Cardiology · 2 h ago
Aortic flow and systemic stiffness differ in BAVA and HTAD
In a prospective study of 185 patients, cardiovascular magnetic resonance and non-invasive haemodynamic testing identified different aortic profiles in bicuspid aortic valve-associated aortopathy (BAVA) and heritable thoracic aortic disease (HTAD). Exploratory analyses linked different measures to adverse aortic events in each group; the findings require external validation.
- BAVA showed greater focal aortic dilation and flow-related measures.
- HTAD was associated with greater systemic arterial stiffness.
- Adverse aortic event rates were similar between groups.
- Event predictors were exploratory and need external validation.
Researchers prospectively enrolled 111 patients with BAVA and 74 with HTAD and compared aortic morphology and haemodynamics using cardiovascular magnetic resonance, including 4D-flow measures, and oscillometry. Composite adverse aortic events included acute aortic syndrome, cardiovascular death, or meeting guideline diameter criteria for surgery. Participants were followed for a mean of 42.1 months (SD 17.6).
Compared with HTAD, BAVA was associated with greater tubular ascending aorta and sinotubular junction dilation, higher ascending-aorta wall shear stress (0.42 vs 0.28 Pa; p=0.020) and energy loss (19.8 vs 12.3 mW; p<0.001), and higher aortic distensibility. Systemic stiffness measures were lower in BAVA: pulse wave velocity was 6.2 vs 7.8 m/s, and augmentation index was 12.1% vs 18.4% (both p<0.001). Adverse aortic event rates were similar between groups.
In exploratory analyses, ascending-aorta wall shear stress was associated with events in BAVA (HR 8.92, 95% CI 2.85–27.95), while systemic pulse wave velocity was associated with events in HTAD (HR 2.16, 95% CI 1.30–3.57). These associations suggest potentially different haemodynamic profiles, but do not establish clinical utility; the authors state that the predictors require external validation.
In practice
The study found distinct haemodynamic profiles in patients with BAVA and HTAD, but it does not support changing clinical assessment or management. Adverse event rates were similar, and the reported associations between wall shear stress in BAVA or systemic pulse wave velocity in HTAD and events came from exploratory, aetiology-specific analyses. External validation is needed before these measures can be considered reliable prognostic tools or used to guide monitoring, referral, or surgery decisions.
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European Heart Journal - Cardiovascular Imaging: Flow dynamics and systemic arterial stiffness distinguish bicuspid aortic valve aortopathy from heritable thoracic aortic disease ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.