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Abnormal pulse wave velocity in bicuspid aortic valve: comparison to trileaflet aortic valve and the impact of aortic regurgitation
Journal of Cardiovascular Magnetic Resonance
Oral presentation Abnormal pulse wave velocity in bicuspid aortic valve: comparison to trileaflet aortic valve and the impact of aortic regurgitation Prabhakar Rajiah*, Randolph Setser and Scott D Flamm
Address: Cleveland Clinic Foundation 0
Cleveland 0
OH 0
USA 0
Corresponding author 0
0 from 13th Annual SCMR Scientific Sessions Phoenix , AZ, USA. 21-24 January 2010
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Introduction
Abnormal aortic stiffness implies an unfavorable
prognosis in a variety of aortic diseases, and is considered an
emerging biomarker for cardiovascular disease. In
bicuspid aortic valve (BAV), aortic stiffness can be elevated as a
result of intrinsic aortopathy, as well as geometrical,
morphological and functional abnormalities. Aortic
regurgitation (AR) is associated with LV dysfunction in
approximately 4% of patients per year. It has been found
that loss of vascular elasticity in patients with AR hastens
the development of symptoms, as typically aortic
regurgitation is compensated for by increased systolic volume,
which is then further accommodated by compliant
arteries.
Purpose
The aim of this study was to assess aortic stiffness by pulse
wave velocity (PWV) measurements from velocity
encoded magnetic resonance (VENC-MRI) in patients
with BAV, and determine if a gradient of PWV
abnormalities exists relative to the degree of aortic regurgitation in
patients with BAV. And secondarily to compare these
abnormalities in patients with AR, but trileaflet valves
along with normal controls.
Methods
VENC-MRI was performed in 100 patients with BAV, 100
patients with trileaflet valve with dilated aorta, and 40
normal control subjects. BAV and trileaflet groups were
aortic size matched. AR was graded based on
echocardiography on a 0-4 scale (0-none, 1-mild, 2-moderate,
3-moderatesevere, 4-severe), with 20 patients each per grade.
PWV was determined between the mid ascending and
descending thoracic aorta.
Results
The mean aortic sinus diameter was 3.9 0.9 cm in BAV,
3.7 0.8 cm in trileaflet valve, and 3.0 0.2 cm in normal
controls. Hypertension (HTN) was higher in the trileaflet
group than the BAV (62% vs 35%, p < 0.001). PWV was
significantly elevated in both the BAV and trileaflet
patients, as compared to controls (8.1 6.3 m/s, 8.1 4.5
m/s vs 4.0 1.1 m/s, p < 0.001). PWV in different grades
of AR in BAV and trileaflet valve were not significantly
different, except for Grade 1 regurgitation patients where
there was a significantly elevated PWV in the BAV patients
compared to the trileaflet Grade 1 group (p < 0.001).
Conclusion
There are minor differences in aortic stiffness between
grades of AR in BAV and trileaflet valves. However,
controlling for aortic size there is no statistically significant
difference between the groups, making uncertain the
etiology for abnormal aortic stiffness. Intrinsic aortopathy in
BAV and increased HTN in trileaflet valve group may have
comparable effects and warrant further research.
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