title: Aortic and left ventricular remodeling in patients with bicuspid aortic valve without significant valvular dysfunction: a prospective study.
abstract: BACKGROUND
  Bicuspid aortic valve (BAV) represents the most common cardiac congenital malformation in the adult age. It is frequently associated with dilatation, aneurysm and dissection of the ascending aorta. The purpose of the following study was to evaluate in patients with BAV: 1) the elastic properties of the ascending aorta, 2) the mechanical function of the left ventricle and 3) stiffness, elasticity and strain of the epi-aortic vessels wall.
  
  
  METHODS
  Forty BAV patients (28M/12F; age 20.9 ± 4.7 years; range 17-26) with no or mild valvular impairment were recruited with 40 control subjects (25M/15F; age 23.4 ± 3.4 years; range 15-31) matched for age, gender and body surface area (BSA). Aortic strain, aortic distensibility (AoDIS) and aortic stiffness index (AoSI) were derived. Left ventricular strain was acquired. Elastic properties of epi-aortic vessels were evaluated.
  
  
  RESULTS
  BAVs vs. controls had increased systolic and diastolic aortic diameters (p<0.001). Aortic strain (%) was lower in BAVs than in controls (8.3 ± 3.6 vs. 11.2 ± 2.6; p<0.001) as well as AoDIS (10(-6)cm(2)dyn(-1)) (6.5 ± 2.8 vs. 8.8 ± 2.9; p=0.002), while AoSI was greater in BAVs (6.4 ± 3.5 vs. 3.9 ± 1.2; p<0.001). Both AoDIS and aortic strain were related to aortic size in BAVs and controls. Left ventricular longitudinal (p=0.01), circumferential (p=0.01) and radial (p<0.001) strain (%) were lower in BAVs. No significant differences were found in elastic properties of epi-aortic vessels.
  
  
  CONCLUSIONS
  Bicuspid aortic valve is associated with an increased aortic stiffness and with a reduction of the aortic and left ventricular deformation properties. Epi-aortic vessels do not seem to be interested by the disease. The use of an echocardiographic method that can estimate the degree of aortic and left ventricular remodeling can provide great benefits in the selection of patients with BAV to be treated and in determining the time for beginning drug therapy.
authors.affiliation: Cardiology Department, Magna Graecia University, Catanzaro, Italy. santarpi@gmail.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Scognamiglio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Salvo
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cotrufo
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000503:physiopathology; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis*; D057791:Cardiac Imaging Techniques / Q000379:methods; D003971:Diastole / Q000502:physiology; D018618:Echocardiography, Doppler, Color / Q000379:methods; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000002:abnormalities* / Q000503:physiopathology; D011446:Prospective Studies; D013599:Systole / Q000502:physiology; D059289:Vascular Stiffness / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*; D055815:Young Adult