Wave Reflection and Ventriculo-Arterial Coupling in Bicuspid Aortic Valve Patients With Repaired Aortic Coarctation

Abstract

BackgroundVentriculo-arterial (VA) coupling in bicuspid aortic valve (BAV) patients can be affected by the global aortopathy characterizing BAV disease and the presence of concomitant congenital lesions such as aortic coarctation (COA). This study aimed to isolate the COA variable and use cardiovascular magnetic resonance (CMR) imaging to perform wave intensity analysis non-invasively to shed light on VA coupling changes in BAV. The primary hypothesis was that BAV patients with COA exhibit unfavorable VA coupling, and the secondary hypothesis was that BAV patients with COA exhibit increased wave speed as a marker of reduced aortic distensibility despite successful surgical correction.MethodsPatients were retrospectively identified from a CMR database and divided into two groups: isolated BAV and BAV associated with repaired COA. Aortic and ventricular dimensions, global longitudinal strain (GLS), and ascending aortic flow data and area were collected and used to derive wave intensity from CMR data. The main variables for the analysis included all wave magnitudes (forward compression/expansion waves, FCW and FEW, respectively, and reflected backward compression wave, BCW) and wave speed.ResultsIn the comparison of patients with isolated BAV and those with BAV associated with repaired COA (n = 25 in each group), no differences were observed in left ventricular ejection fraction, GLS, or ventricular volumes, whilst significant increases in FCW and FEW magnitude were noted in the BAV and repaired COA group. The FCW inversely correlated with age and aortic size. Whilst the BCW was not significantly different compared with that in patients with/without COA, its magnitude tends to increase with a lower COA index. Patients with repaired COA exhibited higher wave speed velocity. Aortic wave speed (inversely related to distensibility) was not significantly different between the two groups.ConclusionIn the absence of a significant restenosis, VA coupling in patients with BAV and COA is not negatively affected compared to patients with isolated BAV. A reduction in the magnitude of the early systolic FCW was observed in patients who were older and with larger aortic diameters.

Feasibility of Wave Intensity Analysis from 4D Cardiovascular Magnetic Resonance Imaging Data

“…These studies have focused both on various cardiovascular diseases [34] and healthy individuals with varying age [35,36] using PC-MRI, which is considered the gold standard for measuring blood flow in the aorta. Our c measurements are also supported by a study that focused solely on BAV patients and reported an average c of 4.2 m/s (range: 2.5-6.3 m/s) [37]. As reported in Table 3, c differences were not significant between the two groups within the ascending and thoracic aorta.…”

Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair

“…In patients with heart failure where cardiac contractility is decreased, VACr increases. Similarly, with ageing, aortic distensibility reduces and Ea increases leading to increase in VACr [12]. Increased VACr has been associated with worse outcomes (atrial brillation, transplantation or death) in several pediatric and adult studies [13,14].…”

“…There is evidence that patients with CoA have decreased aortic distensibility, which can affect Ea even if controlled for hypertension [12]. Also, hypertension itself leads to a change in Ea and Ees and hence VACr.…”