anamika FNU, Jain R, Garg N. Navigating the challenges of bicuspid aortic valve-aortopathy. Glob Cardiol Sci Pract 2023; 2023:e202327. [PMID: 38404628 PMCID: PMC10886853 DOI: 10.21542/gcsp.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/12/2023] [Indexed: 02/27/2024] Open
Abstract
Bicuspid aortic valve (BAV) is a congenital heart defect that affects 0.5-2% of the general population with familial predominance. The modifications in hemodynamics and structure change at cellular level contribute to the dilation of aorta, resulting in bicuspid aortopathy, which can result in catastrophic aortic events. The American Heart Association recommends screening first-degree relatives of patients with bicuspid aortic valve and aortic root disease. BAV may or may not be associated with a syndrome, with the non-syndromic variety having a higher chance of predisposition to congenital and vascular abnormalities. Many genes have been implicated in the etiology of non-syndromic aortic aneurysm such as ACTA2, MYH11, FLNA, and SMAD3. Common diagnostic modalities include transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), multi system computer tomography (MSCT), and cardiac MRI. Medical management reduces the rate of disease progression and surgical management is indicated based on the diameter of the ascending aorta, which differs in American and European guidelines. Our article aims to explore the current understanding of the pathophysiology, clinical aspects, and surgical management of bicuspid aortic valve disease. Additionally, we have included a discussion on the management of this condition in special populations, such as athletes and pregnant women, who require distinct treatment recommendations.
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Affiliation(s)
| | - Aanchal Sawhney
- Department of Internal Medicine, Crozer Chester Medical Center, Pennsylvania, USA
| | | | - Vasu Gupta
- Dayanand Medical College and Hospital, Ludhiana, India
| | | | - FNU Anamika
- University College of Medical Sciences, New Delhi, India
| | - Rohit Jain
- Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nikita Garg
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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5
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Bulut HI, Arjomandi Rad A, Syrengela AA, Ttofi I, Djordjevic J, Kaur R, Keiralla A, Krasopoulos G. A Comprehensive Review of Management Strategies for Bicuspid Aortic Valve (BAV): Exploring Epidemiology, Aetiology, Aortopathy, and Interventions in Light of Recent Guidelines. J Cardiovasc Dev Dis 2023; 10:398. [PMID: 37754827 PMCID: PMC10531880 DOI: 10.3390/jcdd10090398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE bicuspid aortic valve (BAV) stands as the most prevalent congenital heart condition intricately linked to aortic pathologies encompassing aortic regurgitation (AR), aortic stenosis, aortic root dilation, and aortic dissection. The aetiology of BAV is notably intricate, involving a spectrum of genes and polymorphisms. Moreover, BAV lays the groundwork for an array of structural heart and aortic disorders, presenting varying degrees of severity. Establishing a tailored clinical approach amid this diverse range of BAV-related conditions is of utmost significance. In this comprehensive review, we delve into the epidemiology, aetiology, associated ailments, and clinical management of BAV, encompassing imaging to aortic surgery. Our exploration is guided by the perspectives of the aortic team, spanning six distinct guidelines. METHODS We conducted an exhaustive search across databases like PubMed, Ovid, Scopus, and Embase to extract relevant studies. Our review incorporates 84 references and integrates insights from six different guidelines to create a comprehensive clinical management section. RESULTS BAV presents complexities in its aetiology, with specific polymorphisms and gene disorders observed in groups with elevated BAV prevalence, contributing to increased susceptibility to other cardiovascular conditions. The altered hemodynamics inherent to BAV instigate adverse remodelling of the aorta and heart, thus fostering the development of epigenetically linked aortic and heart diseases. Employing TTE screening for first-degree relatives of BAV patients might be beneficial for disease tracking and enhancing clinical outcomes. While SAVR is the primary recommendation for indicated AVR in BAV, TAVR might be an option for certain patients endorsed by adept aortic teams. In addition, proficient teams can perform aortic valve repair for AR cases. Aortic surgery necessitates personalized evaluation, accounting for genetic makeup and risk factors. While the standard aortic replacement threshold stands at 55 mm, it may be tailored to 50 mm or even 45 mm based on patient-specific considerations. CONCLUSION This review reiterates the significance of considering the multifactorial nature of BAV as well as the need for further research to be carried out in the field.
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Affiliation(s)
- Halil Ibrahim Bulut
- Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | | | | | - Iakovos Ttofi
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Jasmina Djordjevic
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Ramanjit Kaur
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - Amar Keiralla
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford OX3 9DU, UK; (I.T.); (J.D.); (R.K.); (A.K.)
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6
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Tarraf SA, Kramer B, Vianna E, Gillespie C, Germano E, Emerton KB, Amini R, Colbrunn R, Hargrave J, Roselli EE, Bellini C. Lengthwise regional mechanics of the human aneurysmal ascending thoracic aorta. Acta Biomater 2023; 162:266-277. [PMID: 36944405 PMCID: PMC10148908 DOI: 10.1016/j.actbio.2023.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
The prognosis of patients undergoing emergency endovascular repair of ascending thoracic aortic aneurysm (ATAA) depends on defect location, with root disease bearing worse outcomes than proximal or distal aortopathy. We speculate that a spatial gradient in aneurysmal tissue mechanics through the length of the ascending thoracic aorta may fuel noted survival discrepancies. To this end, we performed planar biaxial testing on 153 root, proximal, and distal segments of ATAA samples collected from 80 patients receiving elective open surgical repair. Following data averaging via surface fitting-based interpolation of strain-controlled protocols, we combined in-vitro and in-vivo measurements of loads and geometry to resolve inflation-extension kinematics and evaluate mechanical metrics of stress, stiffness, and energy at consistent deformation levels. Representative (averaged) experimental data and simulated in-vivo conditions revealed significantly larger biaxial stiffness at the root compared to either proximal or distal tissues, which persisted as the entire aorta stiffened during aging. Advancing age further reduced biaxial stretch and energy storage, a measure of aortic function, across all ATAA segments. Importantly, age emerged as a stronger predictor of tissue mechanics in ATAA disease than either bicuspid aortic valve or connective tissue disorders. Besides strengthening the general understanding of aneurysmal disease, our findings provide specifications to customize the design of stent-grafts for the treatment of ATAA disease. Optimization of deployment and interaction of novel endovascular devices with the local native environment is expected to carry significant potential for improving clinical outcomes. STATEMENT OF SIGNIFICANCE: Elucidating the lengthwise regional mechanics of ascending thoracic aortic aneurysms (ATAAs) is critical for the design of endovascular devices tailored to the ascending aorta. Stent-grafts provide a less invasive alternative to support the long-term survival of ATAA patients ineligible for open surgical repair. In this study, we developed a numerical framework that combines semi-inverse constitutive and forward modeling with in-vitro and in-vivo data to extract mechanical descriptors of ATAA tissue behavior at physiologically meaningful deformation. Moving distally from the aortic root to the first ascending aortic branch, we observed a progressive decline in biaxial stiffness. Furthermore, we showed that aging leads to reduced aortic function and is a stronger predictor of mechanics than either valve morphology or underlying syndromic disorder.
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Affiliation(s)
- Samar A Tarraf
- Department of Bioengineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02125 USA
| | - Benjamin Kramer
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Emily Vianna
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Callan Gillespie
- Department of Biomedical Engineering, BioRobotics and Mechanical Testing Core, Cleveland Clinic, Cleveland, OH, USA
| | - Emídio Germano
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Kelly B Emerton
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rouzbeh Amini
- Department of Bioengineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02125 USA; Department of Mechanical and Industrial Engineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02125 USA
| | - Robb Colbrunn
- Department of Biomedical Engineering, BioRobotics and Mechanical Testing Core, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Eric E Roselli
- Aortic Center, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, BioRobotics and Mechanical Testing Core, Cleveland Clinic, Cleveland, OH, USA
| | - Chiara Bellini
- Department of Bioengineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02125 USA.
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7
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Staal AHJ, Cortenbach KRG, Gorris MAJ, van der Woude LL, Srinivas M, Heijmen RH, Geuzebroek GSC, Grewal N, Hebeda KM, de Vries IJM, DeRuiter MC, van Kimmenade RRJ. Adventitial adaptive immune cells are associated with ascending aortic dilatation in patients with a bicuspid aortic valve. Front Cardiovasc Med 2023; 10:1127685. [PMID: 37057097 PMCID: PMC10086356 DOI: 10.3389/fcvm.2023.1127685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundBicuspid aortic valve (BAV) is associated with ascending aorta aneurysms and dissections. Presently, genetic factors and pathological flow patterns are considered responsible for aneurysm formation in BAV while the exact role of inflammatory processes remains unknown.MethodsIn order to objectify inflammation, we employ a highly sensitive, quantitative immunohistochemistry approach. Whole slides of dissected, dilated and non-dilated ascending aortas from BAV patients were quantitatively analyzed.ResultsDilated aortas show a 4-fold increase of lymphocytes and a 25-fold increase in B lymphocytes in the adventitia compared to non-dilated aortas. Tertiary lymphoid structures with B cell follicles and helper T cell expansion were identified in dilated and dissected aortas. Dilated aortas were associated with an increase in M1-like macrophages in the aorta media, in contrast the number of M2-like macrophages did not change significantly.ConclusionThis study finds unexpected large numbers of immune cells in dilating aortas of BAV patients. These findings raise the question whether immune cells in BAV aortopathy are innocent bystanders or contribute to the deterioration of the aortic wall.
