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

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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.

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Funding

Funding was provided by National Institutes of Health (Grant Nos. R01HL115828 and R01HL133504).

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Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ozair Rahman, Michael Scott, Emilie Bollache, Kenichiro Suwa, Jeremy Collins, James Carr, Alex J. Barker & Michael Markl

  2. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada

    Paul Fedak

  3. Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, IL, USA

    Paul Fedak

  4. Bluhm Cardiovascular Institute and Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Patrick McCarthy & Chris Malaisrie

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

    Michael Scott & Michael Markl

  6. Department of Radiology, Northwestern University, 737 N. Michigan Avenue Suite 1600, Chicago, IL, 60611, USA

    Michael Markl

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  1. Ozair Rahman
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Correspondence to Michael Markl.

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The authors report the following conflicts of interest: Michael Markl: Research support by Siemens Healthineers, Research Grant: by Cryolife Inc, Consultant and Research Grant by Circle - Cardiovascular Imaging.

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Rahman, O., Scott, M., Bollache, E. et al. Interval changes in aortic peak velocity and wall shear stress in patients with bicuspid aortic valve disease. Int J Cardiovasc Imaging 35, 1925–1934 (2019). https://doi.org/10.1007/s10554-019-01632-7

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  • DOI: https://doi.org/10.1007/s10554-019-01632-7

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