scholarly journals Impaction of Regurgitation Jet on Anterior Mitral Leaflet Causes Diastolic Dysfunction in Patients With Bicuspid Aortic Valve and Mild Insufficiency: A Cardiovascular Magnetic Resonance Study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

Abstract Purpose: To assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging.Methods: Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain.Results: Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10±0.2 s-1 vs 1.34±0.5 s-1 vs 1.53±0.3 s-1 , p:0.001 and 0.68±0.2 s-1 vs 1.17±0.2 s-1 vs 1.05±0.4 s-1 ; p<0.001, PDV = -101.6±28.1 deg/s vs -201.4±85.9 deg/s vs - 221.6±67.1 deg/s; p<0.001 and -28.1±8 mm/s vs -38.9±11.1 mm/s vs -43.6±14.3 mm/s, p<0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups.Conclusion: In BAV patients with AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling

scholarly journals Impaction of regurgitation jet on anterior mitral leaflet is associated with diastolic dysfunction in patients with bicuspid aortic valve and mild insufficiency: a cardiovascular magnetic resonance study

2021 ◽  
Author(s):  
Nicola Galea ◽  
Giacomo Pambianchi ◽  
Giulia Cundari ◽  
Francesco Sturla ◽  
Livia Marchitelli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Control Group ◽  
Cardiovascular Magnetic Resonance Study ◽  
Flow Imaging ◽  
4D Flow ◽  
The Impact ◽  
4D Flow Imaging

AbstractTo assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging. Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain. Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10 ± 0.2 1/s vs. 1.34 ± 0.5 1/s vs. 1.53 ± 0.3 1/s, p:0.001 and 0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. 1.05 ± 0.4 1/s ; p < 0.001, PDV = − 101.6 ± 28.1 deg/s vs. − 201.4 ± 85.9 deg/s vs. − 221.6 ± 67.1 deg/s; p < 0.001 and − 28.1 ± 8 mm/s vs. − 38.9 ± 11.1 mm/s vs. − 43.6 ± 14.3 mm/s, p < 0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups. In BAV patients with mild AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling.

Aortic flow patterns in bicuspid aortic valve disease visualised with 4D flow imaging

2012 ◽  
Vol 97 (Suppl 1) ◽  
pp. A129.3-A130
Author(s):  
MM Gedicke ◽  
A Pitcher ◽  
A Barker ◽  
J Bock ◽  
R Lorenz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Disease ◽  
Flow Patterns ◽  
Aortic Flow ◽  
Valve Disease ◽  
Flow Imaging ◽  
4D Flow ◽  
4D Flow Imaging

scholarly journals The impact of Wilson disease on myocardial tissue and function: a cardiovascular magnetic resonance study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Janek Salatzki ◽  
Isabelle Mohr ◽  
Jannick Heins ◽  
Mert H. Cerci ◽  
Andreas Ochs ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Wilson Disease ◽  
Left Ventricular ◽  
Myocardial Tissue ◽  
Cardiovascular Magnetic Resonance Study ◽  
Structural Remodeling ◽  
Cardiac Phenotype ◽  
The Impact

Abstract Background Systemic effects of altered serum copper processing in Wilson Disease (WD) might induce myocardial copper deposition and consequently myocardial dysfunction and structural remodeling. This study sought to investigate the prevalence, manifestation and predictors of myocardial tissue abnormalities in WD patients. Methods We prospectively enrolled WD patients and an age-matched group of healthy individuals. We applied cardiovascular magnetic resonance (CMR) to analyze myocardial function, strain, and tissue characteristics. A subgroup analysis of WD patients with predominant neurological (WD-neuro+) or hepatic manifestation only (WD-neuro−) was performed. Results Seventy-six patients (37 years (27–49), 47% women) with known WD and 76 age-matched healthy control subjects were studied. The prevalence of atrial fibrillation in WD patients was 5% and the prevalence of symptomatic heart failure was 2.6%. Compared to healthy controls, patients with WD had a reduced left ventricular global circumferential strain (LV-GCS), and also showed abnormalities consistent with global and regional myocardial fibrosis. WD-neuro+ patients presented with more severe structural remodeling and functional impairment when compared to WD-neuro− patients. Conclusions In a large cohort, WD was not linked to a distinct cardiac phenotype except CMR indexes of myocardial fibrosis. More research is warranted to assess the prognostic implications of these findings. Trial registration: This trial is registered at the local institutional ethics committee (S-188/2018).

