Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

Anvesha Singh; Mark A Horsfield; Soliana Bekele; John P Greenwood; Dana K Dawson; Colin Berry; Kai Hogrefe; Damian J Kelly; John G Houston; Prasad Guntur Ramkumar; Akhlaque Uddin; Toru Suzuki; Gerry P McCann

doi:10.1007/s00330-018-5775-6

Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

Anvesha Singh (Corresponding Author), Mark A Horsfield, Soliana Bekele, John P Greenwood, Dana K Dawson, Colin Berry, Kai Hogrefe, Damian J Kelly, John G Houston, Prasad Guntur Ramkumar, Akhlaque Uddin, Toru Suzuki, Gerry P McCann

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Abstract

OBJECTIVES: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).

METHODS: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.

RESULTS: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.

CONCLUSIONS: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.

KEY POINTS: • Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV). • We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness. • Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.

Original language	English
Pages (from-to)	2340-2349
Number of pages	10
Journal	European Radiology
Volume	29
Issue number	5
Early online date	28 Nov 2018
DOIs	https://doi.org/10.1007/s00330-018-5775-6
Publication status	Published - May 2019

Bibliographical note

Funding: The study was funded by a Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011-04-51 Gerald P McCann). Support was also received from NIHR Leicester Cardiovascular Biomedical Research Unit, the NIHR Comprehensive Local Research Networks, and the Leeds and Leicester NIHR Clinical Research Facilities.

Keywords

aortic valve stenosis
pulse wave velocity
aorta, thoracic
aortic valve, bicuspid
magnetic resonance imaging
Aorta, thoracic
Magnetic resonance imaging
Aortic valve stenosis
Pulse wave velocity
Aortic valve, bicuspid
ELASTIC PROPERTIES
bicuspid
MECHANISMS
EXERCISE
REPRODUCIBILITY
WAVE VELOCITY
Aorta
DYSFUNCTION
ASYMPTOMATIC PATIENTS
ASSOCIATION
Aortic valve
DILATATION
thoracic
WALL DISTENSIBILITY

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Aortic stiffness in aortic stenosis assessed by cardiovascular MRI
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Cite this

Singh, A., Horsfield, M. A., Bekele, S., Greenwood, J. P., Dawson, D. K., Berry, C., Hogrefe, K., Kelly, D. J., Houston, J. G., Guntur Ramkumar, P., Uddin, A., Suzuki, T., & McCann, G. P. (2019). Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves. European Radiology, 29(5), 2340-2349. https://doi.org/10.1007/s00330-018-5775-6

Singh, A, Horsfield, MA, Bekele, S, Greenwood, JP, Dawson, DK, Berry, C, Hogrefe, K, Kelly, DJ, Houston, JG, Guntur Ramkumar, P, Uddin, A, Suzuki, T & McCann, GP 2019, 'Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves', European Radiology, vol. 29, no. 5, pp. 2340-2349. https://doi.org/10.1007/s00330-018-5775-6

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title = "Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves",

abstract = "OBJECTIVES: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).METHODS: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.RESULTS: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.CONCLUSIONS: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.KEY POINTS: • Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV). • We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness. • Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.",

keywords = "aortic valve stenosis, pulse wave velocity, aorta, thoracic, aortic valve, bicuspid, magnetic resonance imaging, Aorta, thoracic, Magnetic resonance imaging, Aortic valve stenosis, Pulse wave velocity, Aortic valve, bicuspid, ELASTIC PROPERTIES, bicuspid, MECHANISMS, EXERCISE, REPRODUCIBILITY, WAVE VELOCITY, Aorta, DYSFUNCTION, ASYMPTOMATIC PATIENTS, ASSOCIATION, Aortic valve, DILATATION, thoracic, WALL DISTENSIBILITY",

author = "Anvesha Singh and Horsfield, {Mark A} and Soliana Bekele and Greenwood, {John P} and Dawson, {Dana K} and Colin Berry and Kai Hogrefe and Kelly, {Damian J} and Houston, {John G} and {Guntur Ramkumar}, Prasad and Akhlaque Uddin and Toru Suzuki and McCann, {Gerry P}",

note = "Funding: The study was funded by a Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011-04-51 Gerald P McCann). Support was also received from NIHR Leicester Cardiovascular Biomedical Research Unit, the NIHR Comprehensive Local Research Networks, and the Leeds and Leicester NIHR Clinical Research Facilities.",

year = "2019",

month = may,

doi = "10.1007/s00330-018-5775-6",

language = "English",

volume = "29",

pages = "2340--2349",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "5",

}

TY - JOUR

T1 - Aortic stiffness in aortic stenosis assessed by cardiovascular MRI

T2 - a comparison between bicuspid and tricuspid valves

AU - Singh, Anvesha

AU - Horsfield, Mark A

AU - Bekele, Soliana

AU - Greenwood, John P

AU - Dawson, Dana K

AU - Berry, Colin

AU - Hogrefe, Kai

AU - Kelly, Damian J

AU - Houston, John G

AU - Guntur Ramkumar, Prasad

AU - Uddin, Akhlaque

AU - Suzuki, Toru

AU - McCann, Gerry P

N1 - Funding: The study was funded by a Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011-04-51 Gerald P McCann). Support was also received from NIHR Leicester Cardiovascular Biomedical Research Unit, the NIHR Comprehensive Local Research Networks, and the Leeds and Leicester NIHR Clinical Research Facilities.

PY - 2019/5

Y1 - 2019/5

N2 - OBJECTIVES: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).METHODS: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.RESULTS: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.CONCLUSIONS: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.KEY POINTS: • Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV). • We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness. • Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.

AB - OBJECTIVES: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).METHODS: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.RESULTS: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.CONCLUSIONS: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.KEY POINTS: • Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV). • We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness. • Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.

KW - aortic valve stenosis

KW - pulse wave velocity

KW - aorta, thoracic

KW - aortic valve, bicuspid

KW - magnetic resonance imaging

KW - Aorta, thoracic

KW - Magnetic resonance imaging

KW - Aortic valve stenosis

KW - Pulse wave velocity

KW - Aortic valve, bicuspid

KW - ELASTIC PROPERTIES

KW - bicuspid

KW - MECHANISMS

KW - EXERCISE

KW - REPRODUCIBILITY

KW - WAVE VELOCITY

KW - Aorta

KW - DYSFUNCTION

KW - ASYMPTOMATIC PATIENTS

KW - ASSOCIATION

KW - Aortic valve

KW - DILATATION

KW - thoracic

KW - WALL DISTENSIBILITY

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UR - http://www.mendeley.com/research/aortic-stiffness-aortic-stenosis-assessed-cardiovascular-mri-comparison-between-bicuspid-tricuspid-v

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Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

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Dana Dawson

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Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

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Bibliographical note

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Dana Dawson

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