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A Left ventricle remodeling in patients with bicuspid aortic valve

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Abstract

Purpose

We assessed the impact of bicuspid aortic valve (BAV), aortic stenosis (AS), and regurgitation (AR) on the metrics of left ventricular (LV) remodeling, as measured by electrocardiogram (ECG), transthoracic echocardiography (TTE), and cardiac magnetic resonance (CMR).

Methods

This retrospective CMR study included 11 patients with both AS and AR (BAV-ASR), 30 with AS (BAV-AS), 28 with AR (BAV-AR), 47 with neither AS nor AR (BAV-no_AS/AR), and 40 with trileaflet aortic valve (TAV-no_AS/AR). CMR analysis included the LV end-diastolic volume index (LVEDVi), mass index (LVMi), and extracellular volume fraction (ECV). The Sokolow-Lyon and Cornell products by ECG and TTE-derived E/e’ were measured.

Results

There were no differences in the ECG, TTE, and CMR parameters between BAV-no_AS/AR and TAV-no_AS/AR. However, the presence of aortic valve dysfunction resulted in an elevated Sokolow-Lyon product for BAV-ASR (p = 0.017) and BAV-AR (p = 0.001), as well as increased Cornell product (p = 0.04) and E/e’ (p < 0.001) for BAV-AS compared with BAV-no_AS/AR. LVEDVi and LVMi were elevated in patients with BAV-ASR and BAV-AR compared with those with BAV-no_AS/AR (LVEDVi: 101 ± 29 ml/m2 and 112 ± 32 ml/m2 vs. 74 ± 15 ml/m2, p = 0.005 and p < 0.001, LVMi: 75 ± 7 g/m2 and 64 ± 14 g/m2 vs. 47 ± 9 g/m2, respectively; p < 0.001). There was no difference in ECV between the BAV and TAV-no_AS/AR subgroups.

Conclusion

Normally functioning BAV did not result in LV remodeling. However, concomitant AV dysfunction was associated with statistically significant morphological remodeling.

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Funding

This work was supported by KAMIKAWA Foundation, JSPS KAKENHI (Grant number 20277353) and the National Institutes of Health (contract Grant numbers R01 HL115828 and K25 HL119608).

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Author notes

    Authors and Affiliations

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

      Kenichiro Suwa, Amir Ali Rahsepar, Julia Geiger, Ryan Dolan, Ahmadreza Ghasemiesfe, Alex J. Barker, Jeremy D. Collins, Michael Markl & James C. Carr

    2. Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan

      Kenichiro Suwa

    3. Department of Diagnostic Imaging, University Children`s Hospital Zürich, Zürich, Switzerland

      Julia Geiger

    4. University of Zürich, Zürich, Switzerland

      Julia Geiger

    5. Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA

      Ahmadreza Ghasemiesfe

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

      Alex J. Barker

    7. Department of Radiology, Mayo Clinic, Rochester, MN, USA

      Jeremy D. Collins

    8. Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Chicago, IL, USA

      Michael Markl

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    Contributions

    All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kenichiro Suwa, Amir Ali Rahsepar, and Ahmadreza Ghasemiesfe. The first draft of the manuscript was written by Kenichiro Suwa. All authors read and approved the final manuscript.

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    Correspondence to Kenichiro Suwa.

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    The authors have no relevant financial or non-financial interests to disclose.

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    This retrospective study was approved by the institutional review board.

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    The patients were enrolled with an institutional review board-approved waiver of consent.

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    The authors affirm that human research participants provided informed consent for publication of the images in Fig. 2.

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    Kenichiro Suwa and Amir Ali Rahsepar These authors contributed equally to this work.

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    Suwa, K., Rahsepar, A.A., Geiger, J. et al. A Left ventricle remodeling in patients with bicuspid aortic valve. Int J Cardiovasc Imaging 39, 391–399 (2023). https://doi.org/10.1007/s10554-022-02727-4

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