Top

The International Journal of Cardiovascular Imaging

Published in:

01-10-2019 | Original Paper

Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease

Authors: Ozair Rahman, Michael Scott, Emilie Bollache, Kenichiro Suwa, Jeremy Collins, James Carr, Paul Fedak, Patrick McCarthy, Chris Malaisrie, Alex J. Barker, Michael Markl

Published in: The International Journal of Cardiovascular Imaging | Issue 10/2019

Abstract

Bicuspid aortic valve (BAV) is associated with abnormal valve-mediated hemodynamics including high velocity jets and elevated wall shear stress (WSS). This study investigated interval changes in flow and WSS in a multi-year follow-up study. This cross-sectional study included n = 44 patients with BAV (age = 44.9 ± 12 years), n = 17 patients with tricuspid aortic valve and thoracic aortic dilatation (TAV with dilation, age = 54.6 ± 16.5 years), and n = 9 healthy controls (age = 49.3 ± 14.7 years) underwent baseline and serial aortic 4D flow MRI (follow-up duration: BAV: 2.6 ± 0.7 years, TAV with dilation: 2.7 ± 0.5 years, controls: 1.1 ± 0.5 years). Data analysis included quantification of aortic dimensions, peak systolic velocities, as well as regional 3D WSS in the ascending aorta. At baseline, BAV patients demonstrated uniformly elevated peak velocity and WSS compared to TAV with dilation and control groups (peak velocity 2.2 m/s vs. 1.6 m/s vs. 1.5 m/s, p < 0.004; WSS: 0.74 Pa vs. 0.45 Pa vs. 0.55 Pa, p < 0.001). For BAV, peak velocity increased from baseline to follow up (2.2 ± 0.8 to 2.3 ± 0.9 m/s, p < 0.001) while WSS decreased (0.74 ± 0.22 to 0.65 ± 0.21 Pa, p < 0.001). Aortic growth was minimal for both BAV (0.05 cm/year) and TAV with dilation (0.03–0.04 cm/year) patients. For BAV patients, increase of ascending aorta peak velocities indicated worsening of valve function at follow-up. Compared to TAV with dilation patients, BAV patients demonstrated a reduction in WSS which may indicate a compensatory mechanism to reduce elevated WSS forces by aortic remodeling.

Siu SC, Silversides CK (2010) Bicuspid aortic valve disease. J Am Coll Cardiol 55(25):2789–2800CrossRef

Mahadevia R, Barker AJ, Schnell S et al (2014) Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation 129(6):673–682CrossRef

Girdauskas E, Rouman M, Disha K, et al (2014) Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis. Eur J Cardiothorac Surg 46(2):234–239. discussion 239 CrossRef

Barker AJ, Markl M, Burk J et al (2012) Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging 5(4):457–466CrossRef

Vincent F, Rauch A, Loobuyck V et al (2018) Arterial pulsatility and circulating von willebrand factor in patients on mechanical circulatory support. J Am Coll Cardiol 71(19):2106–2118CrossRef

Reneman RS, Arts T, Hoeks AP (2006) Wall shear stress–an important determinant of endothelial cell function and structure—in the arterial system in vivo. Discrepancies with theory. J Vasc Res 43(3):251–269PubMed

Guzzardi DG, Barker AJ, van Ooij P et al (2015) Valve-related hemodynamics mediate human bicuspid aortopathy: insights from wall shear stress mapping. J Am Coll Cardiol 66(8):892–900CrossRef

Bollache E, Guzzardi DG, Sattari S, et al (2018) Aortic valve-mediated wall shear stress is heterogeneous and predicts regional aortic elastic fiber thinning in bicuspid aortic valve-associated aortopathy. J Thorac Cardiovasc Surg 156(6):2112–2120 e2112CrossRef

den Reijer PM, Sallee D, van der Velden P et al (2010) Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12:4CrossRef

10.

Della Corte A, Body SC, Booher AM, et al (2014) Surgical treatment of bicuspid aortic valve disease: knowledge gaps and research perspectives. J Thorac Cardiovasc Surg 147(6):1749–1757, 1757 e1741CrossRef

11.

Della Corte A, Bancone C, Buonocore M et al (2013) Pattern of ascending aortic dimensions predicts the growth rate of the aorta in patients with bicuspid aortic valve. JACC Cardiovasc Imaging 6(12):1301–1310CrossRef

12.

Cheung K, Boodhwani M, Chan KL, Beauchesne L, Dick A, Coutinho T (2017) Thoracic aortic aneurysm growth: role of sex and aneurysm etiology. J Am Heart Assoc 6(2):e003792

13.

Hope MD, Sigovan M, Wrenn SJ, Saloner D, Dyverfeldt P (2014) MRI hemodynamic markers of progressive bicuspid aortic valve-related aortic disease. J Magn Reson Imaging 40(1):140–145CrossRef

14.

Markl M, Harloff A, Bley TA et al (2007) Time-resolved 3D MR velocity mapping at 3T: improved navigator-gated assessment of vascular anatomy and blood flow. J Magn Reson Imaging 25(4):824–831CrossRef

15.

Schnell S, Entezari P, Mahadewia RJ et al (2016) improved semiautomated 4D Flow MRI analysis in the aorta in patients with congenital aortic valve anomalies versus tricuspid aortic valves. J Comput Assist Tomogr 40(1):102–108CrossRef

16.

Rose MJ, Jarvis K, Chowdhary V et al (2016) Efficient method for volumetric assessment of peak blood flow velocity using 4D flow MRI. J Magn Reson Imaging 44(6):1673–1682CrossRef

17.

Potters WV, van Ooij P, Marquering H, vanBavel E, Nederveen AJ (2015) Volumetric arterial wall shear stress calculation based on cine phase contrast MRI. J Magn Reson Imaging 41(2):505–516CrossRef

18.

