1
|
Hanigk M, Burgstaller E, Latus H, Shehu N, Zimmermann J, Martinoff S, Hennemuth A, Ewert P, Stern H, Meierhofer C. Aortic wall shear stress in bicuspid aortic valve disease-10-year follow-up. Cardiovasc Diagn Ther 2023; 13:38-50. [PMID: 36864959 PMCID: PMC9971286 DOI: 10.21037/cdt-22-477] [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: 09/21/2022] [Accepted: 12/19/2022] [Indexed: 02/21/2023]
Abstract
Background Bicuspid aortic valve (BAV) disease leads to deviant helical flow patterns especially in the mid-ascending aorta (AAo), potentially causing wall alterations such as aortic dilation and dissection. Among others, wall shear stress (WSS) could contribute to the prediction of long-term outcome of patients with BAV. 4D flow in cardiovascular magnetic resonance (CMR) has been established as a valid method for flow visualization and WSS estimation. The aim of this study is to reevaluate flow patterns and WSS in patients with BAV 10 years after the initial evaluation. Methods Fifteen patients (median age 34.0 years) with BAV were re-evaluated 10 years after the initial study from 2008/2009 using 4D flow by CMR. Our particular patient cohort met the same inclusion criteria as in 2008/2009, all without enlargement of the aorta or valvular impairment at that time. Flow patterns, aortic diameters, WSS and distensibility were calculated in different aortic regions of interest (ROI) with dedicated software tools. Results Indexed aortic diameters in the descending aorta (DAo), but especially in the AAo did not change in the 10-year period. Median difference 0.05 cm/m2 (95% CI: 0.01 to 0.22; P=0.06) for AAo and median difference -0.08 cm/m2 (95% CI: -0.12 to 0.01; P=0.07) for DAo. WSS values were lower in 2018/2019 at all measured levels. Aortic distensibility decreased by median 25.6% in the AAo, while stiffness increased concordantly (median +23.6%). Conclusions After a ten years' follow-up of patients with isolated BAV disease, indexed aortic diameters did not change in this patient cohort. WSS was lower compared to values generated 10 years earlier. Possibly a drop of WSS in BAV could serve as a marker for a benign long-term course and implementation of more conservative treatment strategies.
Collapse
Affiliation(s)
- Michael Hanigk
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Elisabeth Burgstaller
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiner Latus
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Judith Zimmermann
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Anja Hennemuth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany;,Fraunhofer MEVIS Institute for Digital Medicine, Bremen, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Goudot G, Cheng C, Guédon AF, Mirault T, Pedreira O, Dahan A, Wang LZ, Pernot M, Messas E. Methods: Aortic wall deformation assessment by ultrafast ultrasound imaging: Application to bicuspid aortic valve associated aortopathy. Front Physiol 2023; 14:1128663. [PMID: 36935759 PMCID: PMC10020335 DOI: 10.3389/fphys.2023.1128663] [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: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose: Aortic maximal rate of systolic distention (MRSD) is a prognosis factor of ascending aorta dilatation with magnetic resonance imaging. Its calculation requires precise continuous tracking of the aortic diameter over the cardiac cycle, which is not feasible by focused ultrasound. We aimed to develop an automatic aortic acquisition using ultrafast ultrasound imaging (UUI) to provide access to the aortic MRSD. Methods: A phased array probe and developed sequences at 2000 frames/s were used. A created interface automatically tracked the anterior and posterior aortic walls over the cardiac cycle. Tissue Doppler allowed a precise estimation of the walls' movements. MRSD was the maximum derivative of the aortic diameter curve over time. To assess its feasibility, 34 patients with bicuspid aortic valve (BAV) and 31 controls were consecutively included to evaluate the BAV-associated aortopathy at the sinus of Valsalva, the tubular ascending aorta, and the aortic arch. Results: UUI acquisitions and the dedicated interface allow tracking of the aortic diameter and calculating the MRSD for the BAV patients and controls (mean age of 34 vs. 43 years, p = 0.120). A trend toward lower deformation in the different aortic segments was observed, as expected. Still, only the MRSD with UUI was significantly different at the sinus of Valsalva in this small series: (0.61 .103.s-1 [0.37-0.72] for BAV patients vs. 0.92 .103.s-1 [0.72-1.02] for controls, p = 0.025). Conclusion: Aortic deformation evaluated with UUI deserves attention with a simple and automated measurement technique that could assess the segmental aortic injury associated with BAV.
