Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

Anvesha Singh (Lead / Corresponding author), Mark A. Horsfield, Soliana Bekele, John P. Greenwood, Dana K. Dawson, Colin Berry, Kai Hogrefe, Damian J. Kelly, John G. Houston, Prasad Guntur Ramkumar, Akhlaque Uddin, Toru Suzuki, Gerry P. McCann

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)
159 Downloads (Pure)


Objectives: To compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).

Methods: MRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm 2/m 2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.

Results: The AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm 2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.

Conclusions: In patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.

Original languageEnglish
Pages (from-to)2340-2349
Number of pages10
JournalEuropean Radiology
Issue number5
Early online date28 Nov 2018
Publication statusPublished - 1 May 2019


  • Aorta, thoracic
  • Aortic valve stenosis
  • Aortic valve, bicuspid
  • Magnetic resonance imaging
  • Pulse wave velocity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves'. Together they form a unique fingerprint.

Cite this