Sievers HH, Schmidtke C (2007) A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 133(5):1226–1233CrossRef

19.

Nishimura RA, Otto CM, Bonow RO, et al. (2014) AHA/ACC guideline for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 63:e57–e185

20.

Nishimura RA, Otto CM, Bonow RO et al (2014) AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 129(23):2440–2492CrossRef

21.

Cawley PJ, Maki JH, Otto CM (2009) Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation 119(3):468–478CrossRef

22.

Burman ED, Keegan J, Kilner PJ (2008) Aortic root measurement by cardiovascular magnetic resonance: specification of planes and lines of measurement and corresponding normal values. Circ Cardiovasc Imaging 1(2):104–113CrossRef

23.

Kimura N, Nakamura M, Komiya K, et al (2017) Patient-specific assessment of hemodynamics by computational fluid dynamics in patients with bicuspid aortopathy. J Thorac Cardiovasc Surg 153(4):S52–S62CrossRef

24.

Michelena HI, Khanna AD, Mahoney D et al (2011) Incidence of aortic complications in patients with bicuspid aortic valves. JAMA 306(10):1104–1112CrossRef

25.

Michelena HI, Desjardins VA, Avierinos JF et al (2008) Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation 117(21):2776–2784CrossRef

26.

Hope MD, Wrenn J, Sigovan M, Foster E, Tseng EE, Saloner D (2012) Imaging biomarkers of aortic disease: increased growth rates with eccentric systolic flow. J Am Coll Cardiol 60(4):356–357CrossRef

27.

Hope MD, Hope TA, Crook SE et al (2011) 4D flow CMR in assessment of valve-related ascending aortic disease. JACC Cardiovasc Imaging 4(7):781–787CrossRef

28.

von Knobelsdorff-Brenkenhoff F, Trauzeddel RF, Barker AJ, Gruettner H, Markl M, Schulz-Menger J (2014) Blood flow characteristics in the ascending aorta after aortic valve replacement–a pilot study using 4D-flow MRI. Int J Cardiol 170(3):426–433CrossRef

29.

van Ooij P, Potters WV, Nederveen AJ et al (2015) A methodology to detect abnormal relative wall shear stress on the full surface of the thoracic aorta using four-dimensional flow MRI. Magn Reson Med 73(3):1216–1227CrossRef

30.

Burk J, Blanke P, Stankovic Z et al (2012) Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR. J Cardiovasc Magn Reson 14:84CrossRef

31.

Boussel L, Rayz V, McCulloch C et al (2008) Aneurysm growth occurs at region of low wall shear stress: patient-specific correlation of hemodynamics and growth in a longitudinal study. Stroke 39(11):2997–3002CrossRef

32.

Regeer MV, Versteegh MI, Klautz RJ et al (2016) Effect of aortic valve replacement on aortic root dilatation rate in patients with bicuspid and Tricuspid Aortic valves. Ann Thorac Surg 102(6):1981–1987CrossRef

33.

Detaint D, Michelena HI, Nkomo VT, Vahanian A, Jondeau G, Sarano ME (2014) Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart 100(2):126–134CrossRef

34.

Trinh B, Dubin I, Rahman O, et al (2016) Aortic volumetry at contrast-enhanced magnetic resonance angiography: feasibility as a sensitive method for monitoring bicuspid aortic valve aortopathy. Invest Radiol. https://doi.org/10.1097/RLI.0000000000000332 CrossRef

35.

Truong U, Fonseca B, Dunning J et al (2013) Wall shear stress measured by phase contrast cardiovascular magnetic resonance in children and adolescents with pulmonary arterial hypertension. J Cardiovasc Magn Reson 15:81CrossRef

36.

Farag ES, van Ooij P, Planken RN, et al (2018) Aortic valve stenosis and aortic diameters determine the extent of increased wall shear stress in bicuspid aortic valve disease. J Magn Reson Imaging 48(2):522–530CrossRef

37.

van Ooij P, Powell AL, Potters WV, Carr JC, Markl M, Barker AJ (2016) Reproducibility and interobserver variability of systolic blood flow velocity and 3D wall shear stress derived from 4D flow MRI in the healthy aorta. J Magn Reson Imaging 43(1):236–248CrossRef

38.

Nordmeyer S, Riesenka E, Messroghli D et al (2013) Four-dimensional velocity-encoded magnetic resonance imaging improves blood flow quantification in patients with complex accelerated flow. J Magn Reson Imaging 37(1):208–216CrossRef

Title: Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease
Authors: Ozair Rahman
Michael Scott
Emilie Bollache
Kenichiro Suwa
Jeremy Collins
James Carr
Paul Fedak
Patrick McCarthy
Chris Malaisrie
Alex J. Barker
Michael Markl
Publication date: 01-10-2019
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 10/2019
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-019-01632-7

2024 ASCO Annual Meeting

Springer Medicine

Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 10/2019

Left atrial stiffness is superior to volume and strain parameters in predicting elevated NT-proBNP levels in systemic sclerosis patients

Imaging assessment and accuracy in coronary artery autopsy: comparison of frequency-domain optical coherence tomography with intravascular ultrasound and histology

Two dimensional and real-time three dimensional ultrasound measurements of left ventricular diastolic function after marathon running: results from a substudy of the BeMaGIC trial

Simple and noninvasive method to estimate right ventricular operating stiffness based on echocardiographic pulmonary regurgitant velocity and tricuspid annular plane movement measurements during atrial contraction

Very early in-stent neoatherosclerosis assessed by optical coherence tomography

The value of the left atrial appendage orifice perimeter of 3D model based on 3D TEE data in the choice of device size of LAmbre™ occluder