| Description |
The bicuspid aortic valve (BAV) is the most common congenital heart defect, occurring in 1–2% of the population. This anomaly represents a significant risk factor for the development of pathologies of the aortic valve and ascending aorta. Patients with BAV often develop aortic stenosis or regurgitation, dilatation of the aortic root or its ascending part, or infectious endocarditis. The aim of this study was to evaluate cardiovascular parameters in patients with bicuspid aortic valve using less commonly utilized methods such as sphygmography and continuous monitoring of blood pressure and heart rate. The obtained values were compared with healthy individuals and correlated with standard echocardiography. The long-term goal is to comprehensively describe the cardiovascular characteristics of BAV patients to support better individualized monitoring of disease progression and treatment. In collaboration with the Center for Cardiovascular and Transplant Surgery (CKTCH) and the Department of Cardiovascular and Transplant Surgery of the Faculty of Medicine at Masaryk University, we examined 76 patients with bicuspid aortic valve (BAV, age 22–56 years). Using transthoracic echocardiography, colleagues from CKTCH assessed the state of the aortic valve, aortic root, and ascending aorta, including basic cardiac parameters – left ventricular diameter in diastole (LVDD) and systole (LVDS), posterior wall (PW), left atrium (LA), interventricular septum (IVS), ejection fraction (EF), transvalvular gradient of the aortic valve (Grmax, Grmean), and the presence of aortic regurgitation (AoR). At the Department of Physiology, six-minute resting blood pressure measurement was performed using the Penáz method (Finapres® NOVA) with ECG recording. The following parameters were evaluated: systolic (SBP) and diastolic blood pressure (DBP), pulse interval (PI), hemodynamics: stroke volume (SV), cardiac index (CI), contractility index (dP/dt), autonomic nervous system function: baroreflex sensitivity (BRS), and heart rate variability: low– to high–frequency ratio (LF/HF). Vascular parameters – carotid–femoral pulse wave velocity (cfPWV), augmentation pressure (AP), augmentation index standardized to heart rate 75/min (AI/75), and subendocardial viability ratio (SEVR) – were assessed using SphygmoCor®. For statistical analysis, the Mann–Whitney test and Spearman’s correlation coefficient were used. We measured physiological values (mean ± standard deviation) for Finapres parameters: SBP (128±13 mmHg), DBP (72±10 mmHg), PI (968±159 ms), CI (3.5±1.0 l/min/m2), BRS (12.7±7.1 ms/mmHg); increased SV (110±33 ml), and decreased dP/dt (852±301 mmHg/s) and LF/HF (0.8±0.6). Vascular parameters were as follows: cfPWV (5.0±1.2 m/s), AP (12.8±9.4 mmHg), increased AI/75 (21.9±14.6%), and borderline SEVR (141.4±29.6%). Echocardiographic parameters were at the upper limit of normal, with presence of AoR (grade 2). We found positive correlations between Finapres SBP and AoR (p?0.05), LVDD (p?0.01), and LVDS (p?0.05). The results indicate that despite standard treatment, patients with BAV show pathological values in key cardiovascular parameters. Increased stroke volume and decreased contractility index suggest impaired mechanical heart function, while decreased LF/HF ratio indicates disrupted autonomic regulation. Borderline SEVR suggests potentially reduced myocardial perfusion, and increased AI/75 indicates higher arterial stiffness. The use of continuous monitoring with Finapres NOVA® and SphygmoCor® enabled detailed analysis and may contribute to better risk stratification in these patients. However, further studies on larger cohorts are necessary to confirm these findings.
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