Effect of Blood Pressure Levels on Sinus Hemodynamics in Relation to Calcification After Bioprosthetic Aortic Valve Replacement
Effect of Blood Pressure Levels on Sinus Hemodynamics in Relation to Calcification After Bioprosthetic Aortic Valve Replacement
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DOI：
10.1007/s10439-023-03426-4
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发表时间：
2023-12-29
影响因子：
3.8
通讯作者：
Hatoum，Hoda
中科院分区：
文献类型：
--
作者：
Vogl，Brennan;Sularz，Agata;Hatoum，Hoda
高血压和主动脉瓣狭窄并存很常见。一些研究表明，血压升高可能与钙化性主动脉瓣疾病 (CAVD) 的进展有关，而其他研究则显示没有相关性。 Valsalva 鼻窦的血流动力学被认为是 CAVD 进展的关键因素。虽然血流动力学和 CAVD 之间的关系尚未完全了解，但已证明它们紧密相关。本研究旨在探讨收缩压和舒张压（分别为 SBP 和 DBP）变化对窦血流动力学的影响，与主动脉瓣置换术 (AVR) 后 CAVD 的潜在发生或进展相关。 Evolut R、SAPIEN 3 和 Magna 瓣膜在脉动条件下部署在主动脉根部。使用粒子图像测速仪评估窦内的血流动力学。计算了速度、涡度、循环（和剪切应力）。本研究表明，在 SBP 和 DBP 升高的情况下，瓣叶附近的速度、涡度和剪切应力增加。此外，在整个心动周期中观察到曲线下面积的较大波动。血压升高与瓣叶附近较高的速度、涡度和剪切应力相关，这可能引发或加速人工瓣叶中的促钙化变化，导致生物瓣膜退化。
Coexisting hypertension and aortic stenosis are common. Some studies showed that elevated blood pressures may be associated with progression of calcific aortic valve disease (CAVD) while others showed no correlation. Flow dynamics in the sinuses of Valsalva are considered key factors in the progression of CAVD. While the relationship between hemodynamics and CAVD is not yet fully understood, it has been demonstrated that they are tightly correlated. This study aims to investigate the effect of changing systolic and diastolic blood pressures (SBP and DBP, respectively) on sinus hemodynamics in relation to potential initiation or progression of CAVD after aortic valve replacement (AVR). Evolut R, SAPIEN 3 and Magna valves were deployed in an aortic root under pulsatile conditions. Using particle image velocimetry, the hemodynamics in the sinus were assessed. The velocity, vorticity, circulation (and shear stress were calculated. This study shows that under elevated SBP and DBP, velocity, vorticity, and shear stress nearby the leaflets increased. Additionally, larger fluctuations ofand area under the curve throughout the cardiac cycle were observed. Elevated blood pressures are associated with higher velocity, vorticity, and shear stress near the leaflets which may initiate or accelerate pro-calcific changes in the prosthetic leaflets leading to bioprosthetic valve degeneration.