Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4-Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects.
Aortic Valve Stenosis Alters Expression of Regional Aortic Wall Shear Stress: New Insights From a 4-Dimensional Flow Magnetic Resonance Imaging Study of 571 Subjects.
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DOI：
10.1161/jaha.117.005959
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发表时间：
2017-09-13
影响因子：
5.4
通讯作者：
Barker AJ
中科院分区：
文献类型：
--
作者：
van Ooij P;Markl M;Collins JD;Carr JC;Rigsby C;Bonow RO;Malaisrie SC;McCarthy PM;Fedak PWM;Barker AJ
壁切应力（WSS）是血管壁重构的刺激因素。据报道，主动脉扩张的二叶式主动脉瓣（BAV）和三叶式主动脉瓣患者的升主动脉（AAo）血流动力学存在差异，但主动脉瓣狭窄（AS）的混杂影响尚不清楚。571例受试者接受了胸主动脉的4维血流磁共振成像（210例右-左BAV瓣尖融合，60例右-非冠状BAV瓣尖融合，245例三尖瓣主动脉瓣扩张患者和56例健康对照）。515例患者中有166例（32%）患有AS。创建WSS图谱，以根据AS严重程度量化AAo中的组特异性WSS模式。在无AS的BAV患者中，不同的瓣尖融合表型导致偏心WSS升高的明显差异：右-左BAV患者在主动脉根部和沿着Aao的整个外弯WSS增加9%至34%（P<0.001），而右-非冠状动脉BAV患者在Aao远端部分WSS增加30%（P<0.001）。三尖瓣主动脉瓣扩张组无主动脉瓣狭窄组6个AAO区中4个区WSS明显降低21%~ 33%（P<0.01）。在所有患者组中，轻度、中度和重度AS导致局部WSS显著增加（P<0.001）。中度至重度AS进一步增加了WSS幅度和AAo的变异性。瓣膜表型之间的差异不再明显。 AS显著改变了主动脉血流动力学和WSS，与主动脉瓣表型无关，并超越了先前描述的与BAV和三尖瓣主动脉瓣相关的血流模式。在研究瓣膜介导的动脉病变时，必须考虑AS的严重程度。
Wall shear stress (WSS) is a stimulus for vessel wall remodeling. Differences in ascending aorta (AAo) hemodynamics have been reported between bicuspid aortic valve (BAV) and tricuspid aortic valve patients with aortic dilatation, but the confounding impact of aortic valve stenosis (AS) is unknown. Five hundred seventy‐one subjects underwent 4‐dimensional flow magnetic resonance imaging in the thoracic aorta (210 right‐left BAV cusp fusions, 60 right‐noncoronary BAV cusp fusions, 245 tricuspid aortic valve patients with aortic dilatation, and 56 healthy controls). There were 166 of 515 (32%) patients with AS. WSS atlases were created to quantify group‐specific WSS patterns in the AAo as a function of AS severity. In BAV patients without AS, the different cusp fusion phenotypes resulted in distinct differences in eccentric WSS elevation: right‐left BAV patients exhibited increased WSS by 9% to 34% (P<0.001) at the aortic root and along the entire outer curvature of the AAo whereas right‐noncoronary BAV patients showed 30% WSS increase (P<0.001) at the distal portion of the AAo. WSS in tricuspid aortic valve patients with aortic dilatation patients with no AS was significantly reduced by 21% to 33% (P<0.01) in 4 of 6 AAo regions. In all patient groups, mild, moderate, and severe AS resulted in a marked increase in regional WSS (P<0.001). Moderate‐to‐severe AS further increased WSS magnitude and variability in the AAo. Differences between valve phenotypes were no longer apparent. AS significantly alters aortic hemodynamics and WSS independent of aortic valve phenotype and over‐rides previously described flow patterns associated with BAV and tricuspid aortic valve with aortic dilatation. Severity of AS must be considered when investigating valve‐mediated aortopathy.