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Multimodal Assessment of Vascular and Ventricular Function in Children and Adults With Bicuspid Aortic Valve Disease

Weismann, Constance G. LU orcid ; Ljungberg, Sara ; Åkesson, Anna and Hlebowicz, J. LU (2021) In Frontiers in Cardiovascular Medicine 8.
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],... (More)

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.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
aortic stiffness and distensibility, augmentation index, bicuspid aortic valve, congenital heart disease, diastolic function, endothelial function, intima media thickness, pulse wave velocity
in
Frontiers in Cardiovascular Medicine
volume
8
article number
643900
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85105956787
  • pmid:33834044
ISSN
2297-055X
DOI
10.3389/fcvm.2021.643900
language
English
LU publication?
yes
additional info
Funding Information: Many thanks to sonographer Bernhard S. Grell, and research nurses Elin Friberg and Annika Maxedius. Funding. This study was supported by the Swedish Heart-Lung Foundation (#20170397; CW), Avtal om Läkarutbildning och Forskning (ALF; CW), and Hjärtebarnsfonden (Swedish Pediatric Heart Foundation).
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6fa2b0d5-5709-4ee6-b46b-6cc06323659a
date added to LUP
2021-06-02 11:02:52
date last changed
2024-04-20 06:57:00
@article{6fa2b0d5-5709-4ee6-b46b-6cc06323659a,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Weismann, Constance G. and Ljungberg, Sara and Åkesson, Anna and Hlebowicz, J.}},
  issn         = {{2297-055X}},
  keywords     = {{aortic stiffness and distensibility; augmentation index; bicuspid aortic valve; congenital heart disease; diastolic function; endothelial function; intima media thickness; pulse wave velocity}},
  language     = {{eng}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Cardiovascular Medicine}},
  title        = {{Multimodal Assessment of Vascular and Ventricular Function in Children and Adults With Bicuspid Aortic Valve Disease}},
  url          = {{http://dx.doi.org/10.3389/fcvm.2021.643900}},
  doi          = {{10.3389/fcvm.2021.643900}},
  volume       = {{8}},
  year         = {{2021}},
}