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Affiliation(s)
- Alexander H. J. Staal
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kimberley R. G. Cortenbach
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mark A. J. Gorris
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lieke L. van der Woude
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Division of Immunotherapy, Oncode Institute, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mangala Srinivas
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Cell Biology and Immunology, Wageningen University and Research, Wageningen, Netherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - I. Jolanda M. de Vries
- Department of Tumor Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marco C. DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Roland R. J. van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Roland R. J. van Kimmenade,
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Gravholt CH, Viuff M, Just J, Sandahl K, Brun S, van der Velden J, Andersen NH, Skakkebaek A. The Changing Face of Turner Syndrome. Endocr Rev 2023; 44:33-69. [PMID: 35695701 DOI: 10.1210/endrev/bnac016] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 01/20/2023]
Abstract
Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is considered a rare genetic condition and is associated with a wide range of clinical stigmata, such as short stature, ovarian dysgenesis, delayed puberty and infertility, congenital malformations, endocrine disorders, including a range of autoimmune conditions and type 2 diabetes, and neurocognitive deficits. Morbidity and mortality are clearly increased compared with the general population and the average age at diagnosis is quite delayed. During recent years it has become clear that a multidisciplinary approach is necessary toward the patient with TS. A number of clinical advances has been implemented, and these are reviewed. Our understanding of the genomic architecture of TS is advancing rapidly, and these latest developments are reviewed and discussed. Several candidate genes, genomic pathways and mechanisms, including an altered transcriptome and epigenome, are also presented.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Mette Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Kristian Sandahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Medical Centre, Amalia Children's Hospital, 6525 Nijmegen, the Netherlands
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Anne Skakkebaek
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus 8200 N, Denmark
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9
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Pan Y, Wang Y, Li J, Xu P, Zeng M, Shan Y, Lin J. Prognostic role of aortic distensibility in patients with bicuspid aortic valve: a CMR study. Int J Cardiovasc Imaging 2023; 39:161-168. [PMID: 36598697 DOI: 10.1007/s10554-022-02710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
To evaluate the prognostic value of aortic distensibility measured by cardiovascular magnetic resonance (CMR) as predictors of prophylactic aortic valve or aortic surgery in patients with bicuspid aortic valve (BAV). 110 patients with BAV were included. Distensibility of middle ascending aorta (AscAo) and proximal descending aorta (DescAo) at baseline was determined using CMR. The association between aortic distensibility and primary endpoint of aortic valve and/or aortic surgery was investigated with Cox proportional hazard regression analyses. The receiver operating characteristics curves (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of different models. During a median follow-up of 66.5 months [IQR 13-75 months], 42 patients experienced surgical treatments. After adjusting for traditional risk factors, aortic distensibility (P = 0.003) and severe valve dysfunction (P < 0.001) were found significantly associated with aortic valve and/or aortic surgery. The model 2 (aortic distensibility and severe valve dysfunction) is slightly better in predicting primary endpoint than the model 1 (aortic diameter and severe valve dysfunction) (AUC: 0.893 vs. 0.842, P = 0.106). In BAV patients, aortic distensibility and severe valve dysfunction are valuable predictors for final aortic valve and/or aortic surgery.
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Affiliation(s)
- Yijun Pan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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10
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Duan Y, Yang B. Editorial for "Global Aortic Pulse Wave Velocity in Bicuspid Aortopathy Similar to Controls but Elevated With Aortic Valve Stenosis". J Magn Reson Imaging 2023; 57:137-138. [PMID: 35616236 DOI: 10.1002/jmri.28265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Yang Duan
- Center for Neuroimaging, Department of Radiology, The Northern Theater General Hospital, Shenyang, Liaoning, China
| | - Benqiang Yang
- Department of Radiology, The Northern Theater General Hospital, Shenyang, Liaoning, China
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Johnson EMI, Scott MB, Jarvis K, Allen B, Carr J, Chris Malaisrie S, McCarthy P, Mehta C, Fedak PWM, Barker AJ, Markl M. Global Aortic Pulse Wave Velocity is Unchanged in Bicuspid Aortopathy With Normal Valve Function but Elevated in Patients With Aortic Valve Stenosis: Insights From a 4D Flow MRI Study of 597 Subjects. J Magn Reson Imaging 2023; 57:126-136. [PMID: 35633284 PMCID: PMC9701914 DOI: 10.1002/jmri.28266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Aortopathy is common with bicuspid aortic valve (BAV), and underlying intrinsic tissue abnormalities are believed causative. Valve-mediated hemodynamics are altered in BAV and may contribute to aortopathy and its progression. The contribution of intrinsic tissue defects versus altered hemodynamics to aortopathy progression is not known. PURPOSE To investigate relative contributions of tissue-innate versus hemodynamics in progression of BAV aortopathy. STUDY TYPE Retrospective. SUBJECTS Four hundred seventy-three patients with aortic dilatation (diameter ≥40 mm; comprised of 281 BAV with varied AS severity, 192 tricuspid aortic valve [TAV] without AS) and 124 healthy controls. Subjects were 19-91 years (141/24% female). FIELD STRENGTH/SEQUENCE 1.5T, 3T; time-resolved gradient-echo 3D phase-contrast (4D flow) MRI. ASSESSMENT A surrogate measure for global aortic wall stiffness, pulse wave velocity (PWV), was quantified from MRI by standardized, automated technique based on through-plane flow cross-correlation maximization. Comparisons were made between BAV patients with aortic dilatation and varying aortic valve stenosis (AS) severity and healthy subjects and aortopathy patients with normal TAV. STATISTICAL TESTS Multivariable regression, analysis of covariance (ANCOVA), Tukey's, student's (t), Mann-Whitney (U) tests, were used with significance levels P < 0.05 or P < 0.01 for post-hoc Bonferroni-corrected t/U tests. Bland-Altman and ICC calculations were performed. RESULTS Multivariable regression showed age with the most significant association for increased PWV in all groups (increase 0.073-0.156 m/sec/year, R2 = 0.30-48). No significant differences in aortic PWV were observed between groups without AS (P = 0.20-0.99), nor were associations between PWV and regurgitation or Sievers type observed (P = 0.60, 0.31 respectively). In contrast, BAV AS patients demonstrated elevated PWV and a significant relationship for AS severity with increased PWV (covariate: age, R2 = 0.48). BAV and TAV patients showed no association between aortic diameter and PWV (P = 0.73). DATA CONCLUSION No significant PWV differences were observed between BAV patients with normal valve function and control groups. However, AS severity and age in BAV patients were directly associated with PWV increases. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
| | - Michael B Scott
- Northwestern University, Radiology,Northwestern University, Bioengineering
| | | | | | | | | | | | | | | | - Alex J Barker
- University of Colorado Anschutz, Radiology, Bioengineering
| | - Michael Markl
- Northwestern University, Radiology,Northwestern University, Bioengineering
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12
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Hosen MR, Goody PR, Zietzer A, Xiang X, Niepmann ST, Sedaghat A, Tiyerili V, Chennupati R, Moore JB, Boon RA, Uchida S, Sinning JM, Zimmer S, Latz E, Werner N, Nickenig G, Jansen F. Circulating MicroRNA-122-5p Is Associated With a Lack of Improvement in Left Ventricular Function After Transcatheter Aortic Valve Replacement and Regulates Viability of Cardiomyocytes Through Extracellular Vesicles. Circulation 2022; 146:1836-1854. [PMID: 35862223 DOI: 10.1161/circulationaha.122.060258] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for high- and intermediate-risk patients with severe symptomatic aortic valve stenosis. A majority of patients exhibit improvements in left ventricular ejection fraction (LVEF) after TAVR in response to TAVR-associated afterload reduction. However, a specific role for circulating microRNAs (miRNAs) in the improvement of cardiac function for patients after TAVR has not yet been investigated. Here, we profiled the differential expression of miRNAs in circulating extracellular vesicles (EVs) in patients after TAVR and, in particular, the novel role of circulating miR-122-5p in cardiomyocytes. METHODS Circulating EV-associated miRNAs were investigated by use of an unbiased Taqman-based human miRNA array. Several EV miRNAs (miR-122-5p, miR-26a, miR-192, miR-483-5p, miR-720, miR-885-5p, and miR-1274) were significantly deregulated in patients with aortic valve stenosis at day 7 after TAVR compared with the preprocedural levels in patients without LVEF improvement. The higher levels of miR-122-5p were negatively correlated with LVEF improvement at both day 7 (r=-0.264 and P=0.015) and 6 months (r=-0.328 and P=0.0018) after TAVR. RESULTS Using of patient-derived samples and a murine aortic valve stenosis model, we observed that the expression of miR-122-5p correlates negatively with cardiac function, which is associated with LVEF. Mice with graded wire injury-induced aortic valve stenosis demonstrated a higher level of miR-122-5p, which was related to cardiomyocyte dysfunction. Murine ex vivo experiments revealed that miR-122-5p is highly enriched in endothelial cells compared with cardiomyocytes. Coculture experiments, copy-number analysis, and fluorescence microscopy with Cy3-labeled miR-122-5p demonstrated that miR-122-5p can be shuttled through large EVs from endothelial cells into cardiomyocytes. Gain- and loss-of-function experiments suggested that EV-mediated shuttling of miR-122-5p increases the level of miR-122-5p in recipient cardiomyocytes. Mechanistically, mass spectrometry, miRNA pulldown, electrophoretic mobility shift assay, and RNA immunoprecipitation experiments confirmed that miR-122-5p interacts with the RNA-binding protein hnRNPU (heterogeneous nuclear ribonucleoprotein U) in a sequence-specific manner to encapsulate miR-122-5p into large EVs. On shuttling, miR-122-5p reduces the expression of the antiapoptotic gene BCL2 by binding to its 3' untranslated region to inhibit its translation, thereby decreasing the viability of target cardiomyocytes. CONCLUSIONS Increased levels of circulating proapoptotic EV-incorporated miR-122-5p are associated with reduced LVEF after TAVR. EV shuttling of miR-122-5p regulates the viability and apoptosis of cardiomyocytes in a BCL2-dependent manner.
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Affiliation(s)
- Mohammed Rabiul Hosen
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Philip Roger Goody
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Andreas Zietzer
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Xu Xiang
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
- Department of International Medical Center, Affiliated Hospital of Qingdao University, Shinan, Qingdao, Shandong, China (X.X.)
| | - Sven Thomas Niepmann
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Ramesh Chennupati
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany (R.C.)
| | - Joseph B Moore
- Christina Lee Brown Environment Institute, Department of Medicine, University of Louisville, KY (J.B.M.)
- Diabetes and Obesity Center, Louisville, KY (J.B.M.)
| | - Reinier A Boon
- Institute for Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt am Main, Germany (R.A.B.)
- Center for Cardiovascular Research (DZHK), Partner Site-Rhein-Main, Frankfurt am Main, Germany (R.A.B.)
