Nature versus nurture in bicuspid aortic valve aortopathy: more evidence that altered hemodynamics may play a role.
Nature versus nurture in bicuspid aortic valve aortopathy: more evidence that altered hemodynamics may play a role.
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二叶式主动脉瓣主动脉病的先天与后天因素：更多证据表明血流动力学改变可能发挥作用。
DOI：
10.1161/circulationaha.113.007282
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发表时间：
2014
期刊：
影响因子：
37.8
通讯作者：
L. Gillam
中科院分区：
文献类型：
--
作者：
S. Uretsky;L. Gillam
没有比主动脉瘤更有助于临床谦虚的疾病了。
>；
>；-威廉·奥斯勒
二尖瓣主动脉瓣(BAV)是一种常见的先天性心脏畸形，影响1-2%的人群，有男性的倾向。2尽管BAV患者经常发展为需要手术治疗的主动脉瘤，3，4主动脉瘤的形成是多种多样的，目前还没有很好的预测动脉瘤形成的指标。尽管研究表明，BAV患者存在易患动脉瘤的遗传性主动脉病变，5，6关于血流动力学改变(后天)和遗传(先天)相互作用的程度仍存在争议。Mahadevia等人在本期《循环》杂志上的研究为这一论点提供了重要的补充支持，即可归因于瓣膜结构异常的血流模式改变确实在BAV大动脉病变中发挥作用。
文章见第673页
相衬磁共振已被用来测量血流速度和流量的变化，用标准技术测量这些参数在二维或通过平面。四维(4D)MRI可以在所有三个维度上可视化和测量主动脉血流的速度和方向，从而不仅提供信息图像，而且是研究血流扰动的改进工具。使用4D MRI的一个比较活跃的研究领域是BAV大动脉病变，希望了解血流障碍将为BAV相关动脉瘤的形成提供新的见解。
先前使用4DMRI的研究8-10已经证实了BAVs患者的升主动脉壁切应力(Wss)的改变，并提示了BAVs融合引起的主动脉流出的改变与升主动脉瘤的发展之间的机制联系。8-13然而，这些研究集中在…
> There is no disease more conducive to clinical humility than aneurysm of the aorta.1
>
> — William Osler
Bicuspid aortic valve (BAV) is a common congenital cardiac malformation affecting 1 to 2% of the population with a predilection for males.2 Although patients with BAV often develop aortic aneurysms requiring surgical intervention,3,4 the formation of aortic aneurysms is variable and there are currently no good predictors of aneurysm formation. Although studies have shown that patients with BAV have genetically inherited aortic disorders that predispose them to aneurysm development,5,6 there is ongoing controversy concerning the degree to which altered hemodynamics (nurture) and genetics (nature) interact. The study by Mahadevia et al7 in this issue of Circulation provides important additional support for the argument that altered flow patterns attributable to abnormal valve architecture do indeed play a role in BAV aortopathy.
Article see p 673
Phase contrast MRI has been used to measure changes in blood velocity and flow with standard techniques measuring these parameters in 2 dimensions, or through plane. Four-dimensional (4D) MRI allows the speed and direction of aortic flow to be visualized and measured over time in all 3 dimensions, thereby providing not only informative images but an improved tool for the study of flow disturbances. One of the more active areas of research using 4D MRI has been in BAV aortopathy with the hope that understanding flow disturbances will give new insight into BAV-associated aneurysm formation.
Prior studies8–10 using 4D MRI have demonstrated altered ascending aortic wall sheer stress (WSS) in patients with BAV and have suggested a mechanistic link between the alteration in aortic outflow caused by the fusion of BAV cusps and the development of ascending aortic aneurysms.8–13 However, these studies have focused …
双刺主动脉尖融合形态改变主动脉三维流出模式，壁剪应力和主动脉病的表达。
影响因子：
37.8
作者：
Mahadevia R;Barker AJ;Schnell S;Entezari P;Kansal P;Fedak PW;Malaisrie SC;McCarthy P;Collins J;Carr J;Markl M
通讯作者：
Markl M
ACE 基因的插入-缺失多态性通过 ACE 抑制调节内皮功能障碍的可逆性。
影响因子：
37.8
作者：
Prasad,A;Narayanan,S;Husain,S;Padder,F;Waclawiw,M;Epstein,N;Quyyumi,AA
通讯作者：
Quyyumi,AA