Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance.
Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance.
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DOI：
10.1186/1532-429x-12-4
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发表时间：
2010-01-13
期刊：
影响因子：
--
通讯作者：
Brummer ME
中科院分区：
文献类型：
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作者：
den Reijer PM;Sallee D 3rd;van der Velden P;Zaaijer ER;Parks WJ;Ramamurthy S;Robbie TQ;Donati G;Lamphier C;Beekman RP;Brummer ME
先天性二叶式主动脉瓣（BAV）是严重并发症的重要风险因素，包括瓣膜功能障碍、主动脉扩张、夹层和猝死。目前尚无用于识别和监测主动脉扩张（一种早期并发症）高风险BAV患者的临床工具。本文报告了一项调查，在18名儿童BAV患者和10名正常对照之间的联系异常血流模式，在升主动脉和主动脉扩张使用速度编码的心血管磁共振。血流模式在收缩期左心室流出道和主动脉根通道轴之间的角度中定量表达，并且还与已知的血管壁疾病的生化标志物相关。数据证实BAV患者的升支动脉大于对照组，并且显示BAV（17.54 ± 0.87度）的LV流出角度大于对照组（10.01 ± 1.29度）（p = 0.01）。BAV患者左室收缩期流出道角与主动脉各节段的扩张呈显著正相关，相关系数为0.386（N = 18，p = 0.048），AAO：r = 0.536（N = 18，p = 0.022），患者和对照组合并为一个人群时发现了更强的相关性：SOV：r = 0.405（N = 28，p = 0.033），STJ：r = 0.562（N = 28，p = 0.002），和AAO r = 0.645（N = 28，p < 0.001）。扩张和射流角度也被发现与基质金属蛋白酶2的血浆水平。本研究的结果为BAV患者主动脉扩张的病理生理过程提供了新的见解。这些结果显示了一个可能的路径，以减少发病率和死亡率为这种常见的先天性心脏病的临床风险分层协议的发展。
Congenital Bicuspid Aortic Valve (BAV) is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees) than controls (10.01 ± 1.29) (p = 0.01). Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048), AAO: r = 0.536 (N = 18, p = 0.022), and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033), STJ: r = 0.562 (N = 28, p = 0.002), and AAO r = 0.645 (N = 28, p < 0.001). Dilatation and the flow jet angle were also found to correlate with plasma levels of matrix metallo-proteinase 2. The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.