Relationship Between Proximal Aorta Morphology and Progression Rate of Aortic Stenosis
Relationship Between Proximal Aorta Morphology and Progression Rate of Aortic Stenosis
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DOI：
10.1016/j.echo.2017.12.008
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发表时间：
2018-05-01
影响因子：
6.5
通讯作者：
Hung, Judy
中科院分区：
文献类型：
--
作者：
Capoulade, Romain;Teoh, Jonathan G.;Hung, Judy
背景：本研究的目的是研究近端主动脉形态异常与主动脉狭窄(AS)进展率之间的关系。主要假设是近端主动脉的形态改变，如窦管连接(STJ)的消失，导致生物力学应力增加，并有助于AS的钙化和进展。方法：2010-2012年间，426例轻至中度AS患者纳入研究。分别在Valsalva窦、STJ和升主动脉三个不同平面测量主动脉近端内径，并用Valsalva窦/STJ和升主动脉/STJ比值判断主动脉畸形程度。AS进展率通过平均梯度的年化增加来评估(中位随访时间，3.1年；四分位数范围，2.6-3.9年)。结果：患者平均年龄71岁+/-13岁，%为男性。比率低的患者AS进展更大(P<；0.05)。综合调整后，Valsalva/STJ(P=0.025)和升主动脉/STJ(P=0.027)比值与AS进展率独立相关。与无STJ消退的患者相比，有STJ消退的患者的主动脉血流紊乱程度更高(24.4%比17.2%，P=.038)。结论：STJ消退独立地与AS进展相关，与动脉血流动力学、主动脉瓣表型或基线的严重程度无关。主动脉近端几何结构异常的患者曾出现主动脉血流模式紊乱。这些发现提示近端主动脉形态和狭窄进展之间存在相互关系。
Background: The aim of this study was to examine the association between abnormal morphology of the proximal aorta and aortic stenosis (AS) progression rate. The main hypothesis was that morphologic changes of the proximal aorta, such as effacement of the sinotubular junction (STJ), result in increased biomechanical stresses and contribute to calcification and progression of AS.Methods: Between 2010 and 2012, 426 patients with mild to moderate AS were included in this study. Proximal aortic dimensions were measured at three different levels (i.e., sinus of Valsalva, STJ, and ascending aorta), and sinuses of Valsalva/STJ and ascending aorta/STJ ratios were used to determine degree of aortic deformity. AS progression rate was assessed by annualized increase in mean gradient (median follow-up time, 3.1 years; interquartile range, 2.6-3.9 years). The degree of aortic flow turbulence was examined in 18 matched patients with and without STJ effacement using cardiac magnetic resonance phase-contrast imaging.Results: Patients' mean age was 71 +/- 13 years, and 64% were men. Patients with low ratios had greater AS progression (P < .05). After comprehensive adjustment, sinuses of Valsalva/STJ (P = .025) and ascending aorta/STJ (P = .027) ratios were independently associated with greater AS progression rate. Compared with patients without STJ effacement, those with effacement of the STJ had higher degrees of aortic flow turbulence (24.4% vs 17.2%, P = .038).Conclusions: Effacement of the STJ is independently associated with greater AS progression, regardless of arterial hemodynamics, aortic valve phenotype, or baseline AS severity. Patients with abnormal proximal aortic geometry had disturbed aortic flow patterns. These findings suggest an interrelation between proximal aorta morphology and stenosis progression.