Biomechanics of Aortic Dissection: A Comparison of Aortas Associated With Bicuspid and Tricuspid Aortic Valves.
Biomechanics of Aortic Dissection: A Comparison of Aortas Associated With Bicuspid and Tricuspid Aortic Valves.
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DOI：
10.1161/jaha.120.016715
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发表时间：
2020-08-04
影响因子：
5.4
通讯作者：
Ouzounian M
中科院分区：
文献类型：
--
作者：
Chung JC;Wong E;Tang M;Eliathamby D;Forbes TL;Butany J;Simmons CA;Ouzounian M
目前的主动脉夹层风险评估方法对于患有与二尖瓣主动脉瓣（BAV）或三尖瓣主动脉瓣（TAV）相关的升主动脉瘤的患者来说是不够的。主动脉组织的生物力学测试可能提供新的见解和生物标志物。 2017年3月至2019年8月，从选择性主动脉手术中收集动脉瘤性升主动脉（BAV = 23，TAV = 23），从移植供体中收集正常主动脉（n = 9），从主动脉夹层手术中收集夹层主动脉（n = 7）。这些主动脉在模拟主动脉夹层中进行了分层测试。进行双轴拉伸测试以确定弹性模量（主动脉刚度）和能量损失（执行 Windkessel 功能的效率的度量）。剥离强度 (S d) 在解剖主动脉中最低 (18±6 mN/mm)，在正常主动脉中最高 (58±16 mN/mm)，动脉瘤介于两者之间，BAV 组的 S d (37±10 mN/mm) 大于 TAV 组 (27±10 mN/mm) (P<0.001)。二尖瓣主动脉病与更大的硬度相关（P<0.001），而TAV 导致的动脉瘤则表现出更大的能量损失（P<0.001）。每十年寿命，S d 每毫米降低 7.8±1.2 mmol/L（r 2=0.45，P<0.001），并且高血压患者显着降低（P=0.001）。主动脉直径每增加一厘米，S d 每毫米减少 6.1±2.1 mmol/L（r 2=0.15，P=0.007）。能量损失增加与S d 降低相关（r 2 = 0.41），而S d 和主动脉僵硬度之间没有关系。 BAV 动脉瘤的 S d 高于 TAV 动脉瘤，表明 BAV 具有保护作用。 BAV 动脉瘤的能量损失较低，并且与 S d 呈负相关，代表一种潜在的新型生物标志物。
Current methods for aortic dissection risk assessment are inadequate for patients with ascending aortic aneurysms associated with either bicuspid aortic valves (BAVs) or tricuspid aortic valves (TAVs). Biomechanical testing of aortic tissue may provide novel insights and biomarkers. From March 2017 to August 2019, aneurysmal ascending aortas (BAV=23, TAV=23) were collected from elective aortic surgery, normal aortas from transplant donors (n=9), and dissected aortas from surgery for aortic dissection (n=7). These aortas underwent delamination testing in simulation of aortic dissection. Biaxial tensile testing was performed to determine modulus of elasticity (aortic stiffness), and energy loss (a measure of efficiency in performing the Windkessel function). Delamination strength (S d) was lowest in dissected aortas (18±6 mN/mm) and highest in normal aortas (58±16 mN/mm), and aneurysms fell in between, with greater S d in the BAV group (37±10 mN/mm) than the TAV group (27±10 mN/mm) (P<0.001). Bicuspid aortopathy was associated with greater stiffness (P<0.001), while aneurysms with TAV demonstrated greater energy loss (P<0.001). S d decreased by 7.8±1.2 mmol/L per mm per decade of life (r 2=0.45, P<0.001), and it was significantly lower for patients with hypertension (P=0.001). S d decreased by 6.1±2.1 mmol/L per mm with each centimeter increase in aortic diameter (r 2=0.15, P=0.007). Increased energy loss was associated with decreased S d (r 2=0.41), whereas there was no relationship between S d and aortic stiffness. Aneurysms with BAV had higher S d than those with TAV, suggesting that BAV was protective. Energy loss was lower in aneurysms with BAV, and inversely associated with S d, representing a potential novel biomarker.