Collapse
Affiliation(s)
- Guillaume Goudot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM U970, PARCC, Paris, France
- *Correspondence: Guillaume Goudot,
| | - Charles Cheng
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Alexis F. Guédon
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM U970, PARCC, Paris, France
| | - Olivier Pedreira
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Alexandre Dahan
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Louise Z. Wang
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Mathieu Pernot
- Physics for Medicine Paris, INSERM U1273, ESPCI Paris, CNRS FRE, PSL Research University, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges-Pompidou European Hospital, AP-HP, Université Paris Cité, Paris, France
- Université Paris Cité, INSERM U970, PARCC, Paris, France
| |
Collapse
|
3
|
Balint B, Federspiel J, Kollmann C, Teping P, Schwab T, Schäfers HJ. SMAD3 contributes to ascending aortic dilatation independent of transforming growth factor-beta in bicuspid and unicuspid aortic valve disease. Sci Rep 2022; 12:15476. [PMID: 36104385 PMCID: PMC9474869 DOI: 10.1038/s41598-022-19335-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
We sought to determine whether there are differences in transforming growth factor-beta (TGFß) signaling in aneurysms associated with bicuspid (BAV) and unicuspid (UAV) aortic valves versus normal aortic valves. Ascending aortic aneurysms are frequently associated with BAV and UAV. The mechanisms are not yet clearly defined, but similarities to transforming growth factor-beta TGFß vasculopathies (i.e. Marfan, Loeys-Dietz syndromes) are reported. Non-dilated (ND) and aneurysmal (D) ascending aortic tissue was collected intra-operatively from individuals with a TAV (N = 10ND, 10D), BAV (N = 7ND, 8D) or UAV (N = 7ND, 8D). TGFß signaling and aortic remodeling were assessed through immuno-assays and histological analyses. TGFß1 was increased in BAV/UAV-ND aortas versus TAV (P = 0.02 and 0.04, respectively). Interestingly, TGFß1 increased with dilatation in TAV (P = 0.03) and decreased in BAV/UAV (P = 0.001). In TAV, SMAD2 and SMAD3 phosphorylation (pSMAD2, pSMAD3) increased with dilatation (all P = 0.04) and with TGFß1 concentration (P = 0.04 and 0.03). No relationship between TGFß1 and pSMAD2 or pSMAD3 was observed for BAV/UAV (all P > 0.05). pSMAD3 increased with dilatation in BAV/UAV aortas (P = 0.01), whereas no relationship with pSMAD2 was observed (P = 0.56). Elastin breaks increased with dilatation in all groups (all P < 0.05). In TAV, elastin degradation correlated with TGFß1, pSMAD2 and pSMAD3 (all P < 0.05), whereas in BAV and UAV aortas, elastin degradation correlated only with pSMAD3 (P = 0.0007). TGFß signaling through SMAD2/SMAD3 contributes to aortic remodeling in TAV, whereas TGFß-independent activation of SMAD3 may underlie aneurysm formation in BAV/UAV aortas. Therefore, SMAD3 should be further investigated as a therapeutic target against ascending aortic dilatation in general, and particularly in BAV/UAV patients.
