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.
Highlights
Changes in ventriculo-arterial (VA) coupling are a key determinant of ventricular energetics [1]
Previous studies exploring the hemodynamics of COA using wave intensity analysis observed that its presence results in a substantial backward reflection wave, in turn associated with left ventricular (LV) hypertrophy [3] and unfavorable LV energetics
Whilst this study focused on comparing bicuspid aortic valve (BAV) patients with and without repaired COA, comparison with values reported in the literature for healthy controls in a similar age range suggests a substantial difference, which should be explored further in a single prospective study
Summary
Changes in ventriculo-arterial (VA) coupling are a key determinant of ventricular energetics [1]. Considering the arterial side of the VA equation, both global and local changes can result in alterations of coupling efficiency These changes can include overall alterations in arterial stiffness of the vessel as well as local changes in the vessel anatomy such as focal stenoses or sites of bifurcations. In this light, patients with bicuspid aortic valve (BAV) represent an interesting population in which to assess VA coupling, considering the presence of both global vascular abnormalities (BAV aortopathy) and the presence of concomitantly associated congenital lesions such as aortic coarctation (COA). 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
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