Aortic flow and wall shear stress in aortic stenosis is associated with left ventricular remodeling

Abstract

Background Aortic stenosis (AS) can lead to highly variable stress for the left ventricle (LV) and consequently a broad range of LV remodeling. We hypothesize that changes in aortic blood flow caused by AS can contribute to cardiac afterload. The aim of this study was to describe the blood flow patterns in the ascending aorta in patients with AS and to determine its association with LV remodeling. Methods Thirty-seven patients with AS (14 mild, 8 moderate, 15 severe, age 63 ± 13 years) and 37 healthy, age-and gendermatched controls (age 60 ± 10 years) were prospectively

Transcatheter aortic valve replacement alters ascending aortic blood flow and wall shear stress patterns: A 4D flow MRI comparison with age-matched, elderly controls

“…Various advanced parameters can be derived from 4D flow MRI-acquired velocity data that may provide novel insight into aortic haemodynamics after TAVR, such as wall shear stress (WSS), flow eccentricity and flow displacement [5][6][7]. A recent histological study has shown that abnormal WSS results in increased deregulation of the aortic extracellular matrix and degeneration of elastic fibres, which may result in progressive aortic dilatation [8].…”

The year in cardiology 2016: imaging

“…Furthermore, in 37 patients with various grades of aortic stenosis and 37 healthy volunteers, helical and vertical flow formations and flow eccentricity were assessed in the ascending aorta using four-dimesional flow CMR. 26 Compared with healthy volunteers, patients with aortic stenosis showed more frequently marked helical and vertical flow formation and eccentric flow with asymmetrical and elevated distribution of peak systolic wall stress in the ascending aorta. Smaller aortic orifice areas were associated with more vertical flow formation and eccentric flow and higher flow displacement whereas bicuspid aortic valve morphology was significantly associated with intense helical flow formation and higher flow displacement and peak systolic wall shear stress.…”

“…25, 26 Koristeći se ovom tehnikom, Garcia i sur. 25 u 50 bolesnika s bikuspidnom i u 50 bolesnika s trikuspidnom valvulom i dilatiranom aortom pokazali su da bolesnici s bikuspidnom valvulom imaju višu vršnu vrijednost brzine protoka mlaza između izlaznog dijela LV-a i sinotubularnoga spoja u usporedbi s bolesnicima s trikuspidnom valvulom, unatoč sličnim dimenzijama aorte.…”

“…Osim toga, u 37 bolesnika s različitim stupnjevima aortne stenoze i u 37 zdravih volontera, spiralne i vertikalne formacije protoka te ekscentričnosti protoka procjenjivani su u ascendentoj aorti primjenom četverodimenzijskoga protočnog CMR-a. 26 U usporedbi s zdravim volonterima, bolesnici s aortnom stenozom češće su pokazivali uočljivu spiralnu i vertikalnu formaciju protoka uz ekscentrični protok s asimetričnom i povišenom distribucijom vršnog naprezanja stijenke u sistoli u ascendentnoj aorti. Manje površine otvora aortne valvule povezivane su s više vertikalnih formacija protoka i ekscentričnoga protoka s asimetričnim protokom, dok je morfologija bikuspidne aortne valvule znatno povezana s intenzivnom spiralnom formacijom protoka i višim pomakom protoka te vršnog naprezanja stijenke u sistoli.…”

“…25, 26 Using this technique, Garcia et al 25 showed in 50 patients with bicuspid and 50 patients with tricuspid aortic valve and dilated aorta that patients with bicuspid aortic valve have higher peak flow jet velocity between the LV outflow tract and the sinotubular junction compared with patients with tricuspid valve, despite having comparable aortic dimensions. On multivariate analysis, age and peak flow jet velocity were the only significant correlates of maximal aortic dimensions.…”