This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (24) Citing Articles via Google Scholar Google Scholar Articles by Grotenhuis, H. B. Articles by de Roos, A. Search for Related Content PubMed PubMed Citation Articles by Grotenhuis, H. B. Articles by de Roos, A.

CLINICAL RESEARCH: VALVULAR HEART DISEASE

Reduced Aortic Elasticity and Dilatation Are Associated With Aortic Regurgitation and Left Ventricular Hypertrophy in Nonstenotic Bicuspid Aortic Valve Patients

Heynric B. Grotenhuis, MD^_*,,,||, Jaap Ottenkamp, MD^,,||, Jos J.M. Westenberg, PhD^_*, Jeroen J. Bax, MD, Lucia J.M. Kroft, MD^_* and Albert de Roos, MD^_*,_*

^_* Department of Radiology, Center for Congenital Anomalies of the Heart, Leiden, the Netherlands
Department of Paediatric Cardiology, Center for Congenital Anomalies of the Heart, Leiden, the Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Emma Children’s Hospital/AMC, Amsterdam, the Netherlands
^|| VU Medical Center, Amsterdam, the Netherlands.

Manuscript received August 24, 2006; revised manuscript received December 6, 2006, accepted December 7, 2006.

^_* Reprint requests and correspondence: Dr. Albert de Roos, Leiden University Medical Center, Department of Radiology, C2-S, Albinusdreef 2, 2300 RC Leiden, the Netherlands. (Email: A.de_Roos{at}lumc.nl).

Objectives: This study sought to assess elasticity and dimensions of the aorta and their impact on aortic valve competence and left ventricular (LV) function in patients with a nonstenotic bicuspid aortic valve (BAV).

Background: Intrinsic pathology of the aortic wall is a possible explanation for reduced aortic elasticity and aortic dilatation in patients with BAVs, even in the absence of a stenotic aortic valve. The relationship between aortic wall elasticity, aortic dimensions, aortic valve competence, and LV function in patients with BAVs has not previously been studied with magnetic resonance imaging.

Methods: Magnetic resonance imaging was performed in 20 patients with nonstenotic BAVs (mean ± SD, age 27 ± 11 years) and 20 matched control patients.

Results: The BAV patients showed reduced aortic elasticity as indicated by increased pulse wave velocity in the aortic arch and descending aorta (5.6 ± 1.3 m/s vs. 4.5 ± 1.1 m/s, p = 0.01; and 5.2 ± 1.8 m/s vs. 4.3 ± 0.9 m/s, p = 0.03, respectively), and reduced aortic root distensibility (3.1 ± 1.2 x 10^–3 mm Hg^–1 vs. 5.6 ± 3.2 x 10^–3 mm Hg^–1, p < 0.01). In addition, BAV patients showed aortic root dilatation as compared with control patients (mean difference 3.6 to 4.2 mm, p 0.04 at all 4 predefined levels). Minor degrees of aortic regurgitation (AR) were present in 11 patients (AR fraction 6 ± 8% vs. 1 ± 1%, p < 0.01). The LV ejection fraction was normal (55 ± 8% vs. 56 ± 6%, p = 0.61), whereas LV mass was significantly increased in patients (54 ± 12 g/m² vs. 46 ± 12 g/m², p = 0.04). Dilatation at the level of the aortic annulus (r = 0.45, p = 0.044) and reduced aortic root distensibility (r = 0.37, p = 0.041) correlated with AR fraction. Increased pulse wave velocity in the aortic arch correlated with increased LV mass (r = 0.42, p = 0.041).

Conclusions: Reduced aortic elasticity and aortic root dilatation were frequently present in patients with nonstenotic BAVs. In addition, reduced aortic wall elasticity was associated with severity of AR and LV hypertrophy.

Abbreviations and Acronyms   AR = aortic regurgitation   BAV = bicuspid aortic valve   LV = left ventricle/ventricular   MRI = magnetic resonance imaging   PWV = pulse wave velocity

This article has been cited by other articles:

				J. L. Cavalcante, J. A. C. Lima, A. Redheuil, and M. H. Al-Mallah Aortic Stiffness: Current Understanding and Future Directions J. Am. Coll. Cardiol., April 5, 2011; 57(14): 1511 - 1522. [Abstract] [Full Text] [PDF]

				A. Nemes, M. Csanady, and T. Forster Aortic Elastic Properties in Patients With Bicuspid Aortic Valve J. Am. Coll. Cardiol., January 25, 2011; 57(4): 518 - 518. [Full Text] [PDF]

				H. B. Grotenhuis and A. de Roos Structure and function of the aorta in inherited and congenital heart disease and the role of MRI Heart, January 1, 2011; 97(1): 66 - 74. [Full Text] [PDF]

				S. Kutty, S. Kaul, C. J. Danford, and D. A. Danford Main pulmonary artery dilation in association with congenital bicuspid aortic valve in the absence of pulmonary valve abnormality Heart, November 1, 2010; 96(21): 1756 - 1761. [Abstract] [Full Text] [PDF]

