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

Elhawaz, Alaa, Archer, Gareth T., Zafar, Hamza, Fidock, Benjamin, Barker, Natasha, Jones, Rachel, Rothman, Alexander, Hose, Rod, Al-Mohammad, Abdallah, Briffa, Norman, Hunter, Steven, Braidley, Peter, Hall, Ian R., Grech, Ever, Van Der Geest, Rob J., Gunn, Julian P., Swift, Andrew J., Wild, James M. and Garg, Pankaj (2021) 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, 11 (4). pp. 1470-1482. ISSN 2223-4292

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Abstract

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.

Item Type: Article
Additional Information: 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.
Uncontrolled Keywords: 4d flow,aortic valve stenosis,doppler,echocardiography,exercise tolerance,magnetic resonance imaging,ventricular remodeling,walk test,radiology nuclear medicine and imaging ,/dk/atira/pure/subjectarea/asjc/2700/2741
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Nov 2021 04:51
Last Modified: 24 Nov 2021 03:13
URI: https://ueaeprints.uea.ac.uk/id/eprint/82127
DOI: 10.21037/qims-20-586

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