Association between flow skewness and aortic dilatation in patients with aortic stenosis
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We investigated association between hemodynamic characteristics and aortic dilatation in patients with severe aortic stenosis (AS). Eighty patients with severe AS (mean age, 67.2 ± 12.5 years) who underwent multi-detector computed tomography and phase-contrast magnetic resonance imaging at the ascending aorta were retrospectively analyzed. Patients with an ascending aorta diameter >4 cm had a significantly higher forward flow rate at systole (28.5 ± 6.0 vs. 36.2 ± 8.6 L min, P < 0.001), and retrograde flow rate at systole (11.3 ± 4.2 vs. 18.8 ± 5.8 L min, P < 0.001), fractional reverse ratio (a ratio of retrograde flow rate to forward flow rate; 34.1 ± 11.9% vs. 43.5 ± 18.0%, P = 0.014), flow skewness Rskewness (a ratio of sum of forward and retrograde systole flow to net systole flow rate; 2.4 ± 0.7 vs. 3.2 ± 1.0, P < 0.001). The presence of bicuspid aortic valve (BAV; odds ratio [OR] 72.01, 95% confidence interval [CI] 10.57–490.46, P < 0.001), Left ventricular mass index (LVMI; OR 1.02 /g/m2; CI 1.00–1.04, P = 0.043) and Rskewness (OR 5.6 per 1, 95% CI 1.8–17.1, P = 0.001) were associated with aortic dilatation. BAV, LVMI, and increased Rskewness in the ascending aorta are associated with aortic dilatation in patients with AS.
KeywordsPhase-contrast magnetic resonance imaging 2D PC-MRI Wall shear stress Aortic stenosis Hemodynamics Aortic dilatation
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2016R1A1A1A05921207, 2015R1A2A2A04003034) and a grant (2017-7208) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. The study protocol was approved by the hospital institutional review board.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 13.Yasuda H, Nakatani S, Stugaard M, Tsujita-Kuroda Y, Bando K, Kobayashi J, Yamagishi M, Kitakaze M, Kitamura S, Miyatake K (2003) Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Circulation 108(10 suppl 1):II-291–II-294Google Scholar
- 15.Bissell MM, Hess AT, Biasiolli L, Glaze SJ, Loudon M, Pitcher A, Davis A, Prendergast B, Markl M, Barker AJ (2013) Aortic dilation in bicuspid aortic valve disease flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging 6(4):499–507CrossRefPubMedGoogle Scholar
- 17.Meierhofer C, Schneider EP, Lyko C, Hutter A, Martinoff S, Markl M, Hager A, Hess J, Stern H, Fratz S (2013) Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging 14(8):797–804CrossRefPubMedGoogle Scholar
- 21.Piatti F, Pirola S, Bissell M, Nesteruk I, Sturla F, Della Corte A, Redaelli A, Votta E (2017) Towards the improved quantification of in vivo abnormal wall shear stresses in BAV-affected patients from 4D-flow imaging: benchmarking and application to real data. J Biomech 50:93–101CrossRefPubMedGoogle Scholar
- 28.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin III JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt III TM, Thomas JD, American College of Cardiology/American Heart Association, Task Force on Practice G (2014) 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 (22):e57–e185. doi: 10.1016/j.jacc.2014.02.536 CrossRefPubMedGoogle Scholar
- 29.Achenbach S, Delgado V, Hausleiter J, Schoenhagen P, Min JK, Leipsic JA (2012) SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 6(6):366–380. doi: 10.1016/j.jcct.2012.11.002 CrossRefPubMedGoogle Scholar
- 30.Kang JW, Song HG, Yang DH, Baek S, Kim DH, Song JM, Kang DH, Lim TH, Song JK (2013) Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging 6(2):150–161. doi: 10.1016/j.jcmg.2012.11.007 CrossRefPubMedGoogle Scholar
- 32.von Knobelsdorff-Brenkenhoff F, Karunaharamoorthy A, Trauzeddel RF, Barker AJ, Blaszczyk E, Markl M, Schulz-Menger J (2016) Evaluation of aortic blood flow and wall shear stress in aortic stenosis and its association with left ventricular remodeling. Circ Cardiovasc Imaging 9(3):e004038Google Scholar
- 40.Ha H, Kim GB, Kweon J, Huh HK, Lee SJ, Koo HJ, Kang J-W, Lim T-H, Kim D-H, Kim Y-H (2016) Turbulent kinetic energy measurement using phase contrast MRI for estimating the post-stenotic pressure drop: in vitro validation and clinical application. PloS ONE 11(3):e0151540CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Fratz S, Chung T, Greil GF, Samyn MM, Taylor AM, Buechel ERV, Yoo S-J, Powell AJ (2013) Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson 15(1):51CrossRefPubMedPubMedCentralGoogle Scholar