Collapse
|
4
|
Surman TL, Abrahams JM, Manavis J, Finnie J, O'Rourke D, Reynolds KJ, Edwards J, Worthington MG, Beltrame J. Histological regional analysis of the aortic root and thoracic ascending aorta: a complete analysis of aneurysms from root to arch. J Cardiothorac Surg 2021; 16:255. [PMID: 34496896 PMCID: PMC8424949 DOI: 10.1186/s13019-021-01641-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/29/2021] [Indexed: 01/16/2023] Open
Abstract
Background Although aortic root and ascending aortic aneurysms are treated the same, they differ in embryological development and pathological processes. This study examines the microscopic structural differences between aortic root and ascending aortic aneurysms, correlating these features to the macroscopic pathophysiological processes. Methods We obtained surgical samples from ascending aortic aneurysms (n = 11), aortic root aneurysms (n = 3), and non-aneurysmal patients (n = 7), Aortic collagen and elastin content were examined via histological analysis, and immunohistochemistry techniques used to determine collagen I, III, and IV subtypes. Analysis was via observational features, and colour deconvolution quantification techniques. Results Elastin fiber disruption and fragmentation was the most extensive in the proximal aneurysmal regions. Medial fibrosis and collagen density increased in proximal aneurysmal regions and aortic root aneurysms (p < 0.005). Collagen I was seen in highest quantity in aortic root aneurysms. Collagen I content was greatest in the sinus tissue regions compared to the valvular and ostial regions (p < 0.005) Collagen III and IV quantification did not vary greatly. The most susceptible regions to ultrastructural changes in disease are the proximal ascending aorta and aortic root. Conclusions The aortic root differs histologically from the ascending aorta confirming its unique composition in aneurysm pathology. These findings should prompt further evaluation on the influence of this altered structure on function which could potentially guide clinical management. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01641-5.
Collapse
Affiliation(s)
- Timothy Luke Surman
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. .,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia. .,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia. .,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia. .,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - John Matthew Abrahams
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jim Manavis
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John Finnie
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dermot O'Rourke
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen Jane Reynolds
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - James Edwards
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael George Worthington
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John Beltrame
- D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Cardiology Department, Queen Elizabeth Hospital, Adelaide, SA, Australia.,Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia.,Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
5
|
Wang J, Deng W, Lv Q, Li Y, Liu T, Xie M. Aortic Dilatation in Patients With Bicuspid Aortic Valve. Front Physiol 2021; 12:615175. [PMID: 34295254 PMCID: PMC8290129 DOI: 10.3389/fphys.2021.615175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/03/2021] [Indexed: 12/16/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality. BAV aortic dilatation is associated with an increased risk of adverse aortic events and represents a potentially lethal disease and hence a considerable medical burden. BAV with aortic dilatation warrants frequent monitoring, and elective surgical intervention is the only effective method to prevent dissection or rupture. The predictive value of the aortic diameter is known to be limited. The aortic diameter is presently still the main reference standard for surgical intervention owing to the lack of a comprehensive understanding of BAV aortopathy progression. This article provides a brief comprehensive review of the current knowledge on BAV aortopathy regarding clinical definitions, epidemiology, natural course, and pathophysiology, as well as hemodynamic and clinically significant aspects on the basis of the limited data available.
Collapse
Affiliation(s)
- Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Wenhui Deng
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tianshu Liu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
6
|
Carlos T, Freitas AA, Alves PM, Martins R, Gonçalves L. Aortic strain in bicuspid aortic valve: an analysis. Int J Cardiovasc Imaging 2021; 37:2399-2408. [PMID: 33818697 DOI: 10.1007/s10554-021-02215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
Bicuspid aortic valve (BAV) is monitored by transthoracic echocardiography and computed tomography (CT) angiography. However, it does not have any early marker of disease progression. This study evaluated speckle-tracking echocardiography (STE) aortic and left ventricular (LV) strain prognostic values, their discriminative power, and their correlation with the degree of valvular regurgitation. We conducted a retrospective analysis of a prospectively enrolled cohort of 45 diagnosed with BAV and 20 gender and age matched controls. We performed 2D-STE aortic and LV strain analysis of the selected population. The cohort was followed-up during a median period of 19.9 months (IQR 12.9-25.2), and outcomes (hospital admission for heart failure (HF), aortic valve replacement (AVR), and death) were determined. The mean patient age was 46.6 ± 15.5 years and 80 % were male. LV indexed volumes and aortic diameter were higher in BAV patients. LV global longitudinal strain (GLS) was impaired (p < 0.001) and aortic GLS was significantly augmented (p = 0.027) in BAV patients. Aortic global circumferential strain (GCS) did not vary between groups. Aortic diameter was the best parameter related to BAV (AUC 0.92) and aortic GLS was best correlated with significant AR (AUC 0.76). AVR was the only outcome observed and its only predictor was indexed LV end-diastolic volume. BAV had impaired LV-GLS values. Aortic GLS was abnormally augmented in BAV patients, which might reflect higher aortic diameters that distorted strain calculations. STE aortic strain is related to AR but does not appear to be a reliable predictor of surgery in BAV patients, at 19 months.
