Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis

Alaa Elhawaz, Gareth T. Archer, Hamza Zafar, Benjamin Fidock, Natasha Barker, Rachel Jones, Alexander Rothman, Rod Hose, Abdallah Al-Mohammad, Norman Briffa, Steven Hunter, Peter Braidley, Ian R. Hall, Ever Grech, Rob J. van der Geest, Julian P. Gunn, Andrew J. Swift, James M. Wild, Pankaj Garg

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Background: Left ventricular (LV) kinetic energy (KE) assessment by four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) may offer incremental value over routine assessment in aortic stenosis (AS). The main objective of this study is to investigate the LV KE in patients with AS before and after the valve intervention. In addition, this study aimed to investigate if LV KE offers incremental value for its association to the six-minute walk test (6MWT) or LV remodelling post-intervention. Methods: We recruited 18 patients with severe AS. All patients underwent transthoracic echocardiography for mean pressure gradient (mPG), CMR including 4D flow and 6MWT. Patients were invited for post-valve intervention follow-up CMR at 3 months and twelve patients returned for follow-up CMR. KE assessment of LV blood flow and the components (direct, delayed, retained and residual) were carried out for all cases. LV KE parameters were normalised to LV end-diastolic volume (LVEDV). Results: For LV blood flow KE assessment, the metrics including time delay (TD) for peak E-wave from base to mid-ventricle (14±48 vs. 2.5±9.75 ms, P=0.04), direct (4.91±5.07 vs. 1.86±1.72 μJ, P=0.01) and delayed (2.46±3.13 vs. 1.38±1.15 μJ, P=0.03) components of LV blood flow demonstrated a significant change between pre- and post-valve intervention. Only LV KEiEDV (r=-0.53, P<0.01), diastolic KEiEDV (r=-0.53, P<0.01) and Ewave KEiEDV (r=-0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEiEDV (r=0.67, P=0.02) demonstrated association to LV remodelling post valve intervention. Conclusions: LV blood flow KE is associated with 6MWT and LV remodelling in patients with AS. LV KE assessment provides incremental value over routine LV function and pressure gradient (PG) assessment in AS.

Original languageEnglish
Pages (from-to)1470-1482
Number of pages13
JournalQuantitative Imaging in Medicine and Surgery
Issue number4
Publication statusPublished - 1 Apr 2021


  • 4D flow
  • Aortic valve stenosis
  • Doppler
  • Echocardiography
  • Exercise tolerance
  • Magnetic resonance imaging
  • Ventricular remodeling
  • Walk test

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