Bicuspid aortic valve (BAV) is associated with a well-known aortic impairment. Despite a common embryological origin of the carotids and ascending aorta, carotid involvement associated to BAV remains controversial. We aimed at evaluating carotid stiffness by ultrafast ultrasound imaging (UF) in a prospective series of BAV patients.

BAV patients and normal first-degree relatives (controls) were consecutively included in a reference center for BAV. Bilateral evaluation of common carotid arteries by UF was carried out by a 7.5MHz linear probe (Aixplorer®, SuperSonic Imagine©). The high frame rate (2000 frames/s) was used to measure the PWV at the foot of the waveform (PWV1), generated at the diastolic blood pressure (DBP) and at the dicrotic notch (PWV2), at the systolic blood pressure (SBP). To evaluate the intrinsic properties of the artery, we therefore reported each PWV measured to their corresponding arterial pressure. Distensibility, maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) were measured by analyzing the carotid diameter change, obtained by tracking the wall with ultrafast Doppler.

92 BAV patients and 48 controls were prospectively included, with similar age but larger aortic diameters in case of BAV (P<0.001). Neither the PWVs, nor the evaluation of distensibility, MRSD, or MRDR, found any difference in term of carotid stiffness between BAV patients and controls (Table 1). The increase of stiffness (evaluated by distensibility or MRSD) with age did not differ between the two groups, whatever the age, underlining the similar behaviour of carotid stiffening with age (Figure 1). Carotid stiffness is linearly correlated with age, with similar slopes in BAV patients and controls.

Comparatively to the impairment observed on the ascending aorta, our results clearly indicate that carotid stiffness parameters are not impacted in case of BAV.