Abstract
Background: Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, has been associated with an aortopathy, increased aortic stiffness and diastolic dysfunction. The involved mechanisms and impact of age remain unclear. It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with a history of BAV.Methods: Multimodal cardiovascular assessment included echocardiography, ascending aortic distensibility, common carotid intima media thickness [cIMT], parameters of wave reflection [central (cAIx75) and peripheral (pAIx75) augmentation index corrected to a heart rate of 75/min, aging index (AI)], carotid-femoral pulse wave velocity [cfPWV], and endothelial function (EndoPAT). Multivariable linear regression and correlation analyses were performed.Results: We included 47 BAV patients and 84 controls (age 8–65 years). Ascending aortic stiffness, pulse wave reflection (cAIx75, pAIx75, and AI) and central blood pressure were significantly increased in patients with BAV. However, PWV, cIMT, and endothelial function were not significantly different from controls. BAV patients had marginally reduced diastolic (E': β = −1.5, p < 0.001) but not systolic function compared to controls. Overall, all parameters of arterial stiffness had moderate-strong correlations with diastolic dysfunction and age. In the BAV group, ascending aortic distensibility had the strongest correlation with diastolic dysfunction.Conclusions: BAV is associated with increased proximal arterial stiffness and wave reflection. However, PWV and cIMT are not increased, and endothelial function is preserved. This suggests that the mechanism of arterial and cardiac stiffening is different from patients with acquired heart diseases.
Highlights
Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, existing in 1–2% of the population
BAV patients were recruited through SWEDCON (Swedish national registry on congenital heart disease) and control patients were recruited through advertisement
AscAo, ascending aorta; carotid intima media thickness (cIMT), common carotid artery intima media thickness; cAIx75, central augmentation index corrected to a heart rate of 75/min; pAIx75, peripheral augmentation index corrected to a heart rate of 75/min
Summary
Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, existing in 1–2% of the population. The cause for diastolic and/or systolic myocardial dysfunction without significant valve dysfunction remains unclear, but could be due to [1] abnormal intraventricular flow dynamics in the setting of an asymmetrically opening valve, [2] intrinsic myocardial abnormalities, or [3] be the result of arterioventricular interaction (i.e., the impact of arterial stiffening on ventricular function). Bicuspid aortic valve (BAV), the most common congenital cardiac anomaly, has been associated with an aortopathy, increased aortic stiffness and diastolic dysfunction. The involved mechanisms and impact of age remain unclear It was the aim of this study to characterize arterial and cardiac function, their correlation, and the effect of age in children and adults with a history of BAV
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