Emerging imaging and circulating biomarkers in relation to underlying mechanisms in Bicuspid Aortic Valve aortopathy

Bicuspid Aortic Valve (BAV) is the most prevalent congenital heart defect with an autosomal dominant inheritance. With up to 2% of the general population affected by the condition, mortality remains high likely due to the development of aortopathy which pre-disposes to the development of aortic dissection. Current guidelines focus on surgical management, once a threshold of aorta diameter is surpassed, via routine image surveillance. However, it is recognised that some will develop aortic dissection without meeting these requirements for surgical intervention. Recent literature has begun to address the need for potential biomarkers specific to aortopathy in the BAV population to aid in risk stratification. Four-dimensional cardiovascular magnetic resonance flow imaging has paved the way to the development of imaging measurements such as wall shear stress and reverse flow which aid in the assessment of aberrant blood flow contributing to aortopathy in the BAV group. Differing levels of plasma biomarkers such as matrix metalloproteinases and microRNA have also been associated with aortopathy development furthering insight into the cellular mechanisms involved in aortic vascular matrix remodelling. This article will provide an overview of the recent research into prospective 4-D imaging and circulating biomarkers that have been studied and potential areas of future work.