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. 2022 Jan;15(1):46-56.
doi: 10.1016/j.jcmg.2021.09.023. Epub 2021 Nov 17.

Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve

Andrea Guala  1 , Lydia Dux-Santoy  2 , Gisela Teixido-Tura  3 , Aroa Ruiz-Muñoz  1 , Laura Galian-Gay  4 , Maria Luz Servato  4 , Filipa Valente  4 , Laura Gutiérrez  4 , Teresa González-Alujas  4 , Kevin M Johnson  5 , Oliver Wieben  5 , Guillem Casas-Masnou  4 , Augusto Sao Avilés  2 , Ruben Fernandez-Galera  4 , Ignacio Ferreira-Gonzalez  6 , Arturo Evangelista  7 , Jose F Rodríguez-Palomares  8
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Free article

Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve

Andrea Guala et al. JACC Cardiovasc Imaging. 2022 Jan.
Free article

Abstract

Objectives: This study sought to assess the predictive value of wall shear stress (WSS) for colocalized ascending aorta (AAo) growth rate (GR) in patients with bicuspid aortic valve (BAV).

Background: BAV is associated with AAo dilation, but there is limited knowledge about possible predictors of aortic dilation in patients with BAV. An increased WSS has been related to aortic wall damage in patients with BAV, but no previous prospective study tested its predictive value for dilation rate. Recently, a registration-based technique for the semiautomatic mapping of aortic GR has been presented and validated.

Methods: Forty-seven patients with BAV free from valvular dysfunction prospectively underwent 4-dimensional flow cardiac magnetic resonance to compute WSS and subsequent follow-up with 2 electrocardiogram-gated high-resolution contrast-enhanced computed tomography angiograms for GR assessment.

Results: During a median follow-up duration of 43 months, mid AAo GR was 0.24 mm/year. WSS and its circumferential component showed statistically significant association with mid AAo GR in bivariate (P = 0.049 and P = 0.014, respectively) and in multivariate analysis corrected for stroke volume and either baseline AAo diameter (P = 0.046 and P = 0.014, respectively) or z-score (P = 0.036 and P = 0.012, respectively). GR mapping further detailed that GR was heterogeneous in the AAo and that circumferential WSS, but not WSS magnitude, showed statistically significant positive associations with GR in the regions with the fastest growth.

Conclusions: 4D flow cardiac magnetic resonance-derived WSS and, in particular, its circumferential component predict progressive dilation of the ascending aorta in patients with BAV. Thus, the assessment of WSS may be considered in the follow-up of these patients.

Keywords: aortic aneurysm; bicuspid aortic valve; dilation mapping; growth rate; wall shear stress.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by funding from the Instituto de Salud Carlos III (projects PI14/01062, PI17/00381 and PI20/01727); the Spanish Ministry of Science, Innovation, and Universities (RTC2019-007280-1), the Spanish Society of Cardiology (SEC/FEC-INV-CLI 20/015 and SEC/FEC-INV-CLI 21/030); and the Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV). Dr Guala has received funding from the Spanish Ministry of Science, Innovation, and Universities (IJC2018-037349-I). Dr Johnson has received research grants from GE Healthcare through the University of Wisconsin-Madison (no personal compensation). Dr Wieben has received research grants from GE Healthcare through the University of Wisconsin-Madison (no personal compensation). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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