Patients with bicuspid aortic valves exhibited a significantly higher percentage of clockwise rotating blood volume in the ascending aorta compared to healthy volunteers (80% vs. 60%, P<0.01).
Observational (n=57)
Does 4D flow MRI reveal differences in aortic blood flow rotational direction between healthy volunteers and patients with bicuspid aortic valves?
4D flow MRI demonstrates that blood flow in the thoracic aorta exhibits simultaneous clockwise and counter-clockwise rotation, with BAV patients showing significantly more clockwise rotating volume in the ascending aorta than healthy volunteers.
Absolute Event Rate: 80% vs 60%
p-value: p=<0.01
Background: The rotational direction (RD) of helical blood flow can be classified as either a clockwise (RD+) or counter-clockwise (RD−) flow. We hypothesized that this simple classification might not be sufficient for analysis in vivo and a simultaneous existence of RD+/− may occur. We utilized volumetric velocity-sensitive cardiovascular magnetic resonance imaging (4D flow MRI) to analyze rotational blood flow in the thoracic aorta. Methods: Forty volunteers (22 females; mean age, 41±16 years) and seventeen patients with bicuspid aortic valves (BAVs) (9 females; mean age, 42±14 years) were prospectively included. The RDs and the calculation of the rotating blood volumes (RBVs) in the thoracic aorta were performed using a pathline-projection strategy. Results: We could confirm a mainly clockwise RD in the ascending, descending aorta and in the aortic arch. Furthermore, we found a simultaneous existence of RD+/RD−. The RD+/−-volume in the ascending aorta was significantly higher in BAV patients, the mean RD+/RD− percentage was approximately 80%/20% vs. 60%/40% in volunteers (P<0.01). The maximum RBV always occurred during systole. There was significantly more clockwise than counter-clockwise rotational flow in the ascending aorta (P<0.01) and the aortic arch (P<0.01), but no significant differences in the descending aorta (P=0.48). Conclusions: A simultaneous occurrence of RD+/RD− indicates that a simple categorization in either of both is insufficient to describe blood flow in vivo. Rotational flow in the ascending aorta and in the aortic arch differs significantly from flow in the descending aorta. BAV patients show significantly more clockwise rotating volume in the ascending aorta compared to healthy volunteers.
Ebel et al. (2023) conducted an observational in Bicuspid aortic valves (n=57). Bicuspid aortic valve vs. Healthy volunteers was evaluated on Mean clockwise rotational direction (RD+) percentage in the ascending aorta (p=<0.01). Patients with bicuspid aortic valves exhibited a significantly higher percentage of clockwise rotating blood volume in the ascending aorta compared to healthy volunteers (80% vs. 60%, P<0.01).