Abstract
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. 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.
Highlights
Bicuspid aortic valve (BAV), with a prevalence of 0.5–2% of the general population [1], includes a heterogeneous spectrum of morphological phenotypes, ranging from the symmetric forms to the asymmetrical forms characterized by partial or complete fusion of the cusps by one or two raphes [2]
left ventricle (LV) stroke volume, ejection fraction and myocardial mass did not show any significant differences between the three groups as well as systolic strain parameters (Table 2)
The same result was found for the longitudinal peak diastolic strain rate (0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. and 1.05 ± 0.4 1/s; p < 0.001), that was significantly lower in PJ group as compared to nPJ group and control group
Summary
Bicuspid aortic valve (BAV), with a prevalence of 0.5–2% of the general population [1], includes a heterogeneous spectrum of morphological phenotypes, ranging from the symmetric forms (with no raphe) to the asymmetrical forms characterized by partial or complete fusion of the cusps by one or two raphes [2]. The lack of coaptation might cause aortic valve regurgitation (AR), which seems to be more frequent in young male patients [3, 4]. The characteristics of the regurgitant jet and its severity in BAV patients can be highly heterogeneous, as they depend on valve phenotype, cusps asymmetry, aortic root dilation and acquired abnormalities (endocarditis or degenerative fibrocalcific appositions) [5, 6]. Mild AR is commonly asymptomatic and may remain clinically silent for years, even though it is unclear whether there may be early markers predicting disease progression or specific features of clinical relevance
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