Key result
Decreased elastin integrity in bicuspid aortic valve aortopathy was associated with lower low-strain tangential modulus (P=0.005) in younger patients (51-60 years) but higher modulus (P=0.049) in older patients (61-70 years).
Why the study?
The relationship between aortic histopathological changes and biomechanics in bicuspid aortic valve patients is incompletely understood.
Cross-Sectional (n=19)
Yes
Elastin histopathologic changes in BAV aortopathy correlate with altered aortic wall mechanical properties in an age-dependent manner, suggesting a need for age-stratified risk assessment.
Supports age-specific biomechanical evaluation in BAV aortopathy; leaves open whether elastin histopathology informs surgical thresholds.
Background: Aortic wall remodelling in bicuspid aortic valve (BAV) patients is heterogeneous and characterized by elastin fiber breakdown alongside impaired biomechanics. However, the relationship between aortic histopathological changes and biomechanics are incompletely understood. We clarify the influence of elastin fiber integrity on ex vivo aortic wall mechanical properties in BAV patients, and explore the influence of patient age. Methods: biaxial mechanical testing generated stress-strain curves from which physiological [low-strain tangential modulus (LTM), transition zone onset stress (TZo)] and supraphysiological [transition zone end stress (TZe) and high-strain tangential modulus (HTM)] mechanical properties were obtained. Relationships between histopathology and mechanical properties were determined using a linear mixed effect model. BAV patients were subdivided according to 'younger' and 'older' age groups (i.e., 51-60 and 61-70 years old, respectively). Results: No statistically significant differences in elastin content were observed between younger and older BAV patients. Older patients showed greater elastin fiber fragmentation compared to their younger cohort (74% versus 61%). Elastin fiber histopathology was associated with differences in physiological mechanical properties: elastin fragmentation corresponded with lower LTM (P=0.005) and TZo (P=0.044) in younger BAV patients and higher LTM (P=0.049) and TZo (P=0.001) in older BAV patients. Histopathology changes were significantly associated with supraphysiological mechanical properties only in older BAV patients: decreased elastin integrity was associated with increased TZe (P=0.049) and HTM (P<0.001). Conclusions: Elastin histopathologic changes in BAV aortopathy correspond with differences in mechanical properties and this relationship is influenced by patient age. These novel findings provide additional mechanistic insights into aortic wall remodeling and support a more nuanced stratification of BAV patients by age.
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Nightingale et al. (2022) conducted a cross-sectional in Bicuspid aortic valve (BAV) aortopathy (n=19). Elastin fiber integrity and age vs. Varying degrees of elastin fragmentation and age groups was evaluated on Ex vivo biaxial mechanical properties (LTM, TZo, TZe, HTM) correlated with elastin content and fragmentation. Decreased elastin integrity in bicuspid aortic valve aortopathy was associated with lower low-strain tangential modulus (P=0.005) in younger patients (51-60 years) but higher modulus (P=0.049) in older patients (61-70 years).
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