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands (R.A.B.)
| | - Shizuka Uchida
- Center for RNA Medicine, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark (S.U.)
| | - Jan-Malte Sinning
- Department of Internal Medicine-III-Cardiology, St. Vinzenz Hospital, Cologne, Germany (J.-M.S.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Eicke Latz
- Institute of Innate Immunity (E.L.), University Hospital Bonn, Venusberg-Campus Germany
| | - Nikos Werner
- Department of Internal Medicine/ Cardiology, Krankenhaus der Barmherzigen Brüder Trier, Germany (N.W.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
| | - Felix Jansen
- Heart Center Bonn, Department of Internal Medicine II (M.R.H., P.R.G., A.Z., X.X., S.T.N., A.S., V.T., S.Z., G.N., F.J.), University Hospital Bonn, Venusberg-Campus Germany
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13
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Sophocleous F, De Garate E, Bigotti MG, Anwar M, Jover E, Chamorro-Jorganes A, Rajakaruna C, Mitrousi K, De Francesco V, Wilson A, Stoica S, Parry A, Benedetto U, Chivasso P, Gill F, Hamilton MCK, Bucciarelli-Ducci C, Caputo M, Emanueli C, Biglino G. A Segmental Approach from Molecular Profiling to Medical Imaging to Study Bicuspid Aortic Valve Aortopathy. Cells 2022; 11:cells11233721. [PMID: 36496981 PMCID: PMC9737804 DOI: 10.3390/cells11233721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients develop ascending aortic (AAo) dilation. The pathogenesis of BAV aortopathy (genetic vs. haemodynamic) remains unclear. This study aims to identify regional changes around the AAo wall in BAV patients with aortopathy, integrating molecular data and clinical imaging. BAV patients with aortopathy (n = 15) were prospectively recruited to surgically collect aortic tissue and measure molecular markers across the AAo circumference. Dilated (anterior/right) vs. non-dilated (posterior/left) circumferential segments were profiled for whole-genomic microRNAs (next-generation RNA sequencing, miRCURY LNA PCR), protein content (tandem mass spectrometry), and elastin fragmentation and degeneration (histomorphometric analysis). Integrated bioinformatic analyses of RNA sequencing and proteomic datasets identified five microRNAs (miR-128-3p, miR-210-3p, miR-150-5p, miR-199b-5p, and miR-21-5p) differentially expressed across the AAo circumference. Among them, three miRNAs (miR-128-3p, miR-150-5p, and miR-199b-5p) were predicted to have an effect on eight common target genes, whose expression was dysregulated, according to proteomic analyses, and involved in the vascular-endothelial growth-factor signalling, Hippo signalling, and arachidonic acid pathways. Decreased elastic fibre levels and elastic layer thickness were observed in the dilated segments. Additionally, in a subset of patients n = 6/15, a four-dimensional cardiac magnetic resonance (CMR) scan was performed. Interestingly, an increase in wall shear stress (WSS) was observed at the anterior/right wall segments, concomitantly with the differentially expressed miRNAs and decreased elastic fibres. This study identified new miRNAs involved in the BAV aortic wall and revealed the concomitant expressional dysregulation of miRNAs, proteins, and elastic fibres on the anterior/right wall in dilated BAV patients, corresponding to regions of elevated WSS.
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Affiliation(s)
- Froso Sophocleous
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Estefania De Garate
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Maria Giulia Bigotti
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- School of Biochemistry, Faculty of Life Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Maryam Anwar
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - Eva Jover
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain
| | | | - Cha Rajakaruna
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Konstantina Mitrousi
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Viola De Francesco
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Aileen Wilson
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Serban Stoica
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Andrew Parry
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Umberto Benedetto
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Pierpaolo Chivasso
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Frances Gill
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Mark C. K. Hamilton
- Department of Clinical Radiology, University Hospitals Bristol, Bristol Royal Infirmary, Bristol BS2 8EJ, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
- Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Massimo Caputo
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Costanza Emanueli
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - Giovanni Biglino
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1TH, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
- Correspondence: ; Tel.: +44-117-342-3287
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14
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Muhl L, Mocci G, Pietilä R, Liu J, He L, Genové G, Leptidis S, Gustafsson S, Buyandelger B, Raschperger E, Hansson EM, Björkegren JL, Vanlandewijck M, Lendahl U, Betsholtz C. A single-cell transcriptomic inventory of murine smooth muscle cells. Dev Cell 2022; 57:2426-2443.e6. [DOI: 10.1016/j.devcel.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
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15
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Burns J, Lastovich L, Dhar A. The genetic, molecular, and hemodynamic basis of bicuspid aortic valve aortopathy: A contemporary narrative review. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Bellaire CP, Tharakan SM, Roy J, Puskas JD, Di Luozzo G. Natural history of bicuspid aortic valves and ascending aortic aneurysms: Aortic center experience. J Card Surg 2022; 37:2326-2335. [PMID: 35535018 DOI: 10.1111/jocs.16597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIM The American Association of Thoracic Surgery published guidelines in 2018 encouraging regular surveillance rather than surgical intervention for ascending aortic aneurysms under 5.5 cm in both bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients. Since then, there have been limited studies reporting outcomes, especially by valve type. We aimed to analyze clinical outcomes including survival and aortic events in a cohort of BAV and TAV patients with ascending aortic aneurisms followed conservatively with routine computerized tomography (CT) surveillance per current guidelines. METHODS We followed 188 patients in our clinic between 2016 and 2019; 147 had two or more CT scans which allowed measurement of aortic growth. Echocardiogram data was evaluated for each patient. We identified similar cohorts of BAV (n = 32) and TAV (n = 64) patients matched by age, sex, hypertension, smoking history, family history of aortic disease, coronary artery disease, and hyperlipidemia. Univariate and multivariate analyses of the unmatched cohorts were performed. RESULTS The mean aneurysm size was 4.3 ± 0.58 cm with 95% confidence interval (3.14, 5.46). This did not differ between BAV and TAV patients, nor did aneurysm growth rates. Overall adverse event rate (dissection, rupture, and death) was low for the entire cohort (BAV group, 3% and TAV group, 3.5%). Survival at 10 years for the entire cohort was 90 ± 32%. CONCLUSIONS Regardless of aortic valve type, there was a similar natural history and low adverse event rate. In the absence of risk factors, conservative management can be accomplished with minimal risk to the patient.
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Affiliation(s)
- Christopher P Bellaire
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Serena M Tharakan
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jordan Roy
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York City, New York, USA
| | - John D Puskas
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York City, New York, USA
| | - Gabriele Di Luozzo
- Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York City, New York, USA
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17
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Point on the Aortic Bicuspid Valve. Life (Basel) 2022; 12:life12040518. [PMID: 35455009 PMCID: PMC9029119 DOI: 10.3390/life12040518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022] Open
Abstract
Background—Bicuspid aortic valve (BAV) disease is the most prevalent congenital heart disease in the world. Knowledge about its subtypes origin, development, and evolution is poor despite the frequency and the potential gravity of this condition. Its prognosis mostly depends on the risk of aortic aneurysm development with an increased risk of aortic dissection. Aims—This review aims to describe this complex pathology in way to improve the bicuspid patients’ management. Study design—We reviewed the literature with MEDLINE and EMBASE databases using MeSH terms such as “bicuspid aortic valve”, “ascending aorta”, and “bicuspid classification”. Results—There are various classifications. They depend on the criteria chosen by the authors to differentiate subtypes. Those criteria can be the number and position of the raphes, the cusps, the commissures, or their arrangements regarding coronary ostia. Sievers’ classification is the reference. The phenotypic description of embryology revealed that all subtypes of BAV are the results of different embryological pathogenesis, and therefore, should be considered as distinct conditions. Their common development towards aortic dilatation is explained by the aortic media’s pathological histology with cystic medial necrosis. At the opposite, BAV seems to display a profound genetic heterogeneity with both sporadic and familial forms. BAV can be even isolated or combined with other congenital malformations. Conclusions—All those characteristics make this pathology a highly complex condition that needs further genetic, embryological, and hemodynamic explorations to complete its well described anatomy.
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18
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Vignac M, Ntika S, Olsson C, Franco-Cereceda A, Björck HM. Metformin therapy is not associated with the lower prevalence of ascending aortic aneurysm in diabetic patients. Eur J Cardiothorac Surg 2021; 61:388-392. [PMID: 34676406 DOI: 10.1093/ejcts/ezab435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Metformin therapy has previously been associated with reduced abdominal aortic aneurysm growth rate in diabetic patients and shown to suppress the formation and progression of abdominal aortic aneurysm in normoglycemic mice. Here, we investigated the association between Metformin treatment and prevalence of aneurysm in the ascending aorta (AscAA). METHODS A total of 734 patients undergoing open-heart surgery for AscAA and/or aortic valve disease were studied. Diabetes status and medication use were self-reported by the patients in a systematic questionnaire. Aortic dilatation was defined as an aortic root or ascending aortic diameter ≥4.0 cm. High-sensitivity C-reactive protein levels were assessed as a measure of systemic inflammation. RESULTS We could confirm the inverse association between diabetes and AscAA prevalence (16% vs 43.9%, for diabetic and non-diabetic patients, respectively; Odds ratio 0.243; 95% CI, 0.129-0.460, P < 0.001). Furthermore, in diabetic patients, Metformin treatment was associated with lower high-sensitivity C-reactive protein levels. There was, however, no difference in the prevalence of AscAA among diabetic patients with and without Metformin treatment (16% vs 16% for treated and non-treated patients, respectively; OR 1.039; 95% CI 0.26-4.19, P = 0.957). CONCLUSIONS Our data do not support a protective effect of Metformin therapy in AscAA formation. SUBJ COLLECTION 161, 173.
