Background and aim of the study: The aortic valve leaflets plus the aorta and sinuses of Valsalva are a functional unit that optimizes distribution of the diastolic pressure load on the aortic valve leaflets. The study aim was to examine the hypothesis that echocardiographically measured parameters of aortic wall stress at the level of the sinuses of Valsalva, namely aortic wall thickness and luminal diameter, are associated with the presence of aortic valve sclerosis (AVS).
Methods: Among 103 patients (age range 60-70 years) referred for echocardiography at a university hospital, 59 with AVS were compared to an age-matched control group (n = 44) with no echocardiographic abnormalities. Subjects with congenital bicuspid aortic valves were excluded from the study. Transthoracic echocardiographically obtained digital loop recordings were reviewed and two-dimensionally guided measurements were made at the level of the aortic annulus and sinus of Valsalva using electronic calipers, from the parasternal long-axis view. Results: There was a significant linear relationship and direct

correlationbetween aortic root diameter at the sinus of Valsalva and body surface area (BSA) (r = 0.488, F = 31.6, p <0.001) in both the AVS (r = 0.491, F = 18.1, p <0.001) and control (r = 0.571; F = 20.3; p <0.001) groups. After adjusting for BSA, aortic wall thickness was significantly (p <0.05) smaller in AVS patients compared to controls. Luminal diameter was not significantly different between the two groups. The specificity of the relationship with sinus of Valsalva wall thickness was confirmed by an absence of any difference in aortic root thickness at the level of the aortic annulus in AVS compared to controls.
Conclusion: AVS is associated with a thinner aortic wall at the level of the sinus of Valsalva. This novel finding suggests that a thinner aortic wall, a reflection of its constituents, likely acting through its contribution to reduced aortic compliance and increased aortic stress, leads to the thickening of aortic valve leaflets characteristic of AVS. Further understanding of this relationship may unravel the pathophysiology of this type of aortic valve disease.
The Journal of Heart Valve Disease 2006;15:158-164