Key result
Surgically created bicuspid aortic valves exhibit ~6-fold higher peak radial strain during systole than tricuspid valves.
Why the study?
Individuals with bicuspid aortic valves are at highest risk of aortic valve calcification, and medical treatment efforts are hampered by a limited understanding of the biomechanical forces involved in its molecular pathogenesis. This study sought to determine whether bicuspid aortic valve leaflets experience increased strain compared to tricuspid aortic valve leaflets.
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Higher radial strain in bicuspid valves supports strain-mediated calcification hypothesis; leaves open in vivo validation and therapeutic targeting.
OBJECTIVE: To determine whether the leaflets of bicuspid aortic valve (BAV) experience increased strain when compared to tricuspid aortic valve (TAV) leaflets. BACKGROUND: The population at highest risk of aortic valve calcification (AVC) are individuals with BAVs. Currently, efforts to medically treat AVC are hampered by a limited understanding of the biomechanical forces involved in the molecular pathogenesis of AVC. METHODS: Surgically created BAVs and control TAVs were placed into a left heart simulator. Strains were calculated by comparing the distances between points on the aortic valve (AoV) leaflet during various time points during a simulated cardiac cycle. RESULTS: The fused leaflets of BAVs experience significantly more strain during systole when compared to TAVs. Specifically, BAVs experience 24% strain (P < .0001) in the radial direction, parallel to the direction of blood flow, as compared to TAVs. There was peak difference of 4% (P < .001) in the circumferential direction. DISCUSSION: Based upon the data presented here, we are in the process of identifying how increased strain activates calcification-associated pathways in AoV cells. Future studies will examine whether these stretch responsive pathways can be blocked to inhibit calcification of BAVs.
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Szeto et al. (2013) studied Bicuspid aortic valve and aortic valve calcification (n=6). Surgically created bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on Peak radial strain of aortic valve leaflets during systole (p=<0.0001). Surgically created bicuspid aortic valves experienced significantly higher peak radial strain during systole compared to tricuspid aortic valves (24% vs 4%, P < .0001).
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