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Rapid Fire Abstracts

Rapid Fire 01- Pediatric/Congenital Heart Disease I

Segmental Assessment of Energy Loss using 4D flow CMR in Bicuspid Aortic Valve Patients with Favorable Prognosis: A Matched Case-Control Study (RF_TH_177)

Thursday, January 30, 2025
11:20 AM – 11:30 AM East Coast USA Time
Location: Blue Room PreFunction

    Presenting Author(s)

  • MH

    Mikiko Harada, MD, PhD

    Research fellow
    Technical University of Munich, School of Medicine and Health, Clinic for Congenital Heart Disease and Pediatric Cardiology, TUM University Hospital, Germany

    • Primary Author(s)

  • MH

    Mikiko Harada, MD, PhD

    Research fellow
    Technical University of Munich, School of Medicine and Health, Clinic for Congenital Heart Disease and Pediatric Cardiology, TUM University Hospital, Germany

    • Co-Author(s)

  • MS

    Maria Skarlatoudi, MD

    Medical Doctor
    Technical University of Munich, School of Medicine and Health, Clinic for Congenital Heart Disease and Pediatric Cardiology, TUM University Hospital, Germany

  • NS

    Nerejda Shehu, Dr.

    Dott.
    German Heart Centre Munich, Germany

  • HS

    Heiko Stern, Prof. Dr.

    Prof. Dr. med.
    German Heart Centre Munich, Germany

  • PE

    Peter Ewert, Prof. Dr.

    Prof. Dr. med.
    German Heart Centre Munich, Germany

  • Christian Meierhofer, MD, PhD

    Deputy Director
    Congenital Heart Disease and Pediatric Cardiology
    Munich heart centre, Germany

EL/flow ratio [mW/(L/min)]


Background: Patients with bicuspid aortic valve (BAV) disease may experience a favorable prognosis in the absence of long-term major complications, such as aortic stenosis, regurgitation, and aortic dilatation. Despite this, the underlying pathophysiology of BAV remains incompletely understood. Energy loss (EL), defined as the energy dissipated within the blood vessels, can be quantified using 4D flow cardiovascular magnetic resonance (4D CMR). This study aims to compare both the total and the segmental EL in the thoracic aorta (TA) between BAV patients with a favorable prognosis and a sex- and age-matched control group.

Methods:

A total of 32 subjects were enrolled in the study, including 16 patients with BAV and 16 healthy controls matched for age, sex, and body size (mean age ± SD: 26.6 ± 8.4 years; 37.5% female). The 4D CMR was performed using a 1.5 Tesla scanner in 2008/2009. The patients in the BAV group were functionally normal and met the following initial inclusion criteria: age > 7 years, no current or past cardiovascular disease other than BAV, no arterial hypertension, no history of connective tissue disorders or thorax deformations, no use of medication. Additionally, the BAV group met the criteria established by echocardiography: aortic valve flow velocity < 2.5 m/s, no moderate or severe aortic regurgitation, and an ascending aorta (AAo) diameter < 4.5 cm in adults and < 2.2 cm/m2 in children. A 10-year follow-up confirmed that the BAV group remained free from major cardiovascular complications, with no significant change in the indexed aortic diameter (i.e., aortic diameter adjusted for body surface area) of the AAo (p= 0.06) and the descending aorta (p= 0.07). The evaluation of EL was conducted in 2023. EL was measured at five segments in the TA, and values were adjusted according to heart rate and flow volume at each segment. The EL/flow ratio [mW/ (L/min)] represents the mean EL value over a cardiac cycle.

Results:

EL/flow ratios were significantly higher in the BAV group compared to the control group at two segments of the AAo, though this difference was not observed when analyzing the complete thoracic aorta. (Table and Figure). The EL/flow ratios were as follows: from the Sinus of Valsalva to the proximal AAo proximal, 0.78 [interquartile range 0.59 - 1.14] in the BAV group compared to 0.40 [0.29 - 0.67] in the control group (p = 0.015); and from the proximal AAo to the distal AAo, 1.26 [0.79 - 1.59] in the BAV group compared to 0.64 [0.39 - 1.07] in the control group (p = 0.013).

Conclusion: Even in BAV patients with a favorable long term course and no major complications in over a 10 year-follow-up, EL was significantly elevated in the AAo. This was demonstrated by the analysis that accounted for flow volume at each TA segment. Further investigation is essential to elucidate the long-term changes in EL and their impact on long term prognosis.

EL/flow ratio [mW/(L/min)]

EL/flow ratio [mW/(L/min)]