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Bicuspid aortic valve morphology and hemodynamics by same-day echocardiography and cardiac MRI

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Abstract

This study investigated the impact of bicuspid aortic valve (BAV) on valve morphology and motion as well as proximal and aortic hemodynamics using a same-day echocardiography and cardiac MRI. Transthoracic echocardiography, two-dimensional cine MRI of the aortic valve, and aortic 4D flow MRI were performed on the same day in 9 normofunctional BAV patients (age = 41 ± 12, 3 female), 4 BAV with moderate to severe aortic stenosis (AS) (age = 63 ± 5, 1 female), and 36 healthy tricuspid aortic valve controls (age = 52 ± 10, 21 female). Valve opening and closing timings and transvalvular peak velocity were measured using B-mode and Doppler echocardiogram, respectively. Valve orifice morphology at a fully-opened state was characterized using cine MRI. Ascending aortic (AAo) wall shear stress (WSS) was measured using 4D flow MRI data. Valve motion timings were similar between BAV and controls. BAV was associated with an increased orifice aspect ratio (1.44 ± 0.11 vs. 1.10 ± 0.13, P < 0.001), transvalvular peak velocity (1.5 ± 0.3 vs. 1.2 ± 0.2 m/s, P < 0.001) and maximum AAo WSS (1.62 ± 0.31 vs. 0.91 ± 0.24 Pa, P < 0.001). The increased orifice aspect ratio was associated with the increase in transvalvular peak velocity (r = 0.80, P < 0.0001) and maximum AAo WSS (r = 0.83, P < 0.0001). Transvalvular peak velocity was also positively correlated with maximum AAo WSS (r = 0.83, P < 0.0001). A same-day echo and MRI imaging allows for a comprehensive assessment of the impact of aortic valve disease on valve function and hemodynamics. In this pilot application to BAV, we found increased orifice aspect ratio may be responsible for increased transvalvular peak velocity and maximum AAo WSS.

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Acknowledgements

This study was supported by NIH R01HL115828 and R01HL133504. We would also like to thank General Electric, Inc., and the Irene D. Pritzker foundation for their financial and equipment support for this study.

Funding

This study was supported by NIH R01HL115828 and R01HL133504. We would also like to thank General Electric, Inc., and the Irene D. Pritzker foundation for their financial and equipment support for this study.

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Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Avenue, Suite 1600, Chicago, IL, 60611, USA

    Jeesoo Lee, Ashitha Pathrose, Gilles Soulat & Michael Markl

  2. Department of Cardiology, Northwestern Memorial Hospital, Chicago, IL, 60611, USA

    Nadia El Hangouche & James D. Thomas

  3. Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA

    Alex J. Barker

  4. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, 60208, USA

    Michael Markl

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  1. Jeesoo Lee
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  2. Nadia El Hangouche
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  4. Gilles Soulat
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  5. Alex J. Barker
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  7. Michael Markl
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Contributions

All authors have made significant contributions to this work and read and commented on previous manuscript versions. JL performed echocardiography and MRI image-processing, statistical data analysis and drafted the first version of the manuscript. NEH, AP, and GS participated in image processing and clinical data interpretation. AB was a senior investigator instrumental in study conceptualization and data acquisition management. JT and MM were principal investigators who conceived this study and provided clinical and technical guidance of echocardiography and MRI data interpretation.

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Correspondence to Jeesoo Lee.

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All authors have no relevant financial or non-financial competing interests to report.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Internal Review Board of Northwestern University (STU00204434).

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Informed consent was obtained from all individuals who participated in the study.

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Lee, J., El Hangouche, N., Pathrose, A. et al. Bicuspid aortic valve morphology and hemodynamics by same-day echocardiography and cardiac MRI. Int J Cardiovasc Imaging 38, 2047–2056 (2022). https://doi.org/10.1007/s10554-022-02593-0

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  • DOI: https://doi.org/10.1007/s10554-022-02593-0

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