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Aortic and vascular disease
Original research
Determinants of aortic growth rate in patients with bicuspid aortic valve by cardiovascular magnetic resonance
  1. Froso Sophocleous1,
  2. Bostjan Berlot1,2,
  3. Maria Victoria Ordonez1,
  4. Mai Baquedano1,
  5. Elena Giulia Milano3,4,
  6. Viola De Francesco2,
  7. Graham Stuart2,
  8. Massimo Caputo1,2,
  9. Chiara Bucciarelli-Ducci1,2 and
  10. Giovanni Biglino1,2,5
  1. 1Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  3. 3Institute of Cardiovascular Science, University College London, London, UK
  4. 4Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
  5. 5National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Dr Giovanni Biglino; g.biglino{at}bristol.ac.uk

Abstract

Objectives This study aimed to identify determinants of aortic growth rate in bicuspid aortic valve (BAV) patients. We hypothesised that (1) BAV patients with repaired coarctation (CoA) exhibit decreased aortic growth rate, (2) moderate/severe re-coarctation (reCoA) results in increased growth rate, (3) patients with right non-coronary (RN) valve cusps fusion pattern exhibit increased aortic growth rate compared with right-left cusps fusion and type 0 valves.

Methods Starting from n=521 BAV patients with cardiovascular magnetic resonance data, we identified n=145 patients with at least two scans for aortic growth analysis. Indexed areas of the sinuses of Valsalva and ascending aorta (AAo) were calculated from cine images in end-systole and end-diastole. Patients were classified based on dilation phenotype, presence of CoA, aortic valve function and BAV morphotype. Comparisons between groups were performed. Linear regression was carried out to identify associations between risk factors and aortic growth rate.

Results Patients (39±16 years of age, 68% male) had scans 3.7±1.8 years apart; 32 presented with AAo dilation, 18 with aortic root dilation and 32 were overall dilated. Patients with repaired CoA (n=61) showed decreased aortic root growth rate compared with patients without CoA (p≤0.03) regardless of sex or age. ReCoA, aortic stenosis, regurgitation and history of hypertension were not associated with growth rate. RN fusion pattern showed the highest aortic root growth rate and type 0 the smallest (0.30 vs 0.08 cm2/m*year, end-systole, p=0.03).

Conclusions Presence of CoA and cusp fusion morphotype were associated with changes in rate of root dilation in our BAV population.

  • bicuspid aortic valve
  • aortic growth
  • aortic root
  • proximal ascending aorta
  • coarctation
  • valve morphotype

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/openhrt-2019-001095

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    Footnotes

    • Twitter @ag_stuart

    • Contributors FS, MC, CBD and GB planned the design of the study. FS, BB, MVO, MB, EGM and VDF collected and analysed MRI data. FS, BB, MVO, GS, MC, CBD and GB contributed to data analysis and interpretation. FS and GB draft the manuscript and all authors critically revised the manuscript and contributed to the final version.

    • Funding CBD and this study are supported by the Bristol National Institute of Health Research (NIHR) Biomedical Research Centre (BRC).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR or Department of Health and Social Care.

    • Competing interests CBD is a consultant for Circle Cardiovascular Imaging (Calgary, Canada).

    • Patient consent for publication Not required.

    • Ethics approval All datasets were anonymised and, in view of the retrospective study design, formal ethical approval was waived by the local Institutional Research and Innovation Department in view of the retrospective nature of the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.