Why the study?
BAV is accompanied by secondary complications requiring lifelong evaluation, prompting assessment of 4D-flow MRI to verify the reliability of LV flow components and pressure drops in silent BAV with mild regurgitation and preserved ejection fraction.
Does 4D-flow MRI-derived intra-cardiac pressure drop and flow distribution differentiate BAV patients with mild regurgitation and preserved ejection fraction from healthy controls?
Does 4D-flow MRI-derived intra-cardiac pressure drop and flow distribution differentiate BAV patients with mild regurgitation and preserved ejection fraction from healthy controls?
In BAV patients with preserved ejection fraction, 4D-flow MRI-derived local pressure measurements, but not global flow components, can reveal early stages of diastolic dysfunction.
May identify early diastolic dysfunction via 4D-flow pressures in BAV; hypothesis-generating and requires prospective validation before clinical adoption.
Background Bicuspid aortic valve (BAV) is more than a congenital defect since it is accompanied by several secondary complications that intensify induced impairments. Hence, BAV patients need lifelong evaluations to prevent severe clinical sequelae. We applied 4D-flow magnetic resonance imaging (MRI) for in detail visualization and quantification of in vivo blood flow to verify the reliability of the left ventricular (LV) flow components and pressure drops in the silent BAV subjects with mild regurgitation and preserved ejection fraction (pEF). Materials and methods A total of 51 BAV patients with mild regurgitation and 24 healthy controls were recruited to undergo routine cardiac MRI followed by 4D-flow MRI using 3T MRI scanners. A dedicated 4D-flow module was utilized to pre-process and then analyze the LV flow components (direct flow, retained inflow, delayed ejection, and residual volume) and left-sided [left atrium (LA) and LV] local pressure drop. To elucidate significant diastolic dysfunction in our population, transmitral early and late diastolic 4D flow peak velocity (E-wave and A-wave, respectively), as well as E/A ratio variable, were acquired. Results The significant means differences of each LV flow component (global measurement) were not observed between the two groups ( p > 0.05). In terms of pressure analysis (local measurement), maximum and mean as well as pressure at E-wave and A-wave timepoints at the mitral valve (MV) plane were significantly different between BAV and control groups ( p : 0.005, p : 0.02, and p : 0.04 and p : <0.001; respectively). Furthermore, maximum pressure and pressure difference at the A-wave timepoint at left ventricle mid and left ventricle apex planes were significant. Although we could not find any correlation between LV diastolic function and flow components, Low but statistically significant correlations were observed with local pressure at LA mid, MV and LV apex planes at E-wave timepoint ( R : −0.324, p : 0.005, R : −0.327, p : 0.004, and R : −0.306, p : 0.008, respectively). Conclusion In BAV patients with pEF, flow components analysis is not sensitive to differentiate BAV patients with mild regurgitation and healthy control because flow components and EF are global parameters. Inversely, pressure (local measurement) can be a more reliable biomarker to reveal the early stage of diastolic dysfunction.
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Aliabadi et al. (2022) studied this question.
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