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

Quantitative Imaging in Medicine and Surgery

article

Alaa Elhawaz¹  Norman Briffa²  Steven Hunter²  Peter Braidley²  Ian R. Hall²  Ever Grech²  Rob J. van der Geest³  Julian P. Gunn¹  Andrew J. Swift¹  James M. Wild¹  Pankaj Garg¹  Gareth T. Archer¹  Hamza Zafar¹  Benjamin Fidock¹  Natasha Barker¹  Rachel Jones¹  Alexander Rothman¹  Rod Hose¹  Abdallah Al-Mohammad¹ 

[1] Department of Infection, University of Sheffield;Sheffield Teaching Hospitals NHS Foundation Trust;Division of Image Processing, Leiden University Medical Centre

关键词: Aortic valve stenosis;    walk test;    ventricular remodeling;    exercise tolerance;    echocardiography;    Doppler;    magnetic resonance imaging;    4D flow;   

DOI  :  10.21037/qims-20-586

学科分类：外科医学

来源: AME Publications

【 摘 要 】

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 KEi EDV (r=−0.53, P<0.01), diastolic KEi EDV (r=−0.53, P<0.01) and E wave KEi EDV (r=−0.38, P=0.04) demonstrated association to the 6MWT. However, Pre-operative LV KEi EDV (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.

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