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- Open Access
Impact of Beta-blocker, ACE Inhibitor, and ARB therapy on thoracic aorta wall shear stress in bicuspid aortic valve patients
© McGee et al. 2016
- Published: 27 January 2016
- Wall Shear Stress
- Angiotensin Converting Enzyme Inhibitor
- Bicuspid Aortic Valve
- Aortic Valve Stenosis
- Bicuspid Aortic Valve Patient
Bicuspid aortic valves (BAV) are associated with higher incidence of aortopathy such as aortic dilatation, dissection, and aortic valve stenosis. Recent 4D flow MRI studies have provided evidence that BAV aortopathy is associated with specific hemodynamic abnormalities and increased wall shear stress (WSS) which is thought to alter aortic endothelial cell function and induce remodeling and dilatation. Pharmacologic management of BAV is currently debated. It has been hypothesized that blood pressure control using medical therapy can decrease or reduce the rate of change to central arterial pressure and thus reduce wall forces such as wall shear stress (WSS) on the aneurysmal segment of the aorta to prevent aortic remodeling and dilatation. However, in-vivo studies investigating the effect of cardiac medications on aortic WSS in BAV patients are lacking. In this longitudinal follow-up 4D flow MRI study, the effects of Beta blockers (BB), Angiotensin converting enzyme inhibitors (ACEI), and Angiotensin II Receptor Blockers (ARB) on the aortic WSS was investigated using 4D Flow MRI.
Summarized in Table 1, the prescription of medical therapy did not result in significant changes in global (entire aorta, table 1) or regional (aortic segments, tables 2 and 3) WSS. Changes in mean global WSS were small and similar for the Drug+ group 0.59 ± 0.07 Pa vs. 0.56 ± 0.08 Pa, -4.9% differences, p = 0.33) and the Drug- group (0.69 ± 0.13 Pa vs. 0.66 ± 0.15 Pa, 8.5% differences, p = 0.421).
Overall there was a small non-significant 4.9% decrease in mean global WSS from baseline in patients prescribed ACEI, ARB, or BB. WSS was not statistically significant between the two patient groups. Our findings suggest that current medical therapy is not effective in changing aortic hemodynamics and reducing systolic WSS. Further investigation in larger cohorts is necessary to confirm these findings and determine if WSS measurements can be used to evaluate the effectiveness of drug therapy.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.