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Affiliation(s)
- Maxime Vignac
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Karolinska University Hospital, Solna, Sweden.,Karolinska University Hospital, Solna, Sweden
| | - Stelia Ntika
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Södertälje Hospital, Department of Research, Södertälje, Sweden
| | - Christian Olsson
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Björck
- Cardiovascular Medicine Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Karolinska University Hospital, Solna, Sweden.,Karolinska University Hospital, Solna, Sweden
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19
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Dubey MK, Mani A, Ojha V. Causal Relationship of the Transverse Left Ventricular Band and Bicuspid Aortic Valve. Sultan Qaboos Univ Med J 2021; 21:403-407. [PMID: 34522405 PMCID: PMC8407896 DOI: 10.18295/squmj.4.2021.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Bicuspid aortic valve (BAV) is the most common congenital lesion found in adults. It can be seen in combination with a transverse left ventricular (LV) band. This study aimed to find an essential relationship between the presence of transverse ventricular band and BAV. Methods A total of 13 patients from a tertiary care centre in India with transverse LV band were investigated during a six-month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV haemodynamics. The morphology of the aortic valve and LV outflow tract gradients was assessed. Results The mean age of the participants was 41 years. A majority had a BAV (n = 11). Average thickness of the LV band was 6.2 mm and the average mean aortic gradient was 4 mmHg. Sequestration of blood was noted at the level of the transverse band in all the patients with two separate jets at the left ventricular outflow tract. The anterolateral jet was deflected from the transverse band and showed higher velocity compared to the other jet, causing turbulence at the BAV. No correlation was found between the thickness of the transverse band and aortic valve gradient. Conclusion Presence of a robust transverse LV band can serve as a surrogate marker for BAV.
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Affiliation(s)
- Manoj K Dubey
- Department of Internal Medicine, Patliputra Medical College and Hospital, Dhanbad, India
| | - Avinash Mani
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
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20
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Michelena HI, Corte AD, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkaar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes. Radiol Cardiothorac Imaging 2021; 3:e200496. [PMID: 34505060 DOI: 10.1148/ryct.2021200496] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes. © 2021 Jointly between the RSNA, the European Association for Cardio-Thoracic Surgery, The Society of Thoracic Surgeons, and the American Association for Thoracic Surgery. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. All rights reserved. Keywords: Bicuspid Aortic Valve, Aortopathy, Nomenclature, Classification.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Borja Fernández
- Departamento de Biologia Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Raj Makkaar
- Cedars Sinai Heart Institute, Los Angeles, CA, USA
| | - Martin B Leon
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Markl
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, PA, USA
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A&M School of Medicine, Dallas Campus, Dallas, TX, USA
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Gebrine El Khoury
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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21
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Ma M, Li Z, Mohamed MA, Liu L, Wei X. Aortic root aortopathy in bicuspid aortic valve associated with high genetic risk. BMC Cardiovasc Disord 2021; 21:413. [PMID: 34461831 PMCID: PMC8404252 DOI: 10.1186/s12872-021-02215-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background The bicuspid aortic valve (BAV) is prone to ascending aortic dilatation (AAD) involving both the tubular segment and the aortic root. The genetic factor was proposed as one of the most important mechanisms for AAD. We hypothesized that the rare genetic variants mainly contribute to the pathogenesis of aortic roots in affected individuals. Methods The diameter of aortic root or ascending aorta ≥ 40 mm was counted as AAD. The targeted next-generation sequencing of 13 BAV-associated genes were performed on a continuous cohort of 96 unrelated BAV patients. The rare variants with allele frequency < 0.05% were selected and analyzed. Variants frequency was compared against the Exome aggregation consortium database. The pathogenicity of the genetic variants was evaluated according to the American College of Medical Genetics and Genomics guidelines. Results A total of 27 rare nonsynonymous coding variants involving 9 genes were identified in 25 individuals. The burden analysis revealed that variants in GATA5, GATA6, and NOTCH1 were significantly associated with BAV. Eighty percent of the pathogenic variants were detected in root group. The detection rate of rare variants was higher in root dilatation group (71.4%) compared with normal aorta (29.0%) and tubular dilatation groups (29.6%) (P = 0.018). The rare variant was identified as the independent risk factor of root dilatation [P = 0.014, hazard ratio = 23.9, 95% confidence interval (1.9–302.9)]. Conclusions Our results presented a broad genetic spectrum in BAV patients. The rare variants of BAV genes contribute the most to the root phenotype among BAV patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02215-y.
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Affiliation(s)
- Mingjia Ma
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, People's Republic of China
| | - Zongzhe Li
- Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, People's Republic of China
| | - Mohamed Abdulkadir Mohamed
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, People's Republic of China
| | - Ligang Liu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, People's Republic of China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, People's Republic of China.
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22
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Ma W, Zhang J, Xu K, Yan S, Liu D, Huang H, Tang Y, Yan G, Sun Y, Li J, Zhang W, Wang C, Zhu K, Lai H. Plasma proteomic profiling reveals biomarkers associated with aortic dilation in patients with bicuspid aortic valve. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1182. [PMID: 34430623 PMCID: PMC8350663 DOI: 10.21037/atm-21-3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
Background Bicuspid aortic valve (BAV) is the most common congenital heart anomaly and is prone to cause complications, such as valvular stenosis and thoracic aortic dilation. There is currently no reliable way to predict the progression rate to thoracic aortic aneurysm. Here, we aimed to characterize the proteomic landscape in the plasma of stenotic BAV patients and provide potential biomarkers to predict progressive aortic dilation. Methods Plasma samples were obtained from 45 subjects (30 stenotic BAV patients and 15 healthy controls). All samples were properly prepared and analyzed using mass spectrometry (MS)-based label-free quantitative proteomics. Results A total of 748 plasma proteins had missingness <50%, and 193 (25.8%) were differentially expressed in the BAV patients. Functions regarding cell junction and actin cytoskeleton were largely enriched. NOTCH3, a Notch receptor known to interact with the BAV-causing gene NOTCH1, was negatively correlated with aortic diameter and was downregulated in BAV patients' plasma and aortic smooth muscle cells. Further, a subset of plasma proteins, including ADAM10, was associated with rapidly progressive aortic dilation in BAV patients. Conclusions Our data reveal unique features in the proteomic architecture of stenotic BAV patients' plasma, and we propose the potential of Notch signaling proteins NOTCH3 and ADAM10 in predicting aortic dilation.
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Affiliation(s)
- Wenrui Ma
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Zhang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kehua Xu
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shiqiang Yan
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dingqian Liu
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hui Huang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuyi Tang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guoquan Yan
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongxin Sun
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weijia Zhang
- Institutes of Biomedical Sciences and Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Zhu
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Lai
- Department of Cardiac Surgery and Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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23
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Jia H, Kang L, Ma Z, Lu S, Huang B, Wang C, Zou Y, Sun Y. MicroRNAs involve in bicuspid aortic aneurysm: pathogenesis and biomarkers. J Cardiothorac Surg 2021; 16:230. [PMID: 34384454 PMCID: PMC8359579 DOI: 10.1186/s13019-021-01613-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/03/2021] [Indexed: 01/27/2023] Open
Abstract
The incidence of bicuspid aortic valves (BAV) is high in the whole population, BAV-related thoracic aortic aneurysm (TAA) is accompanied by many adverse vascular events. So far, there are two key points in dealing with BAV-related TAA. First is fully understanding on its pathogenesis. Second is optimizing surgical intervention time. This review aims to illustrate the potential role of miRNAs in both aspects, that is, how miRNAs are involved in the occurrence and progression of BAV-related TAA, and the feasibilities of miRNAs as biomarkers.
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Affiliation(s)
- Hao Jia
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China
| | - Le Kang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China
| | - Zhen Ma
- Central Laboratory of Cardiovascular Institute, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China
| | - Shuyang Lu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China
| | - Ben Huang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China.
| | - Yunzeng Zou
- Central Laboratory of Cardiovascular Institute, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China.
| | - Yongxin Sun
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 1069 Xietu Road, 200032, Shanghai, People's Republic of China.
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24
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg 2021; 162:e383-e414. [PMID: 34304896 DOI: 10.1016/j.jtcvs.2021.06.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | | | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY
| | | | - Borja Fernández
- Departamento de Biologia Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, Calif; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, Calif
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Conn
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, Calif
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, Pa
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A& M School of Medicine, Dallas Campus, Dallas, Tex
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Md
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lars G Svensson
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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25
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. Eur J Cardiothorac Surg 2021; 60:448-476. [PMID: 34293102 DOI: 10.1093/ejcts/ezab038] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, CA, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, PA, USA
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A & M School of Medicine, Dallas Campus, Dallas, TX, USA
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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26
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes. Ann Thorac Surg 2021; 112:e203-e235. [PMID: 34304860 DOI: 10.1016/j.athoracsur.2020.08.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/30/2020] [Indexed: 01/17/2023]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
- Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Connecticut
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, New York
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, Pennsylvania
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A & M School of Medicine, Dallas Campus, Dallas, Texas
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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27
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Teekakirikul P, Zhu W, Gabriel GC, Young CB, Williams K, Martin LJ, Hill JC, Richards T, Billaud M, Phillippi JA, Wang J, Wu Y, Tan T, Devine W, Lin JH, Bais AS, Klonowski J, de Bellaing AM, Saini A, Wang MX, Emerel L, Salamacha N, Wyman SK, Lee C, Li HS, Miron A, Zhang J, Xing J, McNamara DM, Fung E, Kirshbom P, Mahle W, Kochilas LK, He Y, Garg V, White P, McBride KL, Benson DW, Gleason TG, Mital S, Lo CW. Common deletion variants causing protocadherin-α deficiency contribute to the complex genetics of BAV and left-sided congenital heart disease. HGG ADVANCES 2021; 2:100037. [PMID: 34888534 PMCID: PMC8653519 DOI: 10.1016/j.xhgg.2021.100037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022] Open
Abstract
Bicuspid aortic valve (BAV) with ~1%-2% prevalence is the most common congenital heart defect (CHD). It frequently results in valve disease and aorta dilation and is a major cause of adult cardiac surgery. BAV is genetically linked to rare left-heart obstructions (left ventricular outflow tract obstructions [LVOTOs]), including hypoplastic left heart syndrome (HLHS) and coarctation of the aorta (CoA). Mouse and human studies indicate LVOTO is genetically heterogeneous with a complex genetic etiology. Homozygous mutation in the Pcdha protocadherin gene cluster in mice can cause BAV, and also HLHS and other LVOTO phenotypes when accompanied by a second mutation. Here we show two common deletion copy number variants (delCNVs) within the PCDHA gene cluster are associated with LVOTO. Analysis of 1,218 white individuals with LVOTO versus 463 disease-free local control individuals yielded odds ratios (ORs) at 1.47 (95% confidence interval [CI], 1.13-1.92; p = 4.2 × 10-3) for LVOTO, 1.47 (95% CI, 1.10-1.97; p = 0.01) for BAV, 6.13 (95% CI, 2.75-13.7; p = 9.7 × 10-6) for CoA, and 1.49 (95% CI, 1.07-2.08; p = 0.019) for HLHS. Increased OR was observed for all LVOTO phenotypes in homozygous or compound heterozygous PCDHA delCNV genotype comparison versus wild type. Analysis of an independent white cohort (381 affected individuals, 1,352 control individuals) replicated the PCDHA delCNV association with LVOTO. Generalizability of these findings is suggested by similar observations in Black and Chinese individuals with LVOTO. Analysis of Pcdha mutant mice showed reduced PCDHA expression at regions of cell-cell contact in aortic smooth muscle and cushion mesenchyme, suggesting potential mechanisms for BAV pathogenesis and aortopathy. Together, these findings indicate common variants causing PCDHA deficiency play a significant role in the genetic etiology of common and rare LVOTO-CHD.
