Aortic stiffness assessment with ultrafast ultrasound imaging in case of bicuspid aortic valve

Abstract Background Magnetic resonance imaging allows evaluation of aortic stiffness by the maximum rate of systolic distension (MRSD) a new prognosis factor of aortic dilatation in patients with bicuspid aortic valve (BAV). MRSD requires a continuous monitoring of the aortic diameter during the cardiac cycle, not accessible to conventional echocardiography contrary to ultrafast ultrasound imaging (UF). Purpose To develop specific aortic sequences in ultrafast ultrasound imaging (UF) to provide access to the aortic MRSD Methods Tissue Doppler allowed a precise estimation of the movement of each wall and the fine variation of the aortic diameter. To automatically track the anterior and posterior aortic walls during the cardiac cycle, we developed in the laboratory a specific interface (Figure). MRSD was the maximum of the derivative of the diameter chande over time. To assess this new technique, 24 patients (10 BAV patients and 14 controls, mean age 45.8 vs. 40.7 years, p=0.464, respectively) were consecutively included at a reference center for BAV. The ascending aorta was evaluated at the sinus of Valsalva, the tubular aorta and the aortic arch with a phased array probe (Supersonic Imagine) and dedicated sequences at 2000 frames/s. Results The lab-made interface allowed to track the aortic diameter and to calculate the MRSD from the UF acquisitions for each patient. We found lower MRSD at the sinus of Valsalva in case of BAV in accordance with previously demonstrated higher stiffness at this segment by our team (Table). Table 1. UF Aortic parameters for BAV patients and controls BAV patients Controls p (Mann Whitney) Sinus of Valsalva Diameter (mm) 26.2 [22.4–32.5] 27.09 [23.5–29.5] 0.796 MRSD (s–1) 1.05 [0.73–1.19] 1.51 [1.28–1.99] 0.023 Tubular ascending aorta Diameter 31.4 [29.4–32.2] 28.9 [22.6–31.5] 0.328 MRSD 0.94 [0.59–1.27] 1.09 [0.87–1.41] 0.353 Aortic arch Diameter 24.2 [23.7–24.8] 24.2 [18.9–24.5] 0.673 MRSD 0.57 [0.35–1.07] 0.85 [0.76–1.02] 0.257 Results are median [25th–75th percentile]. Figure 1 Conclusion UF allows evaluation of aortic stiffness by MRSD using dedicated sequence and interface. As echocardiography, UF is easily accessible and therefore deserves attention from cardiologists taking care of BAV patients to evaluate the segmental aortic remodeling associated with BAV.

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Rapid ascending aorta stiffening in bicuspid aortic valve on serial cardiovascular magnetic resonance evaluation: comparison with connective tissue disorders

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00716-5 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Alejandro Perez-Casares ◽

Audrey Dionne ◽

Kimberlee Gauvreau ◽

Ashwin Prakash

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Connective Tissue ◽

Bicuspid Aortic Valve ◽

Aortic Stiffness ◽

Comparison Group ◽

Aortic Distensibility ◽

Connective Tissue Disorders ◽

Aortic Stiffening

Abstract Background Aortic stiffness has been shown to be abnormal in patients with bicuspid aortic valve (BAV), and is considered a component of the aortopathy associated with this condition. Progressive aortic stiffening associated with aging has been previously described in normal adults. However, it is not known if aging related aortic stiffening occurs at the same rate in BAV patients. We determined the longitudinal rate of decline in segmental distensibility in BAV patients using serial cardiovascular magnetic resonance (CMR) studies, and compared to previously published results from a group of patients with connective tissue disorders (CTD). Methods A retrospective review of CMR and clinical data on children and adults with BAV (n = 49, 73% male; 23 ± 11 years) with at least two CMRs (total 98 examinations) over a median follow-up of 4.1 years (range 1–9 years) was performed to measure aortic distensibility at the ascending (AAo) and descending aorta (DAo). Longitudinal changes in aortic stiffness were assessed using linear mixed-effects modeling. The comparison group of CTD patients had a similar age and gender profile (n = 50, 64% male; 20.6 ± 12 years). Results Compared to CTD patients, BAV patients had a more distensible AAo early in life but showed a steeper decline in distensibility on serial examinations [mean 10-year decline in AAo distensibility (× 10−3 mmHg−1) 2.4 in BAV vs 1.3 in CTD, p = 0.005]. In contrast, the DAo was more distensible in BAV patients throughout the age spectrum, and DAo distensibility declined with aging at a rate similar to CTD patients [mean 10 year decline in DAo distensibility (× 10−3 mmHg−1) 0.3 in BAV vs 0.4 in CTD, p = 0.58]. Conclusions On serial CMR measurements, AAo distensibility declined at significantly steeper rate in BAV patients compared to a comparison group with CTDs, while DAo distensibility declined at similar rates in both groups. These findings offer new mechanistic insights into the differing pathogenesis of the aortopathy seen in BAV and CTD patients.

