Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve

Bradley D. Allen, Michael Markl*, Alex J Barker, Pim van Ooij, James Carr, S Chris Malaisrie, Patrick M McCarthy, Robert O Bonow, Preeti Kansal

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB−, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB− patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m2, p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m2, p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m2, p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m2, p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB− groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = −0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.

Original languageEnglish (US)
Pages (from-to)621-628
Number of pages8
JournalInternational Journal of Cardiovascular Imaging
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Aorta
Therapeutics
Sinus of Valsalva
Aortic Valve Stenosis
Bicuspid Aortic Valve
Dilatation
Linear Models
Hemodynamics
Prospective Studies
Control Groups

Keywords

  • 4D flow MRI
  • Aortic dilatation
  • Beta blocker
  • Bicuspid aortic valve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{25dd0a6f52ef4c45aba6882c8166cc46,
title = "Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve",
abstract = "In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB−, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB− patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m2, p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m2, p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m2, p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m2, p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB− groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = −0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.",
keywords = "4D flow MRI, Aortic dilatation, Beta blocker, Bicuspid aortic valve",
author = "Allen, {Bradley D.} and Michael Markl and Barker, {Alex J} and {van Ooij}, Pim and James Carr and Malaisrie, {S Chris} and McCarthy, {Patrick M} and Bonow, {Robert O} and Preeti Kansal",
year = "2016",
month = "4",
day = "1",
doi = "10.1007/s10554-015-0819-3",
language = "English (US)",
volume = "32",
pages = "621--628",
journal = "International Journal of Cardiovascular Imaging",
issn = "1569-5794",
publisher = "Springer Netherlands",
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TY - JOUR

T1 - Influence of beta-blocker therapy on aortic blood flow in patients with bicuspid aortic valve

AU - Allen, Bradley D.

AU - Markl, Michael

AU - Barker, Alex J

AU - van Ooij, Pim

AU - Carr, James

AU - Malaisrie, S Chris

AU - McCarthy, Patrick M

AU - Bonow, Robert O

AU - Kansal, Preeti

PY - 2016/4/1

Y1 - 2016/4/1

N2 - In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB−, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB− patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m2, p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m2, p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m2, p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m2, p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB− groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = −0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.

AB - In patients with bicuspid aortic valve (BAV), beta-blockers (BB) are assumed to slow ascending aorta (AAo) dilation by reducing wall shear stress (WSS) on the aneurysmal segment. The aim of this study was to assess differences in AAo peak velocity and WSS in BAV patients with and without BB therapy. BAV patients receiving BB (BB+, n = 30, age: 47 ± 11 years) or not on BB (BB−, n = 30, age: 46 ± 13 years) and healthy controls (n = 15, age: 43 ± 11 years) underwent 4D flow MRI for the assessment of in vivo aortic 3D blood flow. Peak systolic velocities and 3D WSS were calculated at the anterior and posterior walls of the AAo. Both patient groups had higher maximum and mean WSS relative to the control group (p = 0.001 to p = 0.04). WSS was not reduced in the BB+ group compared to BB− patients in the anterior AAo (maximum: 1.49 ± 0.47 vs. 1.38 ± 0.49 N/m2, p = 0.99, mean: 0.76 ± 0.2 vs. 0.74 ± 0.18 N/m2, p = 1.00) or posterior AAo (maximum: 1.45 ± 0.42 vs. 1.39 ± 0.58 N/m2, p = 1.00; mean: 0.65 ± 0.16 vs. 0.63 ± 0.16 N/m2, p = 1.00). AAo peak velocity was elevated in patients compared to controls (p < 0.01) but similar for BB+ and BB− groups (p = 0.42). Linear models identified significant relationships between aortic stenosis severity and increased maximum WSS (β = 0.186, p = 0.007) and between diameter at the sinus of Valsalva and reduced mean WSS (β = −0.151, p = 0.045). Peak velocity and systolic WSS were similar for BAV patients irrespective of BB therapy. Further prospective studies are needed to investigate the impact of dosage and duration of BB therapy on aortic hemodynamics and development of aortopathy.

KW - 4D flow MRI

KW - Aortic dilatation

KW - Beta blocker

KW - Bicuspid aortic valve

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U2 - 10.1007/s10554-015-0819-3

DO - 10.1007/s10554-015-0819-3

M3 - Article

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VL - 32

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EP - 628

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

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