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La Mura L, Lembo M, Musella F, D’Amato M, D’Andrea A, Izzo R, Esposito G. Aortic Regurgitation in Bicuspid Aortic Valve: The Role of Multimodality Imaging. J Clin Med 2024; 13:3924. [PMID: 38999489 PMCID: PMC11242072 DOI: 10.3390/jcm13133924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
The evaluation of aortic regurgitation (AR) in bicuspid valve (BAV) is still a challenge because of the eccentricity of the jet, which may under/overestimate the regurgitation. The commonly used echocardiography parameters (such as vena contracta, pressure half-time, etc.) may not be useful in this kind of patient. A multimodality approach combining echocardiography, cardiac MRI, cardiac CT, and advanced technologies applied to non-invasive cardiac imaging (e.g., 4D flow and strain imaging) may be useful to better quantify regurgitation and to select patients suitable for valve replacement. This review provides an overview of the most recent insights about cardiovascular imaging tools and their utility in BAV evaluation, focusing on chronic regurgitation. We describe the role of multimodality imaging in both diagnosis and risk assessment of this disease, pointing out the advantages and disadvantages of the imaging techniques, aiming to provide a guide to clinicians and cardiovascular imaging specialists in choosing the best imaging tools to use.
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Affiliation(s)
- Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Francesca Musella
- Division of Cardiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
- Division of Cardiology, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Marianna D’Amato
- Servicio de Cardiologìa, Hospital Central de La Defensa Gomez Ulla, 28028 Madrid, Spain;
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy;
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (M.L.); (R.I.); (G.E.)
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Wang Y, Gong M. Evaluation of aortic biomechanics in patients with aortic disease via imaging: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:458-466. [PMID: 34669189 DOI: 10.1002/jcu.23087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
As a bridge between the heart and the arteries, the aorta plays an important role in the cardiovascular system. The morbidity and mortality of aortic disease are extremely high, which is a serious threat to human life. The biomechanical abnormality of the aorta is an important factor of a series of pathological changes in the aortic wall. At present, there are many imaging methods to evaluate the biomechanics of the aorta, which will benefit to the early diagnosis and treatment of aortic disease. In this review, we describe the application of various imaging methods and parameters in aortic disease.
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Affiliation(s)
- Yanli Wang
- Department of Cardiovascular Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Min Gong
- Department of Cardiovascular Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Cutugno S, Ingrassia T, Nigrelli V, Pasta S. On the Left Ventricular Remodeling of Patients with Stenotic Aortic Valve: A Statistical Shape Analysis. Bioengineering (Basel) 2021; 8:66. [PMID: 34068270 PMCID: PMC8153107 DOI: 10.3390/bioengineering8050066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
The left ventricle (LV) constantly changes its shape and function as a response to pathological conditions, and this process is known as remodeling. In the presence of aortic stenosis (AS), the degenerative process is not limited to the aortic valve but also involves the remodeling of LV. Statistical shape analysis (SSA) offers a powerful tool for the visualization and quantification of the geometrical and functional patterns of any anatomic changes. In this paper, a SSA method was developed to determine shape descriptors of the LV under different degrees of AS and thus to shed light on the mechanistic link between shape and function. A total of n=86 patients underwent computed tomography (CT) for the evaluation of valvulopathy were segmented to obtain the LV surface and then were automatically aligned to a reference template by rigid registrations and transformations. Shape modes of the anatomical LV variation induced by the degree of AS were assessed by principal component analysis (PCA). The first shape mode represented nearly 50% of the total variance of LV shape in our patient population and was mainly associated to a spherical LV geometry. At Pearson's analysis, the first shape mode was positively correlated to both the end-diastolic volume (p<0.01, R=0.814) and end-systolic volume (p<0.01, and R=0.922), suggesting LV impairment in patients with severe AS. A predictive model built with PCA-related shape modes achieved better performance in stratifying the occurrence of adverse events with respect to a baseline model using clinical demographic data as risk predictors. This study demonstrated the potential of SSA approaches to detect the association of complex 3D shape features with functional LV parameters.
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Affiliation(s)
| | - Tommaso Ingrassia
- Dipartimento di Ingegneria (DING), Università degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy; (S.C.); (V.N.); (S.P.)
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Carlos T, Freitas AA, Alves PM, Martins R, Gonçalves L. Aortic strain in bicuspid aortic valve: an analysis. Int J Cardiovasc Imaging 2021; 37:2399-2408. [PMID: 33818697 DOI: 10.1007/s10554-021-02215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022]
Abstract
Bicuspid aortic valve (BAV) is monitored by transthoracic echocardiography and computed tomography (CT) angiography. However, it does not have any early marker of disease progression. This study evaluated speckle-tracking echocardiography (STE) aortic and left ventricular (LV) strain prognostic values, their discriminative power, and their correlation with the degree of valvular regurgitation. We conducted a retrospective analysis of a prospectively enrolled cohort of 45 diagnosed with BAV and 20 gender and age matched controls. We performed 2D-STE aortic and LV strain analysis of the selected population. The cohort was followed-up during a median period of 19.9 months (IQR 12.9-25.2), and outcomes (hospital admission for heart failure (HF), aortic valve replacement (AVR), and death) were determined. The mean patient age was 46.6 ± 15.5 years and 80 % were male. LV indexed volumes and aortic diameter were higher in BAV patients. LV global longitudinal strain (GLS) was impaired (p < 0.001) and aortic GLS was significantly augmented (p = 0.027) in BAV patients. Aortic global circumferential strain (GCS) did not vary between groups. Aortic diameter was the best parameter related to BAV (AUC 0.92) and aortic GLS was best correlated with significant AR (AUC 0.76). AVR was the only outcome observed and its only predictor was indexed LV end-diastolic volume. BAV had impaired LV-GLS values. Aortic GLS was abnormally augmented in BAV patients, which might reflect higher aortic diameters that distorted strain calculations. STE aortic strain is related to AR but does not appear to be a reliable predictor of surgery in BAV patients, at 19 months.
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Affiliation(s)
- Tomás Carlos
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | - André Azul Freitas
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Patrícia Marques Alves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal. .,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal.
| | - Rui Martins
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.,Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal
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Abdelghani M, Nassif M, de Bruin-Bon RH, Al-Amin AM, El-Baz MS, El-Shedoudy SA, Mulder BJ, de Winter RJ, Bouma BJ. Aortic Root Geometric and Dynamic Changes After Device Closure of Interatrial Shunts. J Am Soc Echocardiogr 2019; 32:1016-1026.e5. [DOI: 10.1016/j.echo.2019.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/24/2022]
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