TY - JOUR
T1 - Evaluation of Aortic Blood Flow and Wall Shear Stress in Aortic Stenosis and Its Association with Left Ventricular Remodeling
AU - Von Knobelsdorff-Brenkenhoff, Florian
AU - Karunaharamoorthy, Achudhan
AU - Trauzeddel, Ralf Felix
AU - Barker, Alex J.
AU - Blaszczyk, Edyta
AU - Markl, Michael
AU - Schulz-Menger, Jeanette
N1 - Funding Information:
We acknowledge the technicians Kerstin Kretschel, Evelyn Polzin, Denise Kleindienst, and Franziska Neumann for acquiring the CMR data and the study nurses Elke Nickel-Szczech and Antje Els for assisting in the organization of the CMR scans. We thank Mrs Susanne Schwenke (scossis, Berlin) for her valuable support of the statistical analyses. Deutsche Stiftung für Herzforschung (Frankfurt, Germany; F/37/12; Dr von Knobelsdorff-Brenkenhoff), National Institutes of Health (NIH) K25HL119608 (Dr Barker), and NIH R01HL115828 (Dr Markl).
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background-Aortic stenosis (AS) leads to variable stress for the left ventricle (LV) and consequently a broad range of LV remodeling. The aim of this study was to describe blood flow patterns in the ascending aorta of patients with AS and determine their association with remodeling. Methods and Results-Thirty-seven patients with AS (14 mild, 8 moderate, 15 severe; age, 63±13 years) and 37 healthy controls (age, 60±10 years) underwent 4-dimensional-flow magnetic resonance imaging. Helical and vortical flow formations and flow eccentricity were assessed in the ascending aorta. Normalized flow displacement from the vessel center and peak systolic wall shear stress in the ascending aorta were quantified. LV remodeling was assessed based on LV mass index and the ratio of LV mass:end-diastolic volume (relative wall mass). Marked helical and vortical flow formation and eccentricity were more prevalent in patients with AS than in healthy subjects, and patients with AS exhibited an asymmetrical and elevated distribution of peak systolic wall shear stress. In AS, aortic orifice area was strongly negatively associated with vortical flow formation (P=0.0274), eccentricity (P=0.0070), and flow displacement (P=0.0021). Bicuspid aortic valve was associated with more intense helical (P=0.0098) and vortical flow formation (P=0.0536), higher flow displacement (P=0.11), and higher peak systolic wall shear stress (P=0.0926). LV mass index and relative wall mass were significantly associated with aortic orifice area (P=0.0611, P=0.0058) and flow displacement (P=0.0058, P=0.0283). Conclusions-In this pilot study, AS leads to abnormal blood flow pattern and peak systolic wall shear stress in the ascending aorta. In addition to aortic orifice area, normalized flow displacement was significantly associated with LV remodeling.
AB - Background-Aortic stenosis (AS) leads to variable stress for the left ventricle (LV) and consequently a broad range of LV remodeling. The aim of this study was to describe blood flow patterns in the ascending aorta of patients with AS and determine their association with remodeling. Methods and Results-Thirty-seven patients with AS (14 mild, 8 moderate, 15 severe; age, 63±13 years) and 37 healthy controls (age, 60±10 years) underwent 4-dimensional-flow magnetic resonance imaging. Helical and vortical flow formations and flow eccentricity were assessed in the ascending aorta. Normalized flow displacement from the vessel center and peak systolic wall shear stress in the ascending aorta were quantified. LV remodeling was assessed based on LV mass index and the ratio of LV mass:end-diastolic volume (relative wall mass). Marked helical and vortical flow formation and eccentricity were more prevalent in patients with AS than in healthy subjects, and patients with AS exhibited an asymmetrical and elevated distribution of peak systolic wall shear stress. In AS, aortic orifice area was strongly negatively associated with vortical flow formation (P=0.0274), eccentricity (P=0.0070), and flow displacement (P=0.0021). Bicuspid aortic valve was associated with more intense helical (P=0.0098) and vortical flow formation (P=0.0536), higher flow displacement (P=0.11), and higher peak systolic wall shear stress (P=0.0926). LV mass index and relative wall mass were significantly associated with aortic orifice area (P=0.0611, P=0.0058) and flow displacement (P=0.0058, P=0.0283). Conclusions-In this pilot study, AS leads to abnormal blood flow pattern and peak systolic wall shear stress in the ascending aorta. In addition to aortic orifice area, normalized flow displacement was significantly associated with LV remodeling.
KW - aorta
KW - aortic valve stenosis
KW - heart valve diseases
KW - heart ventricles
KW - magnetic resonance imaging
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U2 - 10.1161/CIRCIMAGING.115.004038
DO - 10.1161/CIRCIMAGING.115.004038
M3 - Article
C2 - 26917824
AN - SCOPUS:84962613558
VL - 9
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
SN - 1941-9651
IS - 3
M1 - e004038
ER -