Background
Methods
Study population
Cardiovascular magnetic resonance protocol
Data analysis: 4D flow data processing
Flow parameters
Wall shear stress
Dilatation morphotypes
Statistical analysis
Results
Healthy Controls | RL-BAV | RN-BAV | p-value | |
---|---|---|---|---|
N
| 20 | 78 | 23 | |
Age (years) | 50.04 ± 16.39 | 48.43 ± 13.15 | 46.97 ± 16.00 | 0.659 |
Men (%) | 73.30 | 62.80 | 65.20 | 0.736 |
Weight (kg) | 78.57 ± 9.24 | 76.17 ± 10.38 | 76.17 ± 10.38 | 0.270 |
Height (cm) | 169.42 ± 7.73 | 170.00 ± 10.66 | 172.00 ± 9.91 | 0.433 |
Body Surface Area (m2) | 1.89 ± 0.13 | 1.83 ± 0.21 | 1.88 ± 0.16 | 0.278 |
Degree of Aortic Regurgitation (%) | 0.240 | |||
0 | – | 26.8 | 35.3 | |
1 | – | 21.1 | 5.9 | |
2 | – | 49.3 | 47.0 | |
3 | – | 2.8 | 11.8 | |
Degree of Aortic Stenosis (%) | 0.695 | |||
Absent | – | 92.9 | 90 | |
Mild | – | 5.7 | 10 | |
Moderate | – | 1.4 | 0 | |
Maximum aortic velocity (m/s) | 97.34 ± 19.0 | 111.15 ± 24.35 | 119.32 ± 21.22 | 0.067 |
Mean pressure gradient (mm Hg) | 3.24 ± 1.21 | 4.9 ± 1.13 | 5.69 ± 1.71 | 0.074 |
Systolic Arterial Pressure (mm Hg) | 136.26 ± 19.47 | 134.18 ± 17.32 | 142 ± 17.76 | 0.064 |
Diastolic Arterial Pressure (mm Hg) | 76.73 ± 8.85 | 75.72 ± 9.06 | 79.69 ± 9.11 | 0.