Collapse
Affiliation(s)
- Tomás Carlos
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - André Azul Freitas
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Patrícia Marques Alves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal. .,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal.
| | - Rui Martins
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| |
Collapse
|
7
|
Weismann CG, Ljungberg S, Åkesson A, Hlebowicz J. Multimodal Assessment of Vascular and Ventricular Function in Children and Adults With Bicuspid Aortic Valve Disease. Front Cardiovasc Med 2021; 8:643900. [PMID: 33834044 PMCID: PMC8021774 DOI: 10.3389/fcvm.2021.643900] [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: 12/19/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, has been associated with an aortopathy, increased aortic stiffness and diastolic dysfunction. The involved mechanisms and impact of age remain unclear. It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with a history of BAV. Methods: Multimodal cardiovascular assessment included echocardiography, ascending aortic distensibility, common carotid intima media thickness [cIMT], parameters of wave reflection [central (cAIx75) and peripheral (pAIx75) augmentation index corrected to a heart rate of 75/min, aging index (AI)], carotid-femoral pulse wave velocity [cfPWV], and endothelial function (EndoPAT). Multivariable linear regression and correlation analyses were performed. Results: We included 47 BAV patients and 84 controls (age 8–65 years). Ascending aortic stiffness, pulse wave reflection (cAIx75, pAIx75, and AI) and central blood pressure were significantly increased in patients with BAV. However, PWV, cIMT, and endothelial function were not significantly different from controls. BAV patients had marginally reduced diastolic (E': β = −1.5, p < 0.001) but not systolic function compared to controls. Overall, all parameters of arterial stiffness had moderate-strong correlations with diastolic dysfunction and age. In the BAV group, ascending aortic distensibility had the strongest correlation with diastolic dysfunction. Conclusions: BAV is associated with increased proximal arterial stiffness and wave reflection. However, PWV and cIMT are not increased, and endothelial function is preserved. This suggests that the mechanism of arterial and cardiac stiffening is different from patients with acquired heart diseases.
Collapse
Affiliation(s)
- Constance G Weismann
- Division of Pediatric Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sara Ljungberg
- Division of Pediatric Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna Åkesson
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - J Hlebowicz
- Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
8
|
Creamer TJ, Bramel EE, MacFarlane EG. Insights on the Pathogenesis of Aneurysm through the Study of Hereditary Aortopathies. Genes (Basel) 2021; 12:genes12020183. [PMID: 33514025 PMCID: PMC7912671 DOI: 10.3390/genes12020183] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Thoracic aortic aneurysms (TAA) are permanent and localized dilations of the aorta that predispose patients to a life-threatening risk of aortic dissection or rupture. The identification of pathogenic variants that cause hereditary forms of TAA has delineated fundamental molecular processes required to maintain aortic homeostasis. Vascular smooth muscle cells (VSMCs) elaborate and remodel the extracellular matrix (ECM) in response to mechanical and biochemical cues from their environment. Causal variants for hereditary forms of aneurysm compromise the function of gene products involved in the transmission or interpretation of these signals, initiating processes that eventually lead to degeneration and mechanical failure of the vessel. These include mutations that interfere with transduction of stimuli from the matrix to the actin-myosin cytoskeleton through integrins, and those that impair signaling pathways activated by transforming growth factor-β (TGF-β). In this review, we summarize the features of the healthy aortic wall, the major pathways involved in the modulation of VSMC phenotypes, and the basic molecular functions impaired by TAA-associated mutations. We also discuss how the heterogeneity and balance of adaptive and maladaptive responses to the initial genetic insult might contribute to disease.
