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. 2016 Mar;9(3):e004038.
doi: 10.1161/CIRCIMAGING.115.004038.

Evaluation of Aortic Blood Flow and Wall Shear Stress in Aortic Stenosis and Its Association With Left Ventricular Remodeling

Florian von Knobelsdorff-Brenkenhoff  1 , Achudhan Karunaharamoorthy  2 , Ralf Felix Trauzeddel  2 , Alex J Barker  2 , Edyta Blaszczyk  2 , Michael Markl  2 , Jeanette Schulz-Menger  2
Affiliations

Evaluation of Aortic Blood Flow and Wall Shear Stress in Aortic Stenosis and Its Association With Left Ventricular Remodeling

Florian von Knobelsdorff-Brenkenhoff et al. Circ Cardiovasc Imaging. 2016 Mar.

Abstract

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.

Keywords: aorta; aortic valve stenosis; heart valve diseases; heart ventricles; magnetic resonance imaging.

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Figures

Figure 1
Figure 1
Schematic of the analysis planes at the sinotubular level, mid-ascendening and distal-ascending aorta (left). Examples for marked vortical and helical flow formation as well as eccentricity compared to the flow of a healthy volunteer.
Figure 2
Figure 2
Prevalence of LV remodeling in patients with AS separated for AS severity grades. AS severity grades were found statistically significant for severity of LV remodeling in ordinal logistic regression (p<0.0001). AS = aortic stenosis.
Figure 3
Figure 3
Qualitative grades for helical and vortical flow formation as well as eccentricity. AS severity grades were found statistically significant for helical and vortical flow formation and eccentricity in ordinal logistic regression (all p<0.0001). AS=aortic stenosis
Figure 4
Figure 4
Visualization of the outflow asymmetry by mapping the peak systolic velocity location and the region of the upper 15th percentile of the velocities on a segmental aortic lumen map. S1 = sinotubular junction, S2 = mid-ascending aorta, S3 = distal ascending aorta; AS= aortic stenosis
Figure 5
Figure 5
WSSpeak distribution along the aortic circumference. Comparison of the AS severity grades with healthy controls. S1 = sinotubular junction, S2 = midascending aorta, S3 = distal ascending aorta. A=anterior, LA=left anterior, L=left, LP=left posterior, P=posterior, RP=right posterior, R=right, RA=right anterior. “*” and “**” indicate significant differences between the groups with p<0.05 and p<0.001. Tests were performed per location.
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