Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients

Minderhoud, Savine C S; Roos‐Hesselink, Jolien W.; Chelu, Raluca G.; Bons, Lidia R.; Hoven, Allard T. van den; Korteland, Suze-Anne; Bosch, Annemien E. van den; Budde, Ricardo P.J.; Wentzel, Jolanda J.; Hirsch, Alexander

doi:10.1093/ehjci/jeab290

Cited by 26 publications

(13 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another inflammatory mediator, TLR9, was only significantly correlated in the subset of patients with BAV, which suggests there may be a relationship between TLR9 and BAV with vascular aging. BAV increases aortic wall stress, 48 which over time could lead to activation of TLR9, an area that will future investigation for verification. With increased mitochondrial dysfunction, mitochondrial DNA may be released and subsequently activate innate immune pathways including the TLR9, inflammasome, and STING pathways.…”

Section: Discussionmentioning

confidence: 99%

Aging Alters the Aortic Proteome in Health and Thoracic Aortic Aneurysm

Tyrrell

Chen

et al. 2022

ATVB

View full text Add to dashboard Cite

Background: Aging enhances most chronic diseases but its impact on human aortic tissue in health and in thoracic aortic aneurysms (TAA) remains unclear. Methods: We employed a human aortic biorepository of healthy specimens (n=17) and those that underwent surgical repair for TAA (n=20). First, we performed proteomics comparing aortas of healthy donors to aneurysmal specimens, in young (ie, <60 years of age) and old (ie, ≥60 years of age) subjects. Second, we measured proteins, via immunoblotting, involved in mitophagy (ie, Parkin) and also mitochondrial-induced inflammatory pathways, specifically TLR (toll-like receptor) 9, STING (stimulator of interferon genes), and IFN (interferon)-β. Results: Proteomics revealed that aging transformed the aorta both quantitatively and qualitatively from health to TAA. Whereas young aortas exhibited an enrichment of immunologic processes, older aortas exhibited an enrichment of metabolic processes. Immunoblotting revealed that the expression of Parkin directly correlated to subject age in health but inversely to subject age in TAA. In TAA, but not in health, phosphorylation of STING and the expression of IFN-β was impacted by aging regardless of whether subjects had bicuspid or tricuspid valves. In subjects with bicuspid valves and TAAs, TLR9 expression positively correlated with subject age. Interestingly, whereas phosphorylation of STING was inversely correlated with subject age, IFN-β positively correlated with subject age. Conclusions: Aging transforms the human aortic proteome from health to TAA, leading to a differential regulation of biological processes. Our results suggest that the development of therapies to mitigate vascular diseases including TAA may need to be modified depending on subject age.

show abstract

Section: Discussionmentioning

confidence: 99%

Aging Alters the Aortic Proteome in Health and Thoracic Aortic Aneurysm

Tyrrell

Chen

et al. 2022

ATVB

View full text Add to dashboard Cite

show abstract

“…Several previous studies have shown, comparing BAV patients to subjects with normal, tricuspid valves (TAV), that WSS is clearly increased in patients with BAV compared to TAV ( 6 , 11 , 35 ). Especially circumferential WSS and progression of helicity seem to have an impact on aortic growth ( 36 , 37 ). Heterogeneous distribution of WSS leads to different affections of the vessel wall, including elastic fiber thinning ( 38 ) as well as intima-media thickening and plaque induction in initiation of atherosclerosis ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Hanigk¹,

