Aortic valve dysfunction in bicuspid aortic valve patients is associated with elevated aortic peak velocities and wall shear stress, which correlate with increased left ventricular mass (r=0.57, P<0.001).
Observational (n=49)
Are BAV-mediated changes in aortic hemodynamics associated with parameters of left ventricular remodeling?
In patients with bicuspid aortic valve, aortic stenosis and regurgitation are associated with elevated aortic peak velocities and wall shear stress, which correlate with left ventricular remodeling.
Effect estimate: r = 0.57
p-value: p=<0.001
BACKGROUND: Patients with bicuspid aortic valve (BAV) show altered hemodynamics in the ascending aorta that can be assessed by 4D flow MRI. PURPOSE: Comprehensive cardiac MRI was applied to test the hypothesis that BAV-mediated changes in aortic hemodynamics (wall shear stress WSS and velocity) are associated with parameters of left ventricular (LV) remodeling. STUDY TYPE: Retrospective data analysis. POPULATION: Forty-nine BAV patients (mean age = 50.2 ± 13.5, 62% male). FIELD STRENGTH/SEQUENCE: mapping with modified Look-Locker inversion recovery (MOLLI), time-resolved 3D phase-contrast (PC) MRI with three-directional velocity encoding (4D flow MRI) at 1.5 and 3T. ASSESSMENT: Quantification of LV volumetric data and myocardial mass, extracellular volume fraction (ECV), aortic valve stenosis (AS), and regurgitation (AR). 3D aortic segmentation, quantification of peak systolic velocities, and 3D WSS in the ascending aorta (AAo), arch, and descending aorta (DAo). STATISTICAL TESTS: Two-sided nonpaired t-test to compare subgroups. Pearson correlation coefficient for correlations between aortic hemodynamics and LV parameters. RESULTS: Of the 49 BAV patients, 35 had aortic valve dysfunction (AS n = 7, AR n = 16, both AS and AR n = 12). Mean systolic WSS in the AAo, peak systolic velocities in the AAo and arch, and LV mass were significantly higher (P < 0.001) in the AS/AR group compared to the patients without AS/AR. In the complete group, we observed significant relationships between increased LV mass and elevated peak systolic velocity (r = 0.57, r = 0.58; P < 0.001) and WSS in the AAo and arch, respectively (r = 0.54, r = 0.46; P < 0.001). We detected an association between ECV and WSS in the AAo (r = 0.38, P = 0.02). These relations did not hold true for patients without AV dysfunction. DATA CONCLUSION: AS and AR in BAV patients have a major impact on elevated aortic peak velocities and WSS that were associated with parameters of LV remodeling. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017.
Geiger et al. (Tue,) conducted a observational in Bicuspid aortic valve (BAV) (n=49). Aortic valve dysfunction (stenosis and/or regurgitation) vs. BAV patients without aortic valve dysfunction was evaluated on Correlation between increased left ventricular mass and elevated peak systolic velocity in the ascending aorta (r = 0.57, p=<0.001). Aortic valve dysfunction in bicuspid aortic valve patients is associated with elevated aortic peak velocities and wall shear stress, which correlate with increased left ventricular mass (r=0.57, P<0.001).