December 18, 2021European Heart Journal - Cardiovascular Imaging40 citationsOpen Access
View Full PaperWall shear stress angle is associated with aortic growth in bicuspid aortic valve patients
Key Result
Wall shear stress angle was independently associated with 3-year proximal aortic growth in bicuspid aortic valve patients (P=0.031), suggesting its utility in stratifying risk for aortic dilation.
Study Design
Type
Cohort (n=60)
Structured PICO
Is wall shear stress angle associated with aortic growth in patients with bicuspid aortic valves?
P
Population
60 subjects (32 bicuspid aortic valve [BAV] patients and 28 healthy controls)
I
Intervention
4D flow cardiovascular magnetic resonance assessment of wall shear stress (WSS) parameters (magnitude, axial, circumferential, and angle)
C
Comparator
Healthy controls (for baseline WSS comparison)
O
Outcome
Three-year computed tomography angiography-based aortic volumetric growth in the proximal and entire ascending aortasurrogate
Wall shear stress angle measured by 4D flow CMR is an independent predictor of aortic growth in patients with bicuspid aortic valves, offering a potential tool for risk stratification.
Main Result
p-value: p=0.031
Abstract
AIMS: Aortic wall shear stress (WSS) distributions in bicuspid aortic valve (BAV) patients have been associated with aortic dilatation, but prospective, longitudinal data are missing. This study assessed differences in aortic WSS distributions between BAV patients and healthy controls and determined the association of WSS with aortic growth in patients. METHODS AND RESULTS: Sixty subjects underwent four-dimensional (4D) flow cardiovascular magnetic resonance of the thoracic aorta (32 BAV patients and 28 healthy controls). Peak velocity, pulse wave velocity, aortic distensibility, peak systolic WSS (magnitude, axial, and circumferential), and WSS angle were assessed. WSS angle is defined as the angle between the WSSmagnitude and WSSaxial component. In BAV patients, three-year computed tomography angiography-based aortic volumetric growth was determined in the proximal and entire ascending aorta. WSSaxial was significantly lower in BAV patients compared with controls (0.93 vs. 0.72 Pa, P = 0.047) and WSScircumferential and WSS angle were significantly higher (0.29 vs. 0.64 Pa and 18° vs. 40°, both P < 0.001). Significant volumetric growth of the proximal ascending aorta occurred in BAV patients (from 49.1 to 52.5 cm3, P = 0.003). In multivariable analysis corrected for baseline aortic volume and diastolic blood pressure, WSS angle was the only parameter independently associated with proximal aortic growth (P = 0.031). In the entire ascending aorta, besides the WSS angle, the WSSmagnitude was also independently associated with growth. CONCLUSION: Increased WSScircumferential and especially WSS angle are typical in BAV patients. WSS angle was found to predict aortic growth. These findings highlight the potential role of WSS measurements in BAV patients to stratify patients at risk for aortic dilation.