TY - JOUR
T1 - Risk Stratification in Bicuspid Aortic Valve Aortopathy
T2 - Emerging Evidence and Future Perspectives
AU - Della Corte, Alessandro
AU - Michelena, Hector I.
AU - Citarella, Angelo
AU - Votta, Emiliano
AU - Piatti, Filippo
AU - Lo Presti, Federica
AU - Ashurov, Rasul
AU - Cipollaro, Marilena
AU - Forte, Amalia
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2021/3
Y1 - 2021/3
N2 - The current management of aortic dilatation associated with congenital bicuspid aortic valve (bicuspid aortic valve aortopathy) is based on dimensional parameters (diameter of the aneurysm, growth of the diameter over time) and few other criteria. The disease is however heterogeneous in terms of natural and clinical history and risk of acute complications, ie aortic dissection. Dimensional criteria are now admitted to have limited value as predictors of such complications. Thus, novel principles for risk stratification have been recently investigated, including phenotypic criteria, flow-related metrics, and circulating biomarkers. A systematization of the typical anatomoclinical forms that the aortopathy can assume has led to the identification of the more severe root phenotype, associated with higher risk of progression of the aneurysm and possible higher aortic dissection risk. Four-dimensional-flow magnetic resonance imaging studies are searching for potentially clinically significant metrics of flow derangement, based on the recognized association of local abnormal shear stress with wall pathology. Other research initiatives are addressing the question whether circulating molecules could predict the presence or, more importantly, the future development of aortopathy. The present review summarizes the latest progresses in the knowledge on risk stratification of bicuspid aortic valve aortopathy, focusing on critical aspects and debated points.
AB - The current management of aortic dilatation associated with congenital bicuspid aortic valve (bicuspid aortic valve aortopathy) is based on dimensional parameters (diameter of the aneurysm, growth of the diameter over time) and few other criteria. The disease is however heterogeneous in terms of natural and clinical history and risk of acute complications, ie aortic dissection. Dimensional criteria are now admitted to have limited value as predictors of such complications. Thus, novel principles for risk stratification have been recently investigated, including phenotypic criteria, flow-related metrics, and circulating biomarkers. A systematization of the typical anatomoclinical forms that the aortopathy can assume has led to the identification of the more severe root phenotype, associated with higher risk of progression of the aneurysm and possible higher aortic dissection risk. Four-dimensional-flow magnetic resonance imaging studies are searching for potentially clinically significant metrics of flow derangement, based on the recognized association of local abnormal shear stress with wall pathology. Other research initiatives are addressing the question whether circulating molecules could predict the presence or, more importantly, the future development of aortopathy. The present review summarizes the latest progresses in the knowledge on risk stratification of bicuspid aortic valve aortopathy, focusing on critical aspects and debated points.
UR - http://www.scopus.com/inward/record.url?scp=85068485920&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068485920&partnerID=8YFLogxK
U2 - 10.1016/j.cpcardiol.2019.06.002
DO - 10.1016/j.cpcardiol.2019.06.002
M3 - Review article
C2 - 31296418
AN - SCOPUS:85068485920
SN - 0146-2806
VL - 46
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
IS - 3
M1 - 100428
ER -