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Affiliation(s)
- Polakit Teekakirikul
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Centre for Cardiovascular Genomics and Medicine, Division of Cardiology, and Division of Medical Sciences, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenjuan Zhu
- Centre for Cardiovascular Genomics and Medicine, Division of Cardiology, and Division of Medical Sciences, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - George C. Gabriel
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cullen B. Young
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kylia Williams
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lisa J. Martin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Jennifer C. Hill
- Department of Cardiothoracic Surgery and Department of Bioengineering, McGowan Institute for Regenerative Medicine, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tara Richards
- Department of Cardiothoracic Surgery and Department of Bioengineering, McGowan Institute for Regenerative Medicine, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Billaud
- Department of Cardiothoracic Surgery and Department of Bioengineering, McGowan Institute for Regenerative Medicine, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie A. Phillippi
- Department of Cardiothoracic Surgery and Department of Bioengineering, McGowan Institute for Regenerative Medicine, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jianbin Wang
- School of Life Sciences, Tsinghua University, Beijing, China
| | - Yijen Wu
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tuantuan Tan
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William Devine
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jiuann-huey Lin
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abha S. Bais
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Klonowski
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne Moreau de Bellaing
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatric Cardiology, Necker-Sick Children Hospital and University of Paris Descartes, Paris, France
| | - Ankur Saini
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael X. Wang
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leonid Emerel
- Department of Cardiothoracic Surgery and Department of Bioengineering, McGowan Institute for Regenerative Medicine, and Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nathan Salamacha
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samuel K. Wyman
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carrie Lee
- Centre for Cardiovascular Genomics and Medicine, Division of Cardiology, and Division of Medical Sciences, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hung Sing Li
- Centre for Cardiovascular Genomics and Medicine, Division of Cardiology, and Division of Medical Sciences, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anastasia Miron
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jingyu Zhang
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jianhua Xing
- Department of Computational and Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dennis M. McNamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Erik Fung
- Centre for Cardiovascular Genomics and Medicine, Division of Cardiology, and Division of Medical Sciences, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Heart Failure and Circulation Research, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, CARE Programme, Lui Che Woo Institute of Innovative Medicine, and Gerald Choa Cardiac Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paul Kirshbom
- Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - William Mahle
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lazaros K. Kochilas
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Vidu Garg
- Center for Cardiovascular Research, The Heart Center, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter White
- The Institute for Genomic Medicine, Center for Cardiovascular Research, Nationwide Children’s Hospital and Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Kim L. McBride
- Center for Cardiovascular Research, The Heart Center, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - D. Woodrow Benson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas G. Gleason
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Seema Mital
- Division of Cardiology, Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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28
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Pepe G, Giusti B, Colonna S, Fugazzaro MP, Sticchi E, De Cario R, Kura A, Pratelli E, Melchiorre D, Nistri S. When should a rare inherited connective tissue disorder be suspected in bicuspid aortic valve by primary-care internists and cardiologists? Proposal of a score. Intern Emerg Med 2021; 16:609-615. [PMID: 32949381 PMCID: PMC8049921 DOI: 10.1007/s11739-020-02458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Size threshold for aortic surgery in bicuspid aortic valve (BAV) is debated. Connective tissue disorders (CTDs) are claimed as a clinical turning point, suggesting early surgery in BAV patients with CTD. Thus, we aimed at developing a score to detect high risk of carrying CTDs in consecutive BAVs from primary care. Ninety-eight BAVs without ectopia lentis or personal/family history of aortic dissection were studied at the Marfan syndrome Tuscany Referral Center. Findings were compared with those detected in 84 Marfan patients matched for sex and age. We selected traits with high statistical difference between MFS and BAV easily obtainable by cardiologists and primary-care internists: mitral valve prolapse, myopia ≥ 3DO, pectus carenatum, pes planus, wrist and thumb signs, and difference between aortic size at root and ascending aorta ≥ 4 mm. Clustering of ≥ 3 of these manifestations were more frequent in Marfan patients than in BAVs (71.4% vs 6.1%, p < 0.0001) resulting into an Odds Ratio to be affected by MFS of 38.3 (95% confidence intervals 14.8-99.3, p < 0.0001). We propose a score assembling simple clinical and echocardiographic variables resulting in an appropriate referral pattern of BAVs from a primary-care setting to a tertiary center to evaluate the presence of a potential, major CTD.
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Affiliation(s)
- Guglielmina Pepe
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy.
- Research and Innovation Center for Marfan Syndrome and Related Disorders, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy.
| | - Betti Giusti
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Stefania Colonna
- Outpatient Cardiology Unit, Health District 1 ULSS 6, Vigonza and Carmignano di Brenta, Padua, Italy
| | | | - Elena Sticchi
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Rosina De Cario
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Ada Kura
- Marfan Syndrome and Related Disorders Regional Referral Center, Careggi Hospital, Viale Gaetano Pieraccini, 50139, Florence, Italy
- Department of Experimental and Clinical Medicine, Section of Critical Medical Care and Medical Specialities, University of Florence, Florence, Italy
- Atherothrombotic Diseases Tuscany Referral Center, Careggi Hospital, Florence, Italy
| | - Elisa Pratelli
- Specialization in Physical and Rehabilitation Medicine, Recovery and Rehabilitation Agency, Careggi Hospital, Florence, Italy
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Section of Rheumatology, University of Florence, Florence, Italy
| | - Stefano Nistri
- Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy
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29
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Federspiel JM, Schnabel PA, Tschernig T, Balint B, Schwab T, Laschke MW, Schäfers HJ. Aortic aneurysms with tricuspid aortic valve have more degeneration than unicuspid aortic valve aneurysms. Eur J Cardiothorac Surg 2021; 60:333-340. [PMID: 33675640 DOI: 10.1093/ejcts/ezab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The unicuspid aortic valve (UAV) is a rare cardiac malformation and is associated with the formation of ascending aortic aneurysms. To characterize its associated aortic wall changes, normal and aneurysmatic ascending aortic wall specimens were analysed, focusing on the potential mechanisms of aneurysm formation. Patients with tricuspid aortic valve (TAV) served as controls. METHODS In a retrospective observational study, 74 specimens (dilated and non-dilated aortas; individuals with UAV and TAV) obtained intraoperatively were studied. Standard stains and immunohistochemical labelling of cleaved caspase-3, cluster of differentiation 31 and endothelial nitric oxide synthase (eNOS) were performed to assess the degree of apoptosis, distribution of eNOS within the aortic wall, smooth muscle cell (SMC) nuclei loss and mucoid extracellular matrix accumulation (MEMA). RESULTS Deeper ingrowth of vasa vasorum was found in dilated aortas. Interestingly, eNOS was expressed mostly in vasa vasorum. More apoptosis was seen in UAV aortas compared to TAV aortas (P < 0.001). Both UAV and TAV aortas were comparable regarding SMC nuclei loss (P = 0.419). In dilated compared to non-dilated aortas regardless valve morphology SMC nuclei loss was increased (P = 0.005) and more pronounced translamellar MEMA was present (P = 0.011). The highest grade of distribution (P = 0.043) and the highest severity (P = 0.005) regarding MEMA were seen in TAV dilated specimens compared to UAV dilated specimens. CONCLUSIONS Aneurysms with UAV show increased apoptosis, the role of which is unclear. Strikingly, more severe MEMA was found in TAV aneurysms compared to UAV aneurysms. Thus, UAV-associated aortic wall changes and resulting aneurysm may be less aggressive than aneurysms with TAV.
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Affiliation(s)
- Jan M Federspiel
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Philipp A Schnabel
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Tschernig
- Institute of Anatomy, Saarland University, Homburg/Saar, Germany
| | - Brittany Balint
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tanja Schwab
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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30
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Anzai I, Kriegel J, Kim I, Pearsall C, Lewis M, Rosenbaum M, Ferrari G, George I, Takayama H. Should all patients with aortic aneurysm and bicuspid aortic valve also undergo hemiarch? JTCVS OPEN 2021; 5:39-43. [PMID: 36003181 PMCID: PMC9390205 DOI: 10.1016/j.xjon.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Isao Anzai
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Jacob Kriegel
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Ilya Kim
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Christian Pearsall
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Matthew Lewis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Marlon Rosenbaum
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Giovanni Ferrari
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
- Address for reprints: Hiroo Takayama, MD, PhD, 177 Fort Washington Ave, New York, NY 10032.
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Cereceda-Monteoliva N, Capoccia M, Mensah K, Stenz R, Petrou M. Quadricuspid aortic valve: a case report and review of the literature. THE BRITISH JOURNAL OF CARDIOLOGY 2020; 27:40. [PMID: 35747224 PMCID: PMC9205227 DOI: 10.5837/bjc.2020.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital anomaly that can present as aortic insufficiency later in life. We report a case of aortic regurgitation associated with a QAV, treated by aortic valve replacement. The patient presented with breathlessness, lethargy and peripheral oedema. Echocardiography and cardiac magnetic resonance revealed abnormal aortic valve morphology and coronary angiography was normal. The presence of a quadricuspid aortic valve was confirmed intra-operatively. This was excised and replaced with a bioprosthetic valve and the patient recovered well postoperatively. Importantly, the literature indicates that specific QAV morphology and associated structural abnormalities can lead to complications. Hence, early detection and diagnosis of QAV allows effective treatment. Aortic valve surgery is the definitive treatment strategy in patients with aortic valve regurgitation secondary to QAV. However, the long-term effects and complications of treatment of this condition remain largely unknown.