Burgstaller²,

Latus³

et al. 2023

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

Background: Bicuspid aortic valve (BAV) disease leads to deviant helical flow patterns especially in the mid-ascending aorta (AAo), potentially causing wall alterations such as aortic dilation and dissection. Among others, wall shear stress (WSS) could contribute to the prediction of long-term outcome of patients with BAV. 4D flow in cardiovascular magnetic resonance (CMR) has been established as a valid method for flow visualization and WSS estimation. The aim of this study is to reevaluate flow patterns and WSS in patients with BAV 10 years after the initial evaluation. Methods: Fifteen patients (median age 34.0 years) with BAV were re-evaluated 10 years after the initial study from 2008/2009 using 4D flow by CMR. Our particular patient cohort met the same inclusion criteria as in 2008/2009, all without enlargement of the aorta or valvular impairment at that time. Flow patterns, aortic diameters, WSS and distensibility were calculated in different aortic regions of interest (ROI) with dedicated software tools.Results: Indexed aortic diameters in the descending aorta (DAo), but especially in the AAo did not change in the 10-year period. Median difference 0.05 cm/m 2 (95% CI: 0.01 to 0.22; P=0.06) for AAo and median difference −0.08 cm/m 2 (95% CI: −0.12 to 0.01; P=0.07) for DAo. WSS values were lower in 2018/2019 at all measured levels. Aortic distensibility decreased by median 25.6% in the AAo, while stiffness increased concordantly (median +23.6%).Conclusions: After a ten years' follow-up of patients with isolated BAV disease, indexed aortic diameters did not change in this patient cohort. WSS was lower compared to values generated 10 years earlier. Possibly a drop of WSS in BAV could serve as a marker for a benign long-term course and implementation of more conservative treatment strategies.

show abstract

“…4D flow MRI has contributed to our understanding of the association between BAV and ascending aortic aneurysms ( 54 - 57 ). Eccentric flow, which is an abnormal transvalvular flow caused by bicuspid valvular morphology, is thought to be an important contributor to the aortopathy in patients with BAV ( 58 , 59 ). Lorenz et al showed that, compared to the normal helical flow in the ascending aorta and arch observed in patients with tricuspid AV, patients with BAV had a significantly higher absolute peak helicity throughout the thoracic aorta ( 54 ).…”

Section: Clinical Application Of Blood Flow Assessment In Aortic Diseasementioning

confidence: 99%

Blood flow assessment technology in aortic surgery: a narrative review

Hohri,

Chung,

Kandula

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

Background and Objective Blood flow assessment is an emerging technique that allows for assessment of hemodynamics in the heart and blood vessels. Recent advances in cardiovascular imaging technologies have made it possible for this technique to be more accessible to clinicians and researchers. Blood flow assessment typically refers to two techniques: measurement-based flow visualization using echocardiography or four-dimensional flow magnetic resonance imaging (4D flow MRI), and computer-based flow simulation based on computational fluid dynamics modeling. Using these methods, blood flow patterns can be visualized and quantitative measurements of mechanical stress on the walls of the ventricles and blood vessels, most notably the aorta, can be made. Thus, blood flow assessment has been enhancing the understanding of cardiac and aortic diseases; however, its introduction to clinical practice has been negligible yet. In this article, we aim to discuss the clinical applications and future directions of blood flow assessment in aortic surgery. We then provide our unique perspective on the technique’s translational impact on the surgical management of aortic disease. Methods Articles from the PubMed database and Google Scholar regarding blood flow assessment in aortic surgery were reviewed. For the initial search, articles published between 2013 and 2023 were prioritized, including original articles, clinical trials, case reports, and reviews. Following the initial search, additional articles were considered based on manual searches of the references from the retrieved literature. Key Content and Findings In aortic root pathology and ascending aortic aneurysms, blood flow assessment can elucidate postoperative hemodynamic changes after surgical reconfiguration of the aortic valve complex or ascending aorta. In cases of aortic dissection, analysis of blood flow can predict future aortic dilatation. For complicated congenital aortic anomalies, surgeons may use preoperative imaging to perform “virtual surgery”, in which blood flow assessment can predict postoperative hemodynamics for different surgical reconstructions and assist in procedural planning even before entering the operating room. Conclusions Blood flow assessment and computational modeling can evaluate hemodynamics and flow patterns by visualizing blood flow and calculating biomechanical forces in patients with aortic disease. We anticipate that blood flow assessment will become an essential tool in the treatment planning and understanding of the progression of aortic disease.

show abstract

Wall shear stress angle is associated with aortic growth in bicuspid aortic valve patients

Cited by 26 publications

References 24 publications

Aging Alters the Aortic Proteome in Health and Thoracic Aortic Aneurysm

Aging Alters the Aortic Proteome in Health and Thoracic Aortic Aneurysm

Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up

Blood flow assessment technology in aortic surgery: a narrative review

Contact Info

Product

Resources

About