Collapse
Affiliation(s)
- Tyler J. Creamer
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Emily E. Bramel
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Predoctoral Training in Human Genetics and Molecular Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Elena Gallo MacFarlane
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (T.J.C.); (E.E.B.)
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence:
| |
Collapse
|
9
|
Hautin R, Mirault T, Munte L, Achouh P, Khider L, Messas E, Goudot G. Aortic Dissection in an Undiagnosed Familial Form of Bicuspid Aortic Valve with a Short Raphe. ACTA ACUST UNITED AC 2020; 4:443-447. [PMID: 33117946 PMCID: PMC7581640 DOI: 10.1016/j.case.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BAV is associated with risk for dissection of the proximal aorta. Thorough BAV investigation is required for any aortic dissection. Familial forms of BAV are probably associated with an increased risk for aortopathy. Familial screening is desirable to organize follow-up of each patient with BAV.
Collapse
Affiliation(s)
- Ryan Hautin
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laura Munte
- Cardiac Surgery Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Paul Achouh
- Cardiac Surgery Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lina Khider
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| |
Collapse
|
10
|
de Oliveira DMC, Abdullah N, Green NC, Espino DM. Biomechanical Assessment of Bicuspid Aortic Valve Phenotypes: A Fluid-Structure Interaction Modelling Approach. Cardiovasc Eng Technol 2020; 11:431-447. [PMID: 32519086 DOI: 10.1007/s13239-020-00469-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Bicuspid aortic valve (BAV) is a congenital heart malformation with phenotypic heterogeneity. There is no prior computational study that assesses the haemodynamic and valve mechanics associated with BAV type 2 against a healthy tricuspid aortic valve (TAV) and other BAV categories. METHODS A proof-of-concept study incorporating three-dimensional fluid-structure interaction (FSI) models with idealised geometries (one TAV and six BAVs, namely type 0 with lateral and anterior-posterior orientations, type 1 with R-L, N-R and N-L leaflet fusion and type 2) has been developed. Transient physiological boundary conditions have been applied and simulations were run using an Arbitrary Lagrangian-Eulerian formulation. RESULTS Our results showed the presence of abnormal haemodynamics in the aorta and abnormal valve mechanics: type 0 BAVs yielded the best haemodynamical and mechanical outcomes, but cusp stress distribution varied with valve orifice orientation, which can be linked to different cusp calcification location onset; type 1 BAVs gave rise to similar haemodynamics and valve mechanics, regardless of raphe position, but this position altered the location of abnormal haemodynamic features; finally, type 2 BAV constricted the majority of blood flow, exhibiting the most damaging haemodynamic and mechanical repercussions when compared to other BAV phenotypes. CONCLUSION The findings of this proof-of-concept work suggest that there are specific differences across haemodynamics and valve mechanics associated with BAV phenotypes, which may be critical to subsequent processes associated with their pathophysiology processes.
