Circulating microRNAs vs. aortic diameter in bicuspid aortic valve aortopathy

There is growing clinical need and interest to implement novel risk prediction tools in bicuspid aortic valve-associated proximal aortic disease, so-called bicuspid aortic valve aortopathy. Inherent limitations of the diameter-based risk stratification for adverse aortic events in bicuspid aortic valve aortopathy patients have recently been recognized. Therefore, alternative diagnostic tools and subsequent adjustments in the treatment guidelines are urgently needed. Herein, we summarize the current evidence on recent diagnostic developments to improve risk stratification in bicuspid aortic valve aortopathy, including circulating microRNAs as biomarkers to predict the progression of aortic disease.

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Expression Patterns of Circulating MicroRNAs in the Risk Stratification of Bicuspid Aortopathy

Journal of Clinical Medicine ◽

10.3390/jcm9010276 ◽

2020 ◽

Vol 9 (1) ◽

pp. 276 ◽

Cited By ~ 1

Author(s):

Evaldas Girdauskas ◽

Niklas Neumann ◽

Johannes Petersen ◽

Tatiana Sequeira-Gross ◽

Shiho Naito ◽

...

Keyword(s):

Aortic Valve ◽

Risk Stratification ◽

Bicuspid Aortic Valve ◽

Aortic Valve Stenosis ◽

Aortic Root ◽

Expression Patterns ◽

Aortic Diameter ◽

Study Cohort ◽

Circulating Mirnas ◽

Circulating Micrornas

Objective: Aortic size-based criteria are of limited value in the prediction of aortic events, while most aortic events occur in patients with proximal aortic diameters < 50 mm. Serological biomarkers and especially circulating microRNAs (miRNAs) have been proposed as an elegant tool to improve risk stratification in patients with different aortopathies. Therefore, we aimed to evaluate the levels of circulating miRNAs in a surgical cohort of patients presenting with bicuspid aortic valve disease and distinct valvulo-aortic phenotypes. Methods: We prospectively examined a consecutive cohort of 145 patients referred for aortic valve surgery: (1) Sixty three patients (mean age 47 ± 11 years, 92% male) with bicuspid aortic valve regurgitation and root dilatation (BAV-AR), (2) thirty two patients (mean age 59 ± 11 years, 73% male) with bicuspid aortic valve stenosis (BAV-AS), and (3) fifty patients (mean age 56 ± 14 years, 55% male) with tricuspid aortic valve stenosis and normal aortic root diameters (TAV-AS) who underwent aortic valve+/-proximal aortic surgery at a single institution. MicroRNAs analysis included 11 miRNAs, all published previously in association with aortopathies. Endpoints of our study were (1) correlation between circulating miRNAs and aortic diameter and (2) comparison of circulating miRNAs in distinct valvulo-aortic phenotypes. Results: We found a significant inverse linear correlation between circulating miRNAs levels and proximal aortic diameter in the whole study cohort. The strongest correlation was found for miR-17 (r = −0.42, p < 0.001), miR-20a (r = −0.37, p < 0.001), and miR-106a (r = −0.32, p < 0.001). All miRNAs were significantly downregulated in BAV vs. TAV with normal aortic root dimensions Conclusions: Our data demonstrate a significant inverse correlation between circulating miRNAs levels and the maximal aortic diameter in BAV aortopathy. When comparing miRNAs expression patterns in BAV vs. TAV patients with normal aortic root dimensions, BAV patients showed significant downregulation of analyzed miRNAs as compared to their TAV counterparts. Further multicenter studies in larger cohorts are needed to further validate these results.

