The impact of the aortic cusps fusion pattern and valve disease severity on the aortic wall mechanics in patients with bicuspid aortic valve

• Published in: The International Journal of Cardiovascular Imaging Vol. 36; no. 8; pp. 1429 - 1436
• Main Authors: Kalinowski, Mariusz E., Szulik, Mariola, Pawlak, Szymon, Rybus-Kalinowska, Barbara, Zembala, Marian, Kalarus, Zbigniew, Kukulski, Tomasz
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.08.2020; Springer Nature B.V
• Subjects: Abnormalities; Acceleration; Adult; Aorta; Aorta - diagnostic imaging; Aorta - physiopathology; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - etiology; Aortic Aneurysm - physiopathology; Aortic dissection; Aortic valve; Aortic Valve - abnormalities; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - etiology; Aortic Valve Stenosis - physiopathology; Bicuspid Aortic Valve Disease; Biomechanical Phenomena; Cardiac Imaging; Cardiology; Coronary vessels; Cusps; Diameters; Dilatation, Pathologic; Doppler effect; Echocardiography; Echocardiography, Doppler, Color; Female; Heart Valve Diseases - complications; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - physiopathology; Heart valves; Hemodynamics; Humans; Imaging; Male; Mechanics (physics); Medicine; Medicine & Public Health; Middle Aged; Original Paper; Predictive Value of Tests; Prognosis; Prospective Studies; Radial velocity; Radiology; Regurgitation; Risk Factors; Severity of Illness Index; Surgery; Velocity; Weight; Mechanics; Aortopathy; Cusp fusion; Hemodynamic; Bicuspid aortic valve; Tissue doppler imaging
• ISSN: 1569-5794; 1875-8312; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-020-01838-0

The ascending aorta dilatation in the bicuspid aortic valve (BAV) patients is often attributed to congenital abnormalities of the aortic wall, but it may be related to hemodynamic disturbances in the course of BAV disease. At present, ascending aortic diameter is used as almost sole but weak predictor of aortic dissection and rupture in BAV. We examined the association between aortic wall mechanics and severity of aortic valve disease including different cusps fusion patterns using conventional echocardiography and tissue Doppler imaging (TDI). We prospectively studied 106 BAV patients: 72 with right-left (R-L) coronary cusp fusion were matched 1:1 to 34 patients with right-noncoronary (R-N) cusp fusion obtaining 34 pairs of patients. Peak systolic radial velocity and acceleration of the ascending aortic wall, measured by TDI, were used as an index of hemodynamic stress imposed on the aorta. Paired analysis showed higher aortic wall radial velocity (4.71 ± 1.61 cm/s vs. 3.33 ± 1.44 cm/s, p = 0.001) and acceleration (1.08 ± 0.46 m/s 2 vs. 0.80 ± 0.34 m/s 2 , p = 0.015) in-R-L compared to R-N fusion. Pearson correlation showed association of ascending tubular aortic diameter with age (r = 0.258, p = 0.012), weight (r = 0.323, p = 0.001), peak aortic valve gradient (r = 0.386, p = 0.0001), aortic root diameter (r = 0.439, p < 0.0001), and R-N fusion pattern (r = 0.209, p = 0.043). Aortic root diameter was related to male gender (r = 0.296, p = 0.003), weight (r = 0.381, p = 0.0001), ascending aortic diameter (r = 0.439, p < 0.0001), and severity of aortic regurgitation (r = 0.337, p = 0.0009). Regional differences in aortic wall motion between different BAV cusp fusion patterns and association of aortic diameters with the severity of aortic valve disease, both suggest a deleterious hemodynamic impact of cusp fusion patterns and aortic valve dysfunction on ascending aortic wall. Assessment of aortic hemodynamic by TDI is feasible and could be potentially used to improve prediction of acute aortic complications, thus helping to establish optimal timing of aortic surgery in BAV patients.