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Affiliation(s)
| | - Massimo Capoccia
- Senior Fellow in Aortic and Cardiac Surgery, Royal Brompton Hospital, Sydney Street, London, SW3 6NP
| | - Kwabena Mensah
- Senior Specialty Training Registrar in Cardiac Surgery, Royal Brompton Hospital, Sydney Street, London, SW3 6NP
| | - Ruediger Stenz
- Consultant Anaesthetist, Royal Brompton Hospital, Sydney Street, London, SW3 6NP
| | - Mario Petrou
- Consultant Cardiac Surgeon, Royal Brompton Hospital, Sydney Street, London, SW3 6NP
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Zhu K, Ma W, Li J, Zhang YS, Zhang W, Lai H, Wang C. Modeling aortic diseases using induced pluripotent stem cells. Stem Cells Transl Med 2020; 10:190-197. [PMID: 33179450 PMCID: PMC7848399 DOI: 10.1002/sctm.20-0322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/02/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
Induced pluripotent stem cells (iPSCs) offer an effective platform for studies of human physiology and have revealed new possibilities for disease modeling at the cellular level. These cells also have the potential to be leveraged in the practice of precision medicine, including personalized drug testing. Aortic diseases result in significant morbidity and mortality and pose a global burden to healthcare. Their pathogenesis is mostly associated with functional alterations of vascular components, such as endothelial cells and vascular smooth muscle cells. Drugs that have been proven to be effective in animal models often fail to protect patients from adverse aortic events in clinical studies, provoking researchers to develop reliable in vitro models using human cells. In this review, we summarize the patient iPSC-derived aortic cells that have been utilized to model aortic diseases in vitro. In advanced models, hemodynamic factors, such as blood flow-induced shear stress and cyclic strain, have been added to the systems to replicate cellular microenvironments in the aortic wall. Examples of the utility of such factors in modeling various aortopathies, such as Marfan syndrome, Loeys-Dietz syndrome, and bicuspid aortic valve-related aortopathy, are also described. Overall, the iPSC-based in vitro cell models have shown the potential to promote the development and practice of precision medicine in the treatment of aortic diseases.
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Affiliation(s)
- Kai Zhu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Wenrui Ma
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Weijia Zhang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China.,Institutes of Biomedical Sciences and Department of Systems Biology for Medicine, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,The State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, People's Republic of China
| | - Hao Lai
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Cardiovascular Diseases, Shanghai, People's Republic of China
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33
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Recurrent germline mutations as genetic markers for aortic root dilatation in bicuspid aortic valve patients. Heart Vessels 2020; 36:530-540. [PMID: 33064175 DOI: 10.1007/s00380-020-01710-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
Bicuspid aortic valve (BAV) is characterized by elevated risk of aortic dilatation and aneurysm. Although genetic susceptibility is suspected to influence on the development of BAV aortopathy, clinical application of genetic markers still needs validation in BAV entities with strictly defined phenotypic features. The 'root phenotype' represents a young, male predominant, and severely aortic regurgitant BAV population prone to aortic root dilatation. The present study launched a two-step genetic survey to evaluate the clinical significance of germline genetic markers in BAV patients. The whole-exome sequencing (WES) cohort consisted of 13 BAV patients with 'root phenotype' under the age of 40 years. We identified 28 different heterozygous missense mutations in 19 genes from the WES cohort, among which six variants (COL1A2 R882C, COL5A1 I1161F, ACVRL1 R218W, NOTCH1 P1227S, MYLK S243W, MYLK D717Y) were identified as pathogenic variants via unanimous agreement of in silico prediction tool analysis, and three variants (C1R I345L, TGFBR2 V216I, FBN2 G475V) were identified as recurrent variants. The panel of nine genetic markers was tested in an independent validation cohort of 154 BAV patients consecutively included from January to May 2018 in our institution. The validation cohort demonstrated 71.4% male predominance and the average age of 57 ± 13 years, among which 26.6% showed aortic root dilatation and 66.9% ascending aortic dilatation. Genetic markers were found in 32 patients, including 18 with C1R I345L, 11 with TGFBR2 V216I, 2 with FBN2 G475V, and 1 with both TGFBR2 V216I and MYLK D717Y. BAV patients carrying these genetic markers demonstrated younger age [(51 ± 12) vs. (58 ± 13) years, P = 0.014], more moderate to severe aortic regurgitation (56.2% vs. 33.6%, P = 0.019), elevated prevalence of mitral valve prolapse (9.4% vs. 0.8%, P = 0.028) and aortic root dilatation (62.5% vs. 17.2%, P < 0.001) but not ascending aortic dilatation than those without these markers. The early-onset 'root phenotype' entities displayed great value for BAV genetic surveys. As one of the promising complements of the current risk stratification system, recurrent germline mutations in TGFBR2, C1R, FBN2 genes could be identified and applied as genetic markers of elevated susceptibility for aortic root but not ascending aortic dilatation among BAV patients.
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Edlin J, Youssefi P, Bilkhu R, Figueroa CA, Morgan R, Nowell J, Jahangiri M. Haemodynamic assessment of bicuspid aortic valve aortopathy: a systematic review of the current literature. Eur J Cardiothorac Surg 2020; 55:610-617. [PMID: 30239633 DOI: 10.1093/ejcts/ezy312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 11/12/2022] Open
Abstract
Both genetic and haemodynamic theories explain the aetiology, progression and optimal management of bicuspid aortic valve aortopathy. In recent years, the haemodynamic theory has been explored with the help of magnetic resonance imaging and computational fluid dynamics. The objective of this review was to summarize the findings of these investigations with focus on the blood flow pattern and associated variables, including flow eccentricity, helicity, flow displacement, cusp opening angle, systolic flow angle, wall shear stress (WSS) and oscillatory shear index. A structured literature review was performed from January 1990 to January 2018 and revealed the following 3 main findings: (i) the bicuspid aortic valve is associated with flow eccentricity and helicity in the ascending aorta compared to healthy and diseased tricuspid aortic valve, (ii) flow displacement is easier to obtain than WSS and has been shown to correlate with valve morphology and type of aortopathy and (iii) the stenotic bicuspid aortic valve is associated with elevated WSS along the greater curvature of the ascending aorta, where aortic dilatation and aortic wall thinning are commonly found. We conclude that new haemodynamic variables should complement ascending aorta diameter as an indicator for disease progression and the type and timing of intervention. WSS describes the force that blood flow exerts on the vessel wall as a function of viscosity and geometry of the vessel, making it a potentially more reliable marker of disease progression.
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Affiliation(s)
- Joy Edlin
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Pouya Youssefi
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Carlos Alberto Figueroa
- Department of Biomedical Engineering, King's College London, London, UK.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert Morgan
- Department of Radiology, St George's Hospital, London, UK
| | - Justin Nowell
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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35
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Affiliation(s)
- John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, United Kingdom. Division of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, United Kingdom. Division of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, United Kingdom
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36
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Goody PR, Hosen MR, Christmann D, Niepmann ST, Zietzer A, Adam M, Bönner F, Zimmer S, Nickenig G, Jansen F. Aortic Valve Stenosis: From Basic Mechanisms to Novel Therapeutic Targets. Arterioscler Thromb Vasc Biol 2020; 40:885-900. [PMID: 32160774 DOI: 10.1161/atvbaha.119.313067] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aortic valve stenosis is the most prevalent heart valve disease worldwide. Although interventional treatment options have rapidly improved in recent years, symptomatic aortic valve stenosis is still associated with high morbidity and mortality. Calcific aortic valve stenosis is characterized by a progressive fibro-calcific remodeling and thickening of the aortic valve cusps, which subsequently leads to valve obstruction. The underlying pathophysiology is complex and involves endothelial dysfunction, immune cell infiltration, myofibroblastic and osteoblastic differentiation, and, subsequently, calcification. To date, no pharmacotherapy has been established to prevent aortic valve calcification. However, novel promising therapeutic targets have been recently identified. This review summarizes the current knowledge of pathomechanisms involved in aortic valve calcification and points out novel treatment strategies.
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Affiliation(s)
- Philip Roger Goody
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | - Mohammed Rabiul Hosen
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | - Dominik Christmann
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | - Sven Thomas Niepmann
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | | | - Matti Adam
- Clinic for Internal Medicine II, University Hospital Cologne, Germany (M.A.)
| | - Florian Bönner
- Clinic for Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Germany (F.B.)
| | - Sebastian Zimmer
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | - Georg Nickenig
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
| | - Felix Jansen
- From the Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (P.R.G., M.R.H., D.C., S.T.N., S.Z., G.N., F.J.)
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37
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Pulignani S, Borghini A, Foffa I, Vecoli C, Ait-Alì L, Andreassi MG. Functional characterization and circulating expression profile of dysregulated microRNAs in BAV-associated aortopathy. Heart Vessels 2020; 35:432-440. [PMID: 31562552 DOI: 10.1007/s00380-019-01509-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
Compelling evidence has shown that microRNAs (miRs) are involved in the pathophysiology of BAV-associated aortopathy. The purpose of this study was to assess the biological role as well as the circulating expression of two miRs (miR-424-3p and miR-3688-3p) that have been previously identified as significantly dysregulated in thoracic aortic aneurysm specimens of BAV patients. Bioinformatic tools were used to predict miR gene targets followed by functional validation transfecting synthetic miR mimics and negative controls into human aortic smooth muscle cells (HASMCs). Levels of miRs and target genes were evaluated by qRT-PCR. The circulating miR expression profile analysis was assessed on plasma samples collected from a cohort of 72 patients with aortopathy including 39 BAV (33 males; 58 ± 13 years) and 33 TAV patients (26 males; 67 ± 9 years). Computational analysis revealed that SMAD7 and YAP1 were potential targets of miR-424-3p and miR-3688-3p, respectively. Transfection with mimics confirmed a significantly decreased gene expression of SMAD7 and YAP1 compared to mimic negative control (p = 0.04 and p = 0.0005, respectively) or blank control (p = 0.01 and p = 0.0007, respectively). Overexpression of miR-3688-3p also significantly upregulated pro-apoptotic caspase-3 gene expression compared to mimic negative control (p = 0.02) or blank control (p = 0.01). Furthermore, a significant down-regulation of the circulating miR-424-3p was observed in BAV compared to TAV patients (p = 0.001). In multiple linear regression analysis, the aortic valve morphology (β = - 0.29, p = 0.04) and the presence of aortic stenosis (β = - 0.28, p = 0.03) had a significant effect on the miR-424-3p expression. In conclusion, our study demonstrated that miR-424-3p and miR-3688-3p directly targeted SMAD7 and YAP1 in HASMCs, pivotal genes of the TGF-β and Hippo-signaling pathways. Circulating miR-424-3p was also found to be significantly decreased in BAV patients when compared to TAV patients, especially in patients with aortic stenosis. Further large studies of well-characterized BAV patient cohorts are needed to define the clinical significance of the miR-424-3p.