scholarly journals P291 Additional value of myocardial work in detecting subclinical systolic dysfunction in patients with bicuspid aortic valve and left ventricular hypertrophy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M E Canonico ◽  
C Santoro ◽  
M Prastaro ◽  
R Sorrentino ◽  
F Luciano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Bicuspid Aortic Valve ◽  
Pulse Pressure ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Lv Mass ◽  
Significant Difference ◽  
Global Work ◽  
The Impact

Abstract Background An impairment of speckle tracking derived left ventricular (LV) global longitudinal strain (GLS) has been observed in patients with bicuspid aortic valve (BAV) and referred to abnormalities of aortic elasticity properties. The impact of LV mass on myocardial deformation has still not been investigated. This issue can be now better addressed by myocardial work software, which incorporates both deformation and hemodynamic load in the analysis. Aim of the study To analyse the impact of both deformation and strain derived myocardial work in BAV patients with and without LV hypertrophy (LVH). Methods Sixty-five patients with BAV underwent a comprehensive echo exam, including speckle tracking derived calculation of GLS (in absolute value). Parameters of myocardial work such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were measured according to standardized procedures. Patients with reduced LV ejection fraction and with more than mild aortic stenosis and/or regurgitation were excluded. Other exclusion criteria included coronary artery disease, concomitant valvular heart disease, heart failure, primary cardiomyopathies, permanent and/or persistent atrial fibrillation and inadequate echo images. BAV patients were divided according to presence of LVH: 10 with LVH (LV mass index &gt;47 g/m^2.7 in women and &gt;50 g/m^2.7 in men) and 55 without LVH. Results The two groups were comparable for sex, age and heart rate whereas systolic blood pressure (p = 0.006) and pulse pressure (p = 0.002) were higher in patients with LVH, who also had higher relative diastolic wall thickness (p &lt; 0.02). No significant difference in ejection fraction (p = 0.56), transmitral E/A ratio (p = 0.504) and E/e" (p = 0.311) was found between the two groups. GLS (19.1 ± 2.5 in LVH group and. 20.0 ± 2.4% in patients without LVH, p = 0.290), GWI (p = 0.356) and GCW (p = 0.396) did not differ significantly whereas GWW was higher (119.5 ± 72.9 vs. 72.3 ± 38.7 mmHg%, p = 0.003) and GWE lower (94.4 ± 3.0 vs. 92.2 ± 1.6%, p = 0.007) in BAV patients with LVH (Figure). In the pooled population, LV mass index was related with GWW (r = 0.26, p = 0.03) and GWE (r=-0.30, p &lt; 0.01) but not with GLS (r=-0.22, p = 0.08). The relation between GWE and LV mass index remained significant even after adjusting for pulse pressure (partial r=-0.28, p &lt; 0.02). Conclusion In patients with BAV, LVH plays a detrimental effect on LV systolic function which cannot be identified by ejection fraction and GLS assessment but is unmasked by the application of myocardial work. In presence of LVH, the wasted work of BAV patients is increased and myocardial efficiency is substantially reduced, it being negatively related to LV mass even after adjusting for a raw index of aortic stiffness such as pulse pressure. Abstract P291 Figure. GLS, GWW and GWE according to LVH

scholarly journals A Bayesian approach for 4D flow imaging of aortic valve in a single breath‐hold

2018 ◽  
Vol 81 (2) ◽  
pp. 811-824 ◽  
Author(s):  
Adam Rich ◽  
Lee C. Potter ◽  
Ning Jin ◽  
Yingmin Liu ◽  
Orlando P. Simonetti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bayesian Approach ◽  
Breath Hold ◽  
Flow Imaging ◽  
4D Flow ◽  
Single Breath ◽  
Single Breath Hold ◽  
4D Flow Imaging

scholarly journals The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

2020 ◽  
Author(s):  
Marek Jasinski ◽  
Karol Miszalski-Jamka ◽  
Radoslaw Gocol ◽  
Izabella Wenzel-Jasinska ◽  
Grzegorz Bielicki ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Aortic Valve Area ◽  
Valve Repair ◽  
Valve Area

Abstract Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodeling using cardiac magnetic resonance (CMR) and compare the mid-term results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period. CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r=0.62; p=0.003) as well as left ventricular ejection fraction (r=-0.53; p=0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5cm2 (2.5; 4.0) vs. 2.5cm2 (2.0; 3.4); p=0.04). In both EA and SCA group, aortic valve area below 3.5cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10mmHg (6; 17) vs. 21mmHg (15; 27); p=0.04). Conclusions: The repair of the bicuspid aortic valve provides significant mid-term postoperative reverse remodeling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. External, circumferential annuloplasty is associated with better hemodynamics compared to subcommissural annuloplasty.

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