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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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 languageEnglish
Pages (from-to)2340-2349
Number of pages10
JournalEuropean Radiology
Issue number5
Early online date28 Nov 2018
Publication statusPublished - 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.


  • 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
  • bicuspid
  • Aorta
  • Aortic valve
  • thoracic


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