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Affiliation(s)
- Silvia Pulignani
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Andrea Borghini
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Ilenia Foffa
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Cecilia Vecoli
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Lamia Ait-Alì
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
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Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) results from fusion of two adjacent aortic valve cusps, and is associated with dilatation of the aorta, known as BAV-associated aortopathy, or bicuspid aortopathy. Bicuspid aortopathy is progressive, increasing the risk of life-threatening clinical events, such as aortic dissection. Regular monitoring and timely intervention with prophylactic surgical resection of the proximal aorta is recommended. RECENT FINDINGS Aortopathy is heterogeneous among patients. Studies have shown that different flow patterns lead to specific phenotypes of aortopathy. Although not uniform, BAV morphology affects flow patterns. Recent work has demonstrated the role of wall shear stress (WSS) in driving aortopathy, and it is suggested that individualized WSS 'heat maps' can be used for clinically monitoring patients with BAV. WSS has the potential to be an imaging biomarker for directing resection timing, surgical strategies, and postsurgical follow-up care. SUMMARY Finding and validating noninvasive hemodynamic biomarkers of aortic risk to assist in the management of BAV patients is of clinical importance. Herein, we will review the latest findings pertaining to the utility of WSS as a specific biomarker of risk for BAV patients with aortopathy.
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Goudot G, Mirault T, Khider L, Pedreira O, Cheng C, Porée J, Gruest M, Jeunemaître X, Pernot M, Messas E. Carotid Stiffness Assessment With Ultrafast Ultrasound Imaging in Case of Bicuspid Aortic Valve. Front Physiol 2019; 10:1330. [PMID: 31708797 PMCID: PMC6819321 DOI: 10.3389/fphys.2019.01330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/04/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS To compare the carotid stiffness and flow parameters by ultrafast ultrasound imaging (UF), in bicuspid aortic valve (BAV) patients to first-degree relatives (controls). METHODS BAV patients (n = 92) and controls (n = 48) were consecutively included at a reference center for BAV. Aortic valve and ascending aorta were evaluated by echocardiography. Common carotid arteries were evaluated by UF with a linear probe. A high frame rate (2,000 frames/s) was used to measure the pulse wave velocity (PWV). The arterial diameter change over the cardiac cycle was obtained by UF-Doppler imaging. This allowed us to measure the distensibility and the maximal rate of systolic distension (MRSD). The wall shear stress (WSS) was measured based on the same acquisitions, by analyzing blood flow velocities close to the carotid walls. RESULTS BAV patients had significantly larger aortic diameters (p < 0.001) at the Valsalva sinus and at the tubular ascending aorta but no larger carotid diameters. No significant differences were found in carotid stiffness parameters (distensibility, MRSD, and PWV), even though these patients had a higher aortic stiffness. Carotid stiffness correlated linearly with age and similar slopes were obtained for BAV patients and controls. No difference in carotid WSS was found between BAV patients and controls. CONCLUSION Our results clearly show that the carotid stiffness and flow parameters are not altered in case of BAV compared with controls.
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Affiliation(s)
- Guillaume Goudot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Tristan Mirault
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- INSERM U970 PARCC, Paris Descartes University – USPC Sorbonne Paris Cité University, Paris, France
| | - Lina Khider
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Olivier Pedreira
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Charles Cheng
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- INSERM U970 PARCC, Paris Descartes University – USPC Sorbonne Paris Cité University, Paris, France
| | - Jonathan Porée
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Maxime Gruest
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Xavier Jeunemaître
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- INSERM U970 PARCC, Paris Descartes University – USPC Sorbonne Paris Cité University, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE 2031, PSL Research University, Paris, France
| | - Emmanuel Messas
- VASC European Research Network, Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- INSERM U970 PARCC, Paris Descartes University – USPC Sorbonne Paris Cité University, Paris, France
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40
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Pulignani S, Borghini A, Andreassi MG. microRNAs in bicuspid aortic valve associated aortopathy: Recent advances and future perspectives. J Cardiol 2019; 74:297-303. [PMID: 31230901 DOI: 10.1016/j.jjcc.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/12/2019] [Accepted: 03/06/2019] [Indexed: 02/08/2023]
Abstract
The risk of acute aortic events in patients with bicuspid aortic valve (BAV) constitutes a medical concern in terms of timing and surgical decision. During the past years, there has been a growing interest in the potential of microRNAs (miRNAs) as crucial epigenetic factors in multiple cellular processes associated with BAV aortopathy. Nevertheless, there are still challenges that need to be overcome before miRNAs could enter clinical practice, and further validation studies in larger and well-defined BAV cohorts are now required. This review aims at providing a comprehensive overview of the available data on the expression profiles and function of specific miRNAs in BAV aortopathy, evaluating miRNA signatures as potential molecular markers of disease. We also discuss the role of other novel classes of non-coding RNAs, including long non-coding RNAs and circular RNAs, in BAV-associated aortopathy, mainly regarding their possible implementation as diagnostic and prognostic markers.
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41
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Pasipoularides A. Clinical-pathological correlations of BAV and the attendant thoracic aortopathies. Part 1: Pluridisciplinary perspective on their hemodynamics and morphomechanics. J Mol Cell Cardiol 2019; 133:223-232. [PMID: 31150733 DOI: 10.1016/j.yjmcc.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
Clinical BAV manifestations pertain to faulty aortic valve (AOV) function, the associated aortopathy, and other complications such as endocarditis, thrombosis and thromboembolism. BAV arises during valvulogenesis when 2 of the 3 leaflets/cusps of the AOV are fused together. Ensuing asymmetric BAV morphologies alter downstream ejection jet flow-trajectories. Based on BAV morphologies, ejection-flows exhibit different wall-impingement and scouring patterns in the proximal aorta, with excessive hydrodynamic wall-shear that correlates closely with mural vascular smooth muscle cell and extracellular matrix disruptions, revealing hemodynamic participation in the pathogenesis of BAV-associated aortopathies. Since the embryologic regions implicated in both BAV and aortopathies derive from neural crest cells and second heart field cells, there may exist a common multifactorial/polygenic embryological basis linking the abnormalities. The use of Electronic Health Records - encompassing integrated NGS variant panels and phenotypic data - in clinical studies could speed-up comprehensive understanding of multifactorial genetic-phenotypic and environmental factor interactions. This Survey represents the first in a 2-article pluridisciplinary work. Taken in toto, the series covers hemodynamic/morphomechanical and environmental (milieu intérieur) aspects in Part 1, and molecular, genetic and associated epigenetic aspects in Part 2. Together, Parts 1-2 should serve as a reference-milestone and driver for further pluridisciplinary research and its urgent translations in the clinical setting.
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Affiliation(s)
- Ares Pasipoularides
- Duke/NSF Center for Emerging Cardiovascular Technologies, Emeritus Faculty of Surgery and of Biomedical Engineering, Duke University School of Medicine and Graduate School, Durham, NC, USA.
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42
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Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol 2019; 133:76-85. [PMID: 31152748 DOI: 10.1016/j.yjmcc.2019.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 01/30/2023]
Abstract
Herein we summarize the current knowledge on the bicuspid aortic valve (BAV)-associated aortopathy regarding clinical presentation and disease sub-classification, genetic background, hemodynamics, histopathology, cells and signaling, animal models, and biomarkers. Despite enormous efforts in research in all of the above areas, important issues remain unknown: (i) what is the ontogenetic basis of BAV development? (ii) how can we explain the diversity of BAV and associated aortopathy phenotypes? (iii) what are the signaling processes in aortopathy pathogenesis and how can we interfere with these processes? Despite undoubtedly great progress that has been made in the understanding of BAV-associated aortopathy, so far researchers have put together a heap of Lego bricks, but at present it is unclear if the bricks are compatible, how they fit together, and which parts are missing to build the true model of the BAV aorta. A joint approach is needed to accelerate research progress.
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Affiliation(s)
- Barbara Messner
- Cardiac Surgery Research Laboratory, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - David Bernhard
- Center for Medical Research, Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
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Balistreri CR, Forte M, Greco E, Paneni F, Cavarretta E, Frati G, Sciarretta S. An overview of the molecular mechanisms underlying development and progression of bicuspid aortic valve disease. J Mol Cell Cardiol 2019; 132:146-153. [PMID: 31103478 DOI: 10.1016/j.yjmcc.2019.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022]
Abstract
Bicuspid aortic valve (BAV) is a common congenital heart malformation frequently associated with the development of aortic valve diseases and severe aortopathy, such as aortic dilatation, aneurysm and dissection. To date, different genetic loci have been identified in syndromic and non- syndromic forms of BAV. Among these, genes involved in the regulation of extracellular matrix remodelling, epithelial to mesenchymal transition and nitric oxide metabolism appear to be the main contributors to BAV pathogenesis. However, no- single gene model explains BAV inheritance, suggesting that more factors are simultaneously involved. In this regard, characteristic epigenetic and immunological profiles have been documented to contradistinguish BAV individuals. In this review, we provide a comprehensive overview addressing molecular mechanisms involved in BAV development and progression.
