Viscous energy losses in ascending aortas of patients with bicuspid aortic valves with versus without aortic stenosis

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Abstract Background Mechanical energy losses in the thoracic aorta are thought to be associated with aberrant aortic flow patterns in the presence of aortic valvular disease. Purpose This study aimed to compare viscous energy losses in the aortas of subjects with bicuspid aortic valves, both with aortic valve stenosis (AS-BAV) and without (BAV), and those with trileaflet aortic valves (TAV) without AS. Methods Twenty-eight prospectively recruited subjects comprising of AS-BAV (n=11), BAV (n=8) and TAV (n=9) underwent four-dimensional flow cardiac magnetic resonance imaging (4DF-CMR). Due to inadequate image quality for one AS-BAV patient, ten subjects with AS-BAV were included in the analysis. Peak systolic and diastolic viscous energy losses were measured between the aortic root reference plane and the mid-ascending aorta (MAAo) and proximal aortic arch (PAA) anatomical planes using Circle Cardiovascular Imaging (Cvi42). Statistical analysis was conducted using ANCOVA, adjusting for age and diastolic blood pressure. Results At the MAAo, systolic and diastolic viscous energy losses were significantly higher in AS-BAV and BAV compared with TAV (Table 1). A similar pattern was demonstrated at the PAA in AS-BAV and BAV compared with TAV. Differences between AS-BAV and BAV patients were only significant at diastole. Conclusion Viscous energy losses derived from 4DF-CMR may be a sensitive biomarker to quantify pathological aortic haemodynamic patterns in BAV disease. Increased aortic viscous energy losses suggest that BAV morphology confers a significant increase in ventricular afterload even before the onset of AS, which may have implications for monitoring and timing of valvular interventions. Figure 1 4DF-CMR using Circle CVI

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