Key result
Valve intervention in severe aortic stenosis significantly reduced the direct component of LV blood flow kinetic energy (4.91 vs 1.86 µJ, P=0.01).
Why the study?
Left ventricular kinetic energy assessment by 4D flow CMR may offer incremental value over routine assessment in aortic stenosis, but its changes and associations with 6MWT and LV remodelling post-valve intervention needed investigation.
Does LV kinetic energy assessment by 4D flow CMR correlate with functional capacity and predict LV remodeling post-valve intervention in patients with severe aortic stenosis?
Observational (n=18)
Does LV kinetic energy assessment by 4D flow CMR correlate with functional capacity and predict LV remodeling post-valve intervention in patients with severe aortic stenosis?
Absolute Event Rate: 1.86% vs 4.91%
p-value: p=0.01
Left ventricular kinetic energy assessment by 4D flow CMR provides incremental value in predicting LV remodeling and correlates with functional capacity in patients with severe aortic stenosis undergoing valve intervention.
LV KE assessment in AS may inform remodelling; hypothesis-generating and requires prospective validation before clinical use.
Background: Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention. Methods: We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases. LV KE parameters were normalised to LV end-diastolic volume (LVEDV). Results: For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14±48 vs. 2.5±9.75 ms, P=0.04), direct (4.91±5.07 vs. 1.86±1.72 µJ, P=0.01) and delayed (2.46±3.13 vs. 1.38±1.15 µJ, P=0.03) components of LV blood flow demonstrated a significant change between pre- and post-valve intervention. Only LV KEiEDV (r=−0.53, P<0.01), diastolic KEiEDV (r=−0.53, P<0.01) and Ewave KEiEDV (r=−0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEiEDV (r=0.67, P=0.02) demonstrated association to LV remodelling post valve intervention. Conclusions: LV blood flow KE is associated with 6MWT and LV remodelling in patients with AS. LV KE assessment provides incremental value over routine LV function and pressure gradient (PG) assessment in AS.
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Elhawaz et al. (2021) conducted an observational in severe aortic stenosis (n=18). Valve intervention vs. Pre-valve intervention was evaluated on Direct component of LV blood flow kinetic energy (µJ) (p=0.01). Valve intervention in severe aortic stenosis significantly reduced the direct component of LV blood flow kinetic energy (4.91 vs 1.86 µJ, P=0.01).
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