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Evolving treatment options for valve and aortic disease with bicuspid aortic valve

Annals of Translational Medicine ◽

10.21037/atm.2017.04.26 ◽

2017 ◽

Vol 5 (16) ◽

pp. 333-333

Author(s):

Nicholas S. Burris ◽

Michael D. Hope

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Treatment Options ◽

Aortic Disease

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Abstract 102: Granular Media Calcinosis in the Aortic Wall of Patients With Bicuspid and Tricuspid Aortic Valves

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.102 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Sandy von Salisch ◽

Josephina Haunschild ◽

Martin Misfeld ◽

Michael A Borger ◽

Stefan Dhein ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Granular Media ◽

Aortic Wall ◽

Aortic Disease ◽

Dissecting Aneurysm ◽

Media Thickness ◽

Significant Difference ◽

The Media ◽

Aneurysm Dissection

Background: Bicuspid aortic valve is the most frequent congenital cardiac abnormality and associated with proximal aortic disease (i.e. aneurysm, dissection or rupture). Granular media calcinosis(GMC)--suggested to increase stiffness and play a pathogenetic role in dissecting aneurysm--has not yet been quantified in BAV. Methods: Specimen of the proximal aortic wall from 76 patients--32 with tricuspid (TAV) and 44 with bicuspid aortic valve (BAV)--were obtained during surgery to quantify media thickness and GMC by von Kossa staining (panel C), comparing the convexity (Cvx) and concavity (Ccv) in BAV vs. TAV. Results: Interlamellar GMC affected the most central layers of the media and those adjacent to the outer adventitia with a doubling within both--the Cvx and Ccv--of pts with BAV compared to patients with TAV (13.3±9.6 vs. 6.6±7.4 and 12.8±10.8 vs. 6.4±7.1; p<0.05, panel A) was seen, but neither a difference in calcification between the Ccx and the Ccv side within the BAV nor the TAV group. No association between age and calcification grade , neither in the Cvx nor the Ccv (r=0.132, p=0.218 and 0.103, p=0.341) was seen. There was a significant difference in the total media thickness between BAV and TAV at the Cvx (867±162μm vs . 993±158μm; p<0.05) and the Ccv (1005 ± 236 vs 1223 ± 217μm; p<0.05, panel B). Independent of aortic valve morphology, the Cvx was thinner than the Ccv side (TAV: 993 ± 158 vs.1223 ± 217μm; p<0.001; BAV: 869 ± 162 vs.1005 ± 236μm; p<0.05, panel B). Conclusion: BAVs had significantly thinner media and twice as much GMC than their tricuspid peers possibly associated with the loosening of the bond between the elastic lamellae causing a decrease in elasticity possibly explaining a higher risk for dissection and rupture.

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Risk Stratification in Bicuspid Aortic Valve Aortopathy: Emerging Evidence and Future Perspectives

Current Problems in Cardiology ◽

10.1016/j.cpcardiol.2019.06.002 ◽

2019 ◽

pp. 100428 ◽

Cited By ~ 3

Author(s):

Alessandro Della Corte ◽

Hector I. Michelena ◽

Angelo Citarella ◽

Emiliano Votta ◽

Filippo Piatti ◽

...

Keyword(s):

Aortic Valve ◽

Risk Stratification ◽

Bicuspid Aortic Valve ◽

Future Perspectives

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The Value of Circulating Biomarkers in Bicuspid Aortic Valve-Associated Aortopathy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1583525 ◽

2016 ◽

Vol 66 (04) ◽

pp. 278-286 ◽

Cited By ~ 7

Author(s):

Shiho Naito ◽

Mathias Hillebrand ◽

Alexander Bernhardt ◽

Annika Jagodzinski ◽

Lenard Conradi ◽

...

Keyword(s):

Aortic Valve ◽

Risk Stratification ◽

Bicuspid Aortic Valve ◽

Aortic Aneurysms ◽

Conventional Imaging ◽

Circulating Biomarkers ◽

Screening Process ◽

Cross Sectional ◽

Thoracic Aortic Aneurysms ◽

Definition Of

AbstractTraditional risk stratification model of bicuspid aortic valve (BAV) aortopathy is based on measurement of maximal cross-sectional aortic diameter, definition of proximal aortic shape, and aortic stiffness/elasticity parameters. However, conventional imaging-based criteria are unable to provide reliable information regarding the risk stratification in BAV aortopathy, especially considering the heterogeneous nature of BAV disease. Given those limitations of conventional imaging, there is a growing clinical interest to use circulating biomarkers in the screening process for thoracic aortic aneurysms as well as in the risk-assessment algorithms. We aimed to systematically review currently available biomarkers, which may be of value to predict the natural evolution of aortopathy in individuals with BAV.

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