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Influence of Aortic Dilation on the Regional Aortic Stiffness of Bicuspid Aortic Valve Assessed by 4-Dimensional Flow Cardiac Magnetic Resonance

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2018.03.017 ◽

2019 ◽

Vol 12 (6) ◽

pp. 1020-1029 ◽

Cited By ~ 21

Author(s):

Andrea Guala ◽

Jose Rodriguez-Palomares ◽

Lydia Dux-Santoy ◽

Gisela Teixido-Tura ◽

Giuliana Maldonado ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Stiffness ◽

Aortic Dilation ◽

Dimensional Flow

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Thoracic Aortic Aneurysm Growth in Bicuspid Aortic Valve Patients: Role of Aortic Stiffness and Pulsatile Hemodynamics

Journal of the American Heart Association ◽

10.1161/jaha.118.010885 ◽

2019 ◽

Vol 8 (8) ◽

Cited By ~ 3

Author(s):

Jasjit Rooprai ◽

Munir Boodhwani ◽

Luc Beauchesne ◽

Kwan‐Leung Chan ◽

Carole Dennie ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Aneurysm ◽

Bicuspid Aortic Valve ◽

Aortic Stiffness ◽

Thoracic Aortic Aneurysm ◽

Aneurysm Growth

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Carotid Stiffness Assessment With Ultrafast Ultrasound Imaging in Case of Bicuspid Aortic Valve

Frontiers in Physiology ◽

10.3389/fphys.2019.01330 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 2

Author(s):

Guillaume Goudot ◽

Tristan Mirault ◽

Lina Khider ◽

Olivier Pedreira ◽

Charles Cheng ◽

...

Keyword(s):

Aortic Valve ◽

Ultrasound Imaging ◽

Bicuspid Aortic Valve ◽

Carotid Stiffness

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EFFECT OF AORTIC STIFFNESS PARAMETERS BY CARDIAC MAGNETIC RESONANCE ON AORTIC DILATION IN PATIENTS WITH BICUSPID AORTIC VALVE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32264-6 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1637

Author(s):

Vasutakarn Chongthammakun ◽

Amy Pan ◽

Stefan Kostelyna ◽

Benjamin Goot ◽

Michael Earing ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Stiffness ◽

Aortic Dilation

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Segmental aortic stiffness in patients with bicuspid aortic valve compared with first-degree relatives

Heart ◽

10.1136/heartjnl-2018-313232 ◽

2018 ◽

Vol 105 (2) ◽

pp. 130-136 ◽

Cited By ~ 6

Author(s):

Guillaume Goudot ◽

Tristan Mirault ◽

Aude Rossi ◽

Samuel Zarka ◽

Juliette Albuisson ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Stiffness ◽

Ascending Aorta ◽

Stiffness Index ◽

Aortic Dilatation ◽

Sinus Of Valsalva ◽

Segmental Analysis ◽

First Degree Relatives ◽

Reference Centre

AimsTo compare the stiffness index in patients with bicuspid aortic valve (BAV) with first-degree relatives at each segment of the thoracic ascending aorta and to compare segmental analysis of aortic stiffness in association with BAV morphotype and function.Methods219 patients with BAV and 148 first-degree relatives (without BAV) were consecutively included at a reference centre for BAV. Ultrasound assessment of aortic and carotid stiffness was based on the variation of the segmental arterial diameters during the cardiac cycle and on blood pressure.ResultsWithout adjustment, the ascending aorta of patients with BAV seemed stiffer at each segment compared with controls (stiffness index at the sinus of Valsalva: 17.0±10.9 vs 8.9±6.1, p<0.001; tubular aorta: 20.4±31.3 vs 12.7±4.8, p=0.04). However, after adjustment on aortic diameter and age, only the sinus of Valsalva remained stiffer (p<0.001), whereas the tubular aorta no longer differed (p=0.610). In patients with BAV, aortic diameters were not influenced by the valve morphotype, except for the arch, which was more dilated in the case of 1- Non coronary sinus-Right subtype of BAV : 36.1 vs 27.6 mm, p<0.001. Aortic regurgitation was associated with an increase in aortic diameters at the sinus of Valsalva (p<0.001) and the tubular aortic levels (p=0.04).ConclusionStiffness increase at the sinus of Valsalva level is independent of aortic dilatation in patients with BAV, contrary to the classic relationship between stiffness and dilatation found on the other segments. The relationship between stiffness and clinical impact needs to be assessed at each aortic segment.

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