Abstract
Patients with a bicuspid aortic valve (BAV) often have proximal aortic dilatation and systemic vascular dysfunction. We hypothesized that BAV patients would have different carotid artery structural and functional characteristics compared to tricuspid aortic valve (TAV) patients. In 28 patients with surgically confirmed BAV and 27 patients with TAV, intima media thickness (IMT), number of plaques, fractional area change (FAC), global circumferential strain (GCS), and standard deviation of CS (SD-CS) in both common carotid arteries were assessed using duplex ultrasound and velocity vector imaging (VVI). Patients with BAV were younger and had less co-morbidity, but showed a significantly larger ascending aorta (43.3 ± 7.5 vs. 37.0 ± 6.2 mm, p < 0.001) and a higher prevalence of aortopathy (61 vs. 30%, p = 0.021) than those with TAV. BAV patients showed a significantly lower IMT and fewer plaques. Although FAC and GCS were not significantly different between the two groups, they tended to be lower in the BAV group when each group was divided into three subgroups according to age. There was a significant age-dependent increase in IMT and decreases in FAC and GCS in the TAV group (p = 0.005, p = 0.001, p = 0.002, respectively), but this phenomenon was not evident in the BAV group (p = 0.074, p = 0.248, p = 0.394, respectively). BAV patients with aortopathy showed a higher SD-CS than those without aortopathy (p = 0.040), reflecting disordered mechanical function. In conclusion, BAV patients have different carotid artery structure and function compared with TAV patients, suggesting intrinsic vascular abnormalities that are less affected by established cardiovascular risk factors and more strongly related to the presence of aortopathy.
Highlights
Bicuspid aortic valve (BAV) is the most common congenital heart valve disease (Verma and Siu, 2014)
We comprehensively evaluated carotid arterial structure and function using either carotid artery Duplex ultrasound or velocity vector imaging (VVI) in patients with bicuspid aortic valve (BAV), compared the findings with those in patients with tricuspid aortic valve (TAV), and analyzed the data according to the presence of aortopathy
Patients with BAV had a significantly larger ascending aorta (43.3 ± 7.5 vs. 37.0 ± 6.2 mm, p < 0.001) and a higher prevalence of aortopathy (61 vs. 30%, p = 0.021) than those with TAV
Summary
Bicuspid aortic valve (BAV) is the most common congenital heart valve disease (Verma and Siu, 2014). Patients with BAV are more likely to have proximal aortic dilation and systemic vascular dysfunction such as endothelial dysfunction or arterial stiffness than patients with a tricuspid aortic valve (TAV; Ferencik and Pape, 2003; Tadros et al, 2009). Reduced arterial elasticity in any site of the aorta or carotid artery has been proven in patients with BAV because the intrinsic pathologic alterations are not confined to the proximal part of aorta but extend into the entire aorta (Grotenhuis et al, 2007; Bilen et al, 2012). Assessment of carotid artery structure and function has been highlighted in patients with aortic valve (AV) disease because carotid atherosclerosis and degenerative AV disease have common risk factors and pathogenesis. Age was the main determinant of the aortic IMT (Petrini et al, 2016)
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