				B. A. Austin, Z. B. Popovic, D. H. Kwon, M. Thamilarasan, T. Boonyasirinant, S. D. Flamm, H. M. Lever, and M. Y. Desai Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study Heart, August 1, 2010; 96(16): 1303 - 1310. [Abstract] [Full Text] [PDF]

				S. C. Siu and C. K. Silversides Bicuspid Aortic Valve Disease J. Am. Coll. Cardiol., June 22, 2010; 55(25): 2789 - 2800. [Abstract] [Full Text] [PDF]

				A. Evangelista Aneurysm of the ascending aorta Heart, June 1, 2010; 96(12): 979 - 985. [Full Text] [PDF]

				N. Tzemos, E. Lyseggen, C. Silversides, M. Jamorski, J. H. Tong, P. Harvey, J. Floras, and S. Siu Endothelial Function, Carotid-Femoral Stiffness, and Plasma Matrix Metalloproteinase-2 in Men With Bicuspid Aortic Valve and Dilated Aorta J. Am. Coll. Cardiol., February 16, 2010; 55(7): 660 - 668. [Abstract] [Full Text] [PDF]

				S. M. Farasat Bicuspid Aortic Valve Disease Beyond the Aortic Root: Potential Prognostic Implications for Ascending Aortic Dilation J. Am. Coll. Cardiol., February 16, 2010; 55(7): 669 - 670. [Full Text] [PDF]

				T. Boonyasirinant, P. Rajiah, R. M. Setser, M. L. Lieber, H. M. Lever, M. Y. Desai, and S. D. Flamm Reply J. Am. Coll. Cardiol., February 2, 2010; 55(5): 505 - 506. [Full Text] [PDF]

				H B Grotenhuis, J Ottenkamp, L de Bruijn, J J M Westenberg, H W Vliegen, L J M Kroft, and A de Roos Aortic elasticity and size are associated with aortic regurgitation and left ventricular dysfunction in tetralogy of Fallot after pulmonary valve replacement Heart, December 1, 2009; 95(23): 1931 - 1936. [Abstract] [Full Text] [PDF]

				A. Brandts, S. G. C. van Elderen, J. J. M. Westenberg, J. van der Grond, M. A. van Buchem, M. V. Huisman, L. J. M. Kroft, J. T. Tamsma, and A. de Roos Association of Aortic Arch Pulse Wave Velocity with Left Ventricular Mass and Lacunar Brain Infarcts in Hypertensive Patients: Assessment with MR Imaging Radiology, December 1, 2009; 253(3): 681 - 688. [Abstract] [Full Text] [PDF]

				E. Bedard, K. P. McCarthy, K. Dimopoulos, G. Giannakoulas, M. A. Gatzoulis, and S. Y. Ho Structural Abnormalities of the Pulmonary Trunk in Tetralogy of Fallot and Potential Clinical Implications: A Morphological Study J. Am. Coll. Cardiol., November 10, 2009; 54(20): 1883 - 1890. [Abstract] [Full Text] [PDF]

				T. Boonyasirinant, P. Rajiah, R. M. Setser, M. L. Lieber, H. M. Lever, M. Y. Desai, and S. D. Flamm Aortic Stiffness Is Increased in Hypertrophic Cardiomyopathy With Myocardial Fibrosis: Novel Insights in Vascular Function From Magnetic Resonance Imaging J. Am. Coll. Cardiol., July 14, 2009; 54(3): 255 - 262. [Abstract] [Full Text] [PDF]

				S. Biner, A. M. Rafique, I. Ray, O. Cuk, R. J. Siegel, and K. Tolstrup Aortopathy Is Prevalent in Relatives of Bicuspid Aortic Valve Patients J. Am. Coll. Cardiol., June 16, 2009; 53(24): 2288 - 2295. [Abstract] [Full Text] [PDF]

				H. B. Grotenhuis, J. Ottenkamp, D. Fontein, H. W. Vliegen, J. J. M. Westenberg, L. J. M. Kroft, and A. de Roos Aortic Elasticity and Left Ventricular Function after Arterial Switch Operation: MR Imaging--Initial Experience Radiology, December 1, 2008; 249(3): 801 - 809. [Abstract] [Full Text] [PDF]

				S. D. Roes, R. Alizadeh Dehnavi, J. J.M. Westenberg, H. J. Lamb, B. J.A. Mertens, J. T. Tamsma, and A. de Roos Assessment of Aortic Pulse Wave Velocity and Cardiac Diastolic Function in Subjects With and Without the Metabolic Syndrome: HDL cholesterol is independently associated with cardiovascular function Diabetes Care, July 1, 2008; 31(7): 1442 - 1444. [Abstract] [Full Text] [PDF]

				S. S. Fazel, H. R. Mallidi, R. S. Lee, M. P. Sheehan, D. Liang, D. Fleischman, R. Herfkens, R. S. Mitchell, and D. C. Miller The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 901 - 907.e2. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola The Year in Valvular Heart Disease J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]

				P. Matt MMPs in gene- and protein-expression Interact CardioVasc Thorac Surg, February 1, 2008; 7(1): 40 - 41. [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al. Highlights of the Year in JACC 2007 J. Am. Coll. Cardiol., January 29, 2008; 51(4): 490 - 512. [Full Text] [PDF]