TY - JOUR
T1 - Left ventricular blood flow kinetic energy is associated with the six-minute walk test and left ventricular remodelling post valvular intervention in aortic stenosis
AU - Elhawaz, Alaa
AU - Archer, Gareth T.
AU - Zafar, Hamza
AU - Fidock, Benjamin
AU - Barker, Natasha
AU - Jones, Rachel
AU - Rothman, Alexander
AU - Hose, Rod
AU - Al-Mohammad, Abdallah
AU - Briffa, Norman
AU - Hunter, Steven
AU - Braidley, Peter
AU - Hall, Ian R.
AU - Grech, Ever
AU - van der Geest, Rob J.
AU - Gunn, Julian P.
AU - Swift, Andrew J.
AU - Wild, James M.
AU - Garg, Pankaj
N1 - We thank all the staff at the Cardiothoracic Department, Sheffield Teaching Hospitals NHS Foundation Trust for their support and help during this study. Funding: This work was supported in part by EurValve (European Union funding) (Personalised Decision Support for Heart Valve Disease), Project Number: H2020 PHC-30–2015, 689617. AR was supported by Clinical Research Career Development Fellowships from the Wellcome Trust (206632/Z/17/Z). AJS was supported by the Wellcome Trust (205188/Z/16/Z). PG was supported by the Academy of Sciences Starter Grant (SGL018/1100).
Ethical Statement: The study was approved by the National Research Ethics Service (17/LO/0283), and sponsored by the Sheffield Teaching Hospitals (STH) NHS Foundation Trust. Written informed consent was obtained from all participants, in accordance with the Helsinki declaration.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - 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.
AB - 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.
KW - 4D flow
KW - Aortic valve stenosis
KW - Doppler
KW - Echocardiography
KW - Exercise tolerance
KW - Magnetic resonance imaging
KW - Ventricular remodeling
KW - Walk test
UR - http://www.scopus.com/inward/record.url?scp=85101002686&partnerID=8YFLogxK
U2 - 10.21037/qims-20-586
DO - 10.21037/qims-20-586
M3 - Article
VL - 11
SP - 1470
EP - 1482
JO - Quantitative Imaging in Medicine and Surgery
JF - Quantitative Imaging in Medicine and Surgery
SN - 2223-4292
IS - 4
ER -