Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Bicuspid aortic valve (BAV) disease (n=15). Intervention: Natural disease progression and aging vs. Baseline evaluation 10 years prior. Primary outcome: Indexed aortic diameter in the mid-ascending aorta (AAo) (median difference 0.05 cm/m2, 95% CI 0.01-0.22, p=0.06).

Q: What does this research mean for the field?

Over a 10-year follow-up in patients with isolated bicuspid aortic valve disease, indexed aortic diameters do not significantly change, while aortic wall shear stress decreases across multiple aortic levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Michael Hanigk; Elisabeth Burgstaller; Heiner Latus; Nerejda Shehu; Judith Zimmermann; Stefan Martinoff; Anja Hennemuth; Peter Ewert; Heiko Stern; Christian Meierhofer

doi:10.21037/cdt-22-477

February 1, 2023Cardiovascular Diagnosis and TherapyOpen Access

Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

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Key result

Over a 10-year follow-up, natural disease progression in isolated bicuspid aortic valve disease did not significantly change indexed aortic diameters (median difference 0.05 cm/m2, p=0.06) but lowered wall shear stress.

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Why the study?

Wall shear stress could contribute to predicting long-term outcomes in BAV, prompting the re-evaluation of flow patterns and WSS 10 years after initial evaluation.

Does long-term disease progression alter aortic diameter and wall shear stress in patients with isolated bicuspid aortic valve disease?

Key Points

To reevaluate aortic flow patterns, wall shear stress, and aortic dimensions in patients with bicuspid aortic valve disease ten years after initial baseline imaging.
Prospective follow-up of N=15 asymptomatic patients with bicuspid aortic valve disease (median age 34.0 years, range 19.8 to 54.3 years; 8 males) reevaluated after a median of 9.8 years (range 9.5 to 10.7 years).
Conducted 4D flow cardiovascular magnetic resonance to measure helical flow patterns, absolute and indexed aortic diameters, distensibility, stiffness index, and wall shear stress across multiple aortic regions.
Indexed aortic diameters remained stable across the follow-up period in both the ascending aorta (median difference 0.05 cm/m 2, 95% CI: 0.01 to 0.22, P=0.06) and the descending aorta (median difference -0.08 cm/m 2, 95% CI: -0.12 to 0.01, P=0.07).
Wall shear stress was lower at all measured levels, including magnitudinal stress at the main pulmonary artery level (median difference -0.32 N/m 2, 95% CI: 0.2 to 0.4, P=0.001) and brachiocephalic trunk level (median difference -0.27 N/m 2, 95% CI: 0.16 to 0.36, P=0.002).
Ascending aorta distensibility decreased by a median of 25.6% (P=0.08), while aortic stiffness index increased by a median of 23.6% (median difference 0.97, 95% CI: -4.83 to -0.13, P=0.02).

Study Design

Type

Cohort (n=15)

Blinding

Investigators blinded to previous findings during post-processing

Multicenter

No

Structured PICO

Does long-term disease progression alter aortic diameter and wall shear stress in patients with isolated bicuspid aortic valve disease?

P

Population

15 patients (median age 34.0) with isolated bicuspid aortic valve disease, initially lacking aortic enlargement or valvular impairment, followed over 10 years.

E

Exposure

10 years of natural aging and disease progression assessed via 4D flow CMR

C

Comparator

Baseline imaging measurements taken 10 years prior (2008/2009)

O

Outcome

Indexed aortic diameter and Wall Shear Stress (WSS) in the mid-ascending aorta (AAo) and descending aorta (DAo) after 10 yearssurrogate

Main Result

Mean Difference: 0.05 (95% CI 0.01–0.22)

Absolute Event Rate: 1.78% vs 1.73%

p-value: p=0.06

Limitations

Single-center study with a limited number of patients
Only adults included, pre-selected in 2008
No histological specimens gathered
Insufficient participation of former evaluated TAV volunteers for reference group
Software version of the scanner changed over the ten-year period
Systematical underestimation of WSS due to limited spatial resolution in PC-CMR
Adults only (pre-selected)
Lack of histological specimens for correlation
No tricuspid aortic valve (TAV) reference group for follow-up
Scanner software version changed between studies

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Implication

In isolated bicuspid aortic valve disease, aortic distensibility decreases while stiffness increases over 10 years, leading to a concurrent reduction in wall shear stress that may reflect a benign compensatory remodeling process.

Abstract

Background: Bicuspid aortic valve (BAV) disease leads to deviant helical flow patterns especially in the mid-ascending aorta (AAo), potentially causing wall alterations such as aortic dilation and dissection. Among others, wall shear stress (WSS) could contribute to the prediction of long-term outcome of patients with BAV. 4D flow in cardiovascular magnetic resonance (CMR) has been established as a valid method for flow visualization and WSS estimation. The aim of this study is to reevaluate flow patterns and WSS in patients with BAV 10 years after the initial evaluation. Methods: Fifteen patients (median age 34.0 years) with BAV were re-evaluated 10 years after the initial study from 2008/2009 using 4D flow by CMR. Our particular patient cohort met the same inclusion criteria as in 2008/2009, all without enlargement of the aorta or valvular impairment at that time. Flow patterns, aortic diameters, WSS and distensibility were calculated in different aortic regions of interest (ROI) with dedicated software tools. Results: (95% CI: -0.12 to 0.01; P=0.07) for DAo. WSS values were lower in 2018/2019 at all measured levels. Aortic distensibility decreased by median 25.6% in the AAo, while stiffness increased concordantly (median +23.6%). Conclusions: After a ten years' follow-up of patients with isolated BAV disease, indexed aortic diameters did not change in this patient cohort. WSS was lower compared to values generated 10 years earlier. Possibly a drop of WSS in BAV could serve as a marker for a benign long-term course and implementation of more conservative treatment strategies.

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Cite This Study

Hanigk et al. (2023) conducted a cohort in Bicuspid aortic valve (BAV) disease (n=15). Natural disease progression and aging vs. Baseline evaluation 10 years prior was evaluated on Indexed aortic diameter in the mid-ascending aorta (AAo) (median difference 0.05 cm/m2, 95% CI 0.01-0.22, p=0.06). Over a 10-year follow-up, natural disease progression in isolated bicuspid aortic valve disease did not significantly change indexed aortic diameters (median difference 0.05 cm/m2, p=0.06) but lowered wall shear stress.

synapsesocial.com/papers/6a204250a3b3c564e0df600a https://doi.org/10.21037/cdt-22-477

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Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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