Web of Science: 77 cites, Scopus: 76 cites, Google Scholar: cites,
Aortic flow patterns and wall shear stress maps by 4D-flow cardiovascular magnetic resonance in the assessment of aortic dilatation in bicuspid aortic valve disease
Rodríguez-Palomares, José Fernando (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Dux-Santoy, Lydia (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Guala, Andrea (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Kale, Raquel (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Maldonado, Giuliana (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Teixidó-Turà, Gisela (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Galian Gay, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Huguet, Marina (Cardiac Imaging Department, CETIR-ERESA, Clínica del Pilar-Sant Jordi, Barcelona, Spain)
Valente, Filipa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Gutiérrez, Laura (Hospital Universitari Vall d'Hebron. Institut de Recerca)
González-Alujas, Teresa (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Johnson, Kevin M. (Madison, WI USA)
Wieben, Oliver (Madison, WI USA)
Garcia-Dorado, David (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Evangelista Masip, Arturo (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Data: 2018
Resum: In patients with bicuspid valve (BAV), ascending aorta (AAo) dilatation may be caused by altered flow patterns and wall shear stress (WSS). These differences may explain different aortic dilatation morphotypes. Using 4D-flow cardiovascular magnetic resonance (CMR), we aimed to analyze differences in flow patterns and regional axial and circumferential WSS maps between BAV phenotypes and their correlation with ascending aorta dilatation morphotype. One hundred and one BAV patients (aortic diameter ≤ 45 mm, no severe valvular disease) and 20 healthy subjects were studied by 4D-flow CMR. Peak velocity, flow jet angle, flow displacement, in-plane rotational flow (IRF) and systolic flow reversal ratio (SFRR) were assessed at different levels of the AAo. Peak-systolic axial and circumferential regional WSS maps were also estimated. Unadjusted and multivariable adjusted linear regression analyses were used to identify independent correlates of aortic root or ascending dilatation. Age, sex, valve morphotype, body surface area, flow derived variables and WSS components were included in the multivariable models. The AAo was non-dilated in 24 BAV patients and dilated in 77 (root morphotype in 11 and ascending in 66). BAV phenotype was right-left (RL-) in 78 patients and right-non-coronary (RN-) in 23. Both BAV phenotypes presented different outflow jet direction and velocity profiles that matched the location of maximum systolic axial WSS. RL-BAV velocity profiles and maximum axial WSS were homogeneously distributed right-anteriorly, however, RN-BAV showed higher variable profiles with a main proximal-posterior distribution shifting anteriorly at mid-distal AAo. Compared to controls, BAV patients presented similar WSS magnitude at proximal, mid and distal AAo (p = 0. 764, 0. 516 and 0. 053, respectively) but lower axial and higher circumferential WSS components (p < 0. 001 for both, at all aortic levels). Among BAV patients, RN-BAV presented higher IRF at all levels (p = 0. 024 proximal, 0. 046 mid and 0. 002 distal AAo) and higher circumferential WSS at mid and distal AAo (p = 0. 038 and 0. 046, respectively) than RL-BAV. However, axial WSS was higher in RL-BAV compared to RN-BAV at proximal and mid AAo (p = 0. 046, 0. 019, respectively). Displacement and axial WSS were independently associated with the root-morphotype, and circumferential WSS and SFRR with the ascending-morphotype. Different BAV-phenotypes present different flow patterns with an anterior distribution in RL-BAV, whereas, RN-BAV patients present a predominant posterior outflow jet at the sinotubular junction that shifts to anterior or right anterior in mid and distal AAo. Thus, RL-BAV patients present a higher axial WSS at the aortic root while RN-BAV present a higher circumferential WSS in mid and distal AAo. These results may explain different AAo dilatation morphotypes in the BAV population. The online version of this article (10. 1186/s12968-018-0451-1) contains supplementary material, which is available to authorized users.
Ajuts: Instituto de Salud Carlos III PI11-01081
Nota: Altres ajuts: This study has been funded by , La Marató de TV3 (project number 20151330). Guala A. has received funding from the European Union Seventh Framework Programme FP7/People under grant agreement n° 267128.
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Llengua: Anglès
Document: Article ; recerca ; Versió publicada
Matèria: Bicuspid aortic valve ; 4D flow cardiovascular magnetic resonance (4D flow CMR) ; Wall shear stress ; Ascending aorta ; Aorta hemodynamics ; Aortic dilatation
Publicat a: Journal of Cardiovascular Magnetic Resonance, Vol. 20 (april 2018) , ISSN 1532-429X

DOI: 10.1186/s12968-018-0451-1
PMID: 29695249

15 p, 4.8 MB

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