Wave Reflection and Ventriculo-Arterial Coupling in Bicuspid Aortic Valve Patients With Repaired Aortic Coarctation

Area of Science:

• Cardiovascular Physiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Bicuspid aortic valve (BAV) disease is associated with global aortopathy and congenital lesions like coarctation (COA).
• Ventriculo-arterial (VA) coupling can be affected by these conditions.
• Understanding these effects is crucial for patient management.

Purpose of the Study:

• To isolate the impact of COA on VA coupling in BAV patients.
• To utilize cardiovascular magnetic resonance (CMR) imaging for non-invasive wave intensity analysis.
• To investigate changes in VA coupling and aortic distensibility in BAV patients with COA.

Main Methods:

• Retrospective analysis of CMR data from BAV patients with and without repaired COA.
• Measurement of aortic and ventricular dimensions, global longitudinal strain (GLS), and ascending aortic flow.
• Derivation of wave intensity parameters (FCW, FEW, BCW) and wave speed from CMR data.

Main Results:

• No significant differences in left ventricular ejection fraction, GLS, or volumes between groups.
• Increased forward compression wave (FCW) and forward expansion wave (FEW) magnitudes in the BAV with repaired COA group.
• Higher wave speed velocity observed in patients with repaired COA, but aortic wave speed (distensibility) was not significantly different.

Conclusions:

• Ventriculo-arterial coupling is not negatively affected in BAV patients with COA compared to isolated BAV, in the absence of restenosis.
• A reduction in early systolic FCW magnitude was associated with older age and larger aortic diameters.
• Cardiovascular magnetic resonance imaging provides valuable insights into hemodynamic alterations in BAV and COA.