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Affiliation(s)
- Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy.
| | | | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland; University Heart Center, Cardiology, University Hospital Zurich, Switzerland
| | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Giacomo Frati
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Sebastiano Sciarretta
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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Kim ML, Thakur SK. Unusual case of a non-healing sternal wound after ascending aorta surgery. ANZ J Surg 2019; 90:E57-E58. [PMID: 31067597 DOI: 10.1111/ans.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Michelle Lynne Kim
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Sanjay Kumar Thakur
- Department of Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
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Howard C, Picca L, Smith T, Sharif M, Bashir M, Harky A. The bicuspid aortic valve: Is it an immunological disease process? J Card Surg 2019; 34:482-494. [PMID: 31012137 DOI: 10.1111/jocs.14050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 01/03/2023]
Abstract
Bicuspid aortic valves (BAVs) are the most common congenital cardiac condition and are characterized by a structural abnormality whereby the aortic valve is composed of two leaflets instead of being trileaflet. It is linked to an increased risk for a variety of complications of the aorta, many with an immunological pathogenesis. The aim of this study is to review and analyze the literature regarding immunological processes involving BAVs, associated common pathologies, and their incidence in the population. This study will also examine current trends in surgical and therapeutic approaches to treatment and discuss the future direction of BAV treatment.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Monira Sharif
- Department of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Mohamad Bashir
- Department of Emergency Medicine and Surgery, Macclesfield General Hospital, Macclesfield, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
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Goudot G, Mirault T, Bruneval P, Soulat G, Pernot M, Messas E. Aortic Wall Elastic Properties in Case of Bicuspid Aortic Valve. Front Physiol 2019; 10:299. [PMID: 31024329 PMCID: PMC6467952 DOI: 10.3389/fphys.2019.00299] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/06/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose of the Review Bicuspid aortic valve (BAV) is associated with a significant risk of development of aneurysm and dissection of the ascending thoracic aorta. Development of what is called BAV associated aortopathy is particularly heterogeneous with an uncertain prognosis and with no prognostic biomarkers except for the aortic diameter. This situation leads to an important variability of the therapeutic strategy of this aortopathy. By reviewing the literature on aortic stiffness in the case of BAV, we aimed at evaluating its potential prognostic role in the development of aortic dilatation. Recent Findings Studies evaluating aortic stiffness, with ultrasound or magnetic resonance imaging, converge toward the description of an increased segmental aortic stiffness in BAV patients regardless of age, diameter or aortic level, from the root to the arch. Even though there is a lack of longitudinal studies evaluating the progression of aortic dilatation, new data have recently shown the potential prognostic role of the maximal rate of systolic distension of the aortic wall with magnetic resonance imaging. Summary Although the use of aortic distensibility calculation is a simple evaluation of stiffness that could be easily transposed in daily practice, its interpretation remains uncertain. New arterial stiffening indicators seem more promising but need a stronger validation.
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Affiliation(s)
- Guillaume Goudot
- INSERM U1273, ESPCI Paris, CNRS FRE 2031, Physics for Medicine Paris, PSL Research University, Paris, France
| | - Tristan Mirault
- Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,INSERM U970 PARCC, Paris Descartes University - Sorbonne Paris Cité University, Paris, France
| | - Patrick Bruneval
- Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Service d'Anatomie Pathologique, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Gilles Soulat
- Service de Radiologie Cardiovasculaire, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Mathieu Pernot
- INSERM U1273, ESPCI Paris, CNRS FRE 2031, Physics for Medicine Paris, PSL Research University, Paris, France
| | - Emmanuel Messas
- Centre de Référence des Maladies Vasculaires Rares, Hôpital Européen Georges-Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,INSERM U970 PARCC, Paris Descartes University - Sorbonne Paris Cité University, Paris, France
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Park JE, Park JS, Jang SY, Park SH, Kim JW, Ki CS, Kim DK. A novel SMAD6 variant in a patient with severely calcified bicuspid aortic valve and thoracic aortic aneurysm. Mol Genet Genomic Med 2019; 7:e620. [PMID: 30848080 PMCID: PMC6503022 DOI: 10.1002/mgg3.620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 02/11/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) is the most common congenital heart defect with a prevalence of 1%-2% in the general population. NOTCH1, SMAD6, and GATA5 are associated with BAV in humans, but few cases have been reported that did not involve NOTCH1. Here, we identified novel in-frame variants in SMAD6 (c.1168_1173dup; p.Gly390_Ile391dup) in a BAV patient, who presented with dilatation of the ascending aorta and severe calcification of the aortic valve. METHODS Twenty BAV associated genes were screened by exome sequencing. Functional effects of SMAD6 variant were investigated using bone morphogenetic protein (BMP) signaling assays through in vitro functional study. RESULTS Exome sequencing revealed he had novel in-frame variants in the SMAD6 gene (c.1168_1173dup; p.Gly390_Ile391dup). SMAD6 is known to be an inhibitory protein in the BMP signaling pathway. In vitro functional study of the p.Gly390_Ile391dup variant revealed impaired inhibition of BMP signaling and BMP-induced alkaline phosphatase activity. CONCLUSION In conclusion, we identified a novel SMAD6 variant causing a severely calcified BAV and TAA, which contributes to our understanding of the clinical and genetic background of SMAD6-related BAV.
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Affiliation(s)
- Jong Eun Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Park
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea
| | - Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Hee Park
- Department of Biological Sciences, Sungkyunkwan University, Suwon, Korea
| | - Jong-Won Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liu T, Xie M, Lv Q, Li Y, Fang L, Zhang L, Deng W, Wang J. Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment. Front Physiol 2019; 9:1921. [PMID: 30761020 PMCID: PMC6363677 DOI: 10.3389/fphys.2018.01921] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
The bicuspid aortic valve, a kind of heart disease that comes from parents, has been paid attention around the world. Although most bicuspid aortic valve (BAV) patients will suffer from some complications including aortic stenosis, aortic regurgitation, endocarditis, and heart dysfunction in the late stage of the disease, there is none symptom in the childhood, which restrains us to diagnose and treatment in the onset phase of BAV. Hemodynamic abnormalities induced by the malformations of the valves in BAV patients for a long time will cause BAV-associated aortopathy: including progress aortic dilation, aneurysm, dissection and rupture, cardiac cyst and even sudden death. At present, preventive surgical intervention is the only effective method used in this situation and the diameter of the aorta is the primary reference criterion for surgery. And the treatment effects are always not satisfactory for patients and clinicians. Therefore, we need more methods to evaluate the progression of BAV and the surgery value and the appropriate intervention time by combining basic research with clinical treatment. In this review, advances in morphology, genetic, biomarkers, diagnosis and treatments are summarized, which expects to provide an update about BAV. It is our supreme expectations to provide some evidences for BAV early screening and diagnosis, and in our opinion, personalized surgical strategy is the trend of future BAV treatment.
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Affiliation(s)
- Tianshu Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lingyun Fang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Abstract
A bicuspid aortic valve is not only a common congenital heart defect but also an enigmatic condition that can cause a large spectrum of diseases, such as aortic valve stenosis and severe heart failure in newborns whereas aortic dissection in adults. On the contrary, a bicuspid aortic valve can also occur with normal function throughout life and never need treatment. Numerous genetic mechanisms are involved in the abnormal cellular functions that may cause abnormal development of the aortic valve during early foetal life. As several chromosomal disorders are also associated with a bicuspid valve, there does not appear to be an apparent common trigger to the abnormal development of the aortic valve. The clinical care of the bicuspid aortic valve patient has been changed by a significant body of evidence that has improved the understanding of the natural history of the disease, including when to best intervene with valve replacement and when to provide prophylactic aortic root surgery. Moreover, as bicuspid valve disease is also part of various syndromes, we can identify high-risk patients in whom a bicuspid valve is much more unfavourable than in the normal population. This review provides an overview of all aspects of the bicuspid aortic valve condition and gives an updated perspective on issues from pathophysiology to clinical care of bicuspid aortic valve disease and associated aortic disease in asymptomatic, symptomatic, and pregnant patients, as well as our viewpoint on population screening.
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Liu J, Shar JA, Sucosky P. Wall Shear Stress Directional Abnormalities in BAV Aortas: Toward a New Hemodynamic Predictor of Aortopathy? Front Physiol 2018; 9:993. [PMID: 30154723 PMCID: PMC6102585 DOI: 10.3389/fphys.2018.00993] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 12/17/2022] Open
Abstract
The bicuspid aortic valve (BAV) generates wall shear stress (WSS) abnormalities in the ascending aorta (AA) that may be responsible for the high prevalence of aortopathy in BAV patients. While previous studies have analyzed the magnitude and oscillatory characteristics of the total or streamwise WSS in BAV AAs, the assessment of the circumferential component is lacking despite its expected significance in this highly helical flow environment. This gap may have hampered the identification of a robust hemodynamic predictor of BAV aortopathy. The objective of this study was to perform a global and component-specific assessment of WSS magnitude, oscillatory and directional characteristics in BAV AAs. The WSS environments were computed in the proximal and middle convexity of tricuspid aortic valve (TAV) and BAV AAs using our previous valve-aorta fluid-structure interaction (FSI) models. Component-specific WSS characteristics were investigated in terms of temporal shear magnitude (TSM) and oscillatory shear index (OSI). WSS directionality was quantified in terms of mean WSS vector magnitude and angle, and angular dispersion index (Dα). Local WSS magnitude and multidirectionality were captured in a new shear magnitude and directionality index (SMDI) calculated as the product of the mean WSS magnitude and Dα. BAVs subjected the AA to circumferential TSM overloads (2.4-fold increase vs. TAV). TAV and BAV AAs exhibited a unidirectional circumferential WSS (OSI < 0.04) and an increasingly unidirectional longitudinal WSS between the proximal (OSI > 0.21) and middle (OSI < 0.07) sections. BAVs generated mean WSS vectors skewed toward the anterior wall and WSS angular distributions exhibiting decreased uniformity in the proximal AA (0.27-point increase in Dα vs. TAV). SMDI was elevated in all BAV AAs but peaked in the proximal LR-BAV AA (3.6-fold increase vs. TAV) and in the middle RN-BAV AA (1.6-fold increase vs. TAV). This analysis demonstrates the significance of the circumferential WSS component and the existence of substantial WSS directional abnormalities in BAV AAs. SMDI abnormality distributions in BAV AAs follow the morphotype-dependent occurrence of dilation in BAV AAs, suggesting the predictive potential of this metric for BAV aortopathy.
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Affiliation(s)
- Janet Liu
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, United States
| | - Jason A Shar
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, United States
| | - Philippe Sucosky
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, United States
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