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The Impact of Aortic Distensibility in Patients with Bicuspid Aortic Valve Stenosis
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 19 - DOENÇA VALVULAR
Speaker:
Débora Da Silva Correia
Congress:
CPC 2025
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
22. Aortic Disease
Subtheme:
22.3 Aortic Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Débora Da Silva Correia; Kamil Stankowski; João Abecasis; Pedro Lopes; Rita Reis Santos; Rita Lima; Telma Lima; António Ferreira; Maria João Andrade; Regina Ribeiras; Sância Ramos; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Introduction:</u> Ventricular adaptation to aortic stenosis (AS) is influenced by both valve obstruction and overall vascular load. Bicuspid aortic valve (BAV) is associated with intrinsic aortopathy, impacting aortic stiffness. We aimed to compare aortic stiffness, using distensibility as its surrogate marker, between AS patients with BAV and tricuspid aortic valve (TAV) and to assess its impact on LV remodeling.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods:</u><em> </em>Single-centre, prospective cohort study of 158 patients with severe symptomatic AS<em> </em>(71±8 years, 50% male; mean transaortic gradient 61±17mmHg, mean indexed aortic valve area 0.4±0.1cm2/m2 and mean LV ejection fraction 58±9%) referred for SAVR between 2019 and 2022. Patients with previous cardiomyopathy, concomitant moderate/severe aortic regurgitation and severe non-AS valvulophaty were excluded. All participants underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) before SAVR. Valve morphology was determined from TTE or surgical operative reports. Average systolic and diastolic ascending aortic (AA) dimensions were measured at <em>cine</em> images on the horizontal three-chamber and coronal left ventricular outflow views, at the level of pulmonary artery bifurcation. Maximum and minimum aortic areas were then inferred and aortic distensibility calculated. Relative aortic valve load (VL) and valvulo-arterial impedance (Zva) were calculated and correlated with aortic distensibility. LV ventricular geometric remodeling, defined from CMR, was assessed according to valve morphology and aortic distensibility.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results:</u> <em>A</em> total of 123 patients were included (71 years[IQR 9]; 50% male), 13% with BAV, and 87% with TAV (25 patients with undetermined valve morphology). All patients had normal flow/high gradient AS, and BAV cases exhibited the ascending phenotype without root involvement. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BAV patients were younger, with lower prevalence of hypertension and with higher prevalence of aortopathy. AS severity indexes were similar between groups, except for higher mean transvalvular gradients in BAV-<em>Table 1</em>. BAV patients exhibited higher aortic distensibility and VL, though these differences were not statistically significant. Zva values were comparable between groups-<em>Table 2</em>. A negative correlation was found between distensibility and Zva in BAV patients (ρ=-0.615,p=0.011) but not in the TAV group (ρ=-0.151,p=0.122)-Figure 2. LV geometric remodeling had no significant correlation with aortic distensibility in both group of patients (ρ -0.114 p=0.246 in BAV and ρ 0.137,p=0.264 in TAV).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion:</u> Aortic distensibility was similar between BAV and TAV patients and showed no association with LV remodeling in either group. However, in BAV patients there was a significant negative correlation between distensibility and Zva, favouring a distinct ventricular-valvular and vascular relationship in this subgroup.</span></span></p>
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