Association of aortic distensibility and left ventricular function in patients with stenotic bicuspid aortic valve and preserved ejection fraction: a CMR study.

Yijun Pan,Pengju Xu,Jiang Lin,Yan Shan,Jun Li,Mengsu Zeng,Yongshi Wang

doi:10.1007/s10554-022-02581-4

Abstract

To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0T CMR. Patients were divided into LV remodeling group (LV mass/volume ≥ 1.15, n = 21) and non-remodeling group (LV mass/volume < 1.15, n = 22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04 ± 8.70% vs. 32.92 ± 7.81%, P = 0.009; circumferential: - 17.20 ± 3.38% vs. - 19.65 ± 2.34%, P = 0.008; longitudinal: - 9.13 ± 2.34% vs. - 11.63 ± 1.99%, P < 0.001) and decreased mid-AA distensibility (1.22 ± 0.24 10-3mm/Hg vs 1.60 ± 0.41 10-3mm/Hg, P = 0.001). In addition, mid-AA distensibility was independently associated with LV remodeling (β = - 0.282, P = 0.003), and it was also significantly correlated with LV global strain (radial: r = 0.392, P = 0.009; circumferential: r = - 0.348, P = 0.022; longitudinal: r = - 0.333, P = 0.029), cTNT (r = - 0.333, P = 0.029) and NT-proBNP (r = - 0.440, P = 0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV remolding, which encouraging to better understand mechanism of ventricular vascular coupling.

Highlights

Bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation in adult, affecting 0.5-2% of the population
BAV is characterized by a narrowed valve orifice and severe valve calcification, concomitant aortic stenosis (AS) aggravates the degree of left ventricular (LV) outflow tract obstruction, resulting in increased LV afterload
We found a reduction of global myocardial strain in BAV patients with LV remolding, which is consistent with prior echocardiography studies[4, 9]

Summary

Introduction

Bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation in adult, affecting 0.5-2% of the population. BAV is characterized by a narrowed valve orifice and severe valve calcification, concomitant AS aggravates the degree of left ventricular (LV) outflow tract obstruction, resulting in increased LV afterload. Studies have indicated that stenotic BAV patients exhibited increased LV mass, depressed LV contractility and impaired diastolic function with marked hemodynamic alterations[3, 4]. The impaired LV diastolic function is related to reduced aortic elasticity [5– 7], supporting the hypothesis that BAV disease is not confined to valve and affects aorta and left ventricle. LV remodeling has emerged as a key predictor of adverse cardiovascular events in BAV, especially for patients with significant valvular dysfunction[9, 10]. There has been few reports so far documenting the relationship between aortic distensibility and LV remodeling and myocardial strain in patients with stenotic BAV and preserved ejection fraction (EF)

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