Collapse
Affiliation(s)
- Diana M C de Oliveira
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Nazirul Abdullah
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Naomi C Green
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| |
Collapse
|
11
|
Haunschild J, Schellinger IN, Barnard SJ, von Aspern K, Davierwala P, Misfeld M, Petroff D, Borger MA, Etz CD. Bicuspid aortic valve patients show specific epigenetic tissue signature increasing extracellular matrix destruction. Interact Cardiovasc Thorac Surg 2020; 29:937-943. [PMID: 31501876 DOI: 10.1093/icvts/ivz210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Patients with a bicuspid aortic valve (BAV) have an increased risk for developing thoracic aortic aneurysm, which is characterized by the destruction of the elastic media of the aortic wall. Several important enzymes have been characterized to play key roles in extracellular matrix homeostasis, namely matrix metalloproteinases (MMPs). In this study, we investigated MMP-2 levels and their epigenetic regulation via the miR-29 family. METHODS Aortic tissue samples from 58 patients were collected during cardiac surgery, of which 30 presented with a BAV and 28 with a tricuspid aortic valve. Polymerase chain reaction, western blot analysis and immunohistochemistry were performed to analyse MMP-2. In addition, enzyme-linked immunosorbent assay measurements were carried out to investigate both MMP-2 and tissue inhibitor of metalloproteinase-2 levels. To examine the epigenetic regulation of aortic extracellular matrix homeostasis, we furthermore studied the expression levels of miR-29 via qRT-PCR. RESULTS Patients with a BAV were significantly younger at the time of surgery, presented significantly less frequently with arterial hypertension and displayed more often with an additional valvular disease. On a molecular level, we found that MMP-2 is increased on gene and protein level in BAV patients. Tissue inhibitor of metalloproteinase-2 levels do not differ between the groups. Interestingly, we also found that only miR-29A is significantly downregulated in BAVs. CONCLUSIONS Our findings highlight the importance of MMP-2 in the context of extracellular matrix destruction in BAV patients. We present new evidence that miR-29A is a crucial epigenetic regulator of these pathomechanistic processes and might hold promise for future translational research.
Collapse
Affiliation(s)
- Josephina Haunschild
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | - Isabel N Schellinger
- Department of Endocrinology and Nephrology, University Medical Center Leipzig, Leipzig, Germany
| | - Sarah J Barnard
- Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| | | | - Piroze Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - David Petroff
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Saxonian Incubator for Clinical Translation, University Leipzig, Leipzig, Germany
| |
Collapse
|
12
|
|
13
|
Gaur L, Kutty S. Surveillance of Repaired Aortic Coarctation: The Quest for a Better Index of Left Ventricular Afterload. Circ Cardiovasc Imaging 2020; 13:e010426. [PMID: 32069117 DOI: 10.1161/circimaging.120.010426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lasya Gaur
- The Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| | - Shelby Kutty
- The Blalock-Taussig-Thomas Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD
| |
Collapse
|
14
|
A Razik N, Kishk YT, Bakheet MY, Nous M, Abdel Ghany M. Cardiac magnetic resonance assessment of aortic distensibility in prediabetic patients. Egypt Heart J 2020; 72:4. [PMID: 31965377 PMCID: PMC6973669 DOI: 10.1186/s43044-020-0040-0] [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: 10/07/2019] [Accepted: 01/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Hyperglycemia, insulin resistance, and hyperinsulinemia represent important pathophysiological components of the prediabetic stage that result in arteriosclerosis and increased arterial stiffness. We sought to compare the aortic distensibility (AD) assessed by cardiac magnetic resonance (CMR) in prediabetic patients presenting with chronic coronary artery disease (CCAD) versus patients with normal HbA1C. Ninety-eight patients with CCAD were recruited. All patients were screened for HbA1C levels and then underwent a CMR study to assess AD of the aortic root and the ascending and descending thoracic aorta. Patients were classified into two groups: 52 prediabetic (HbA1C 5.7–6.4%) (study group) and 46 with normal glycemic status (HbA1C < 5.7%) (control group). Results AD values at the aortic root (AR) (13.93 ± 5.17 vs 34.3 ± 9.65 Kpa-1 × 10-3), ascending aorta (AA) (13.17 ± 4.81 vs 28.1 ± 8.33 Kpa-1 × 10-3), and descending thoracic aorta (DA) (18.12 ± 4.34 vs 33.68 ± 7.57 Kpa-1 × 10-3) were significantly lower in the study group than in the control group (P value for all was < 0.001). Twenty-eight patients fulfilled the criteria for metabolic syndrome, and in those patients, AD was significantly lower than in those without metabolic syndrome. Aortic distensibility at the AR, AA, and DA had strong significant negative correlations with the level of glycosylated hemoglobin (AA, AR, DA; r − 0.66, − 0.68, − 0.58, respectively) (P < 0.001). Conclusion AD values at different points (AR, AA, and DA) were significantly lower in prediabetic and metabolic syndrome patients than in controls. These values also showed a significant negative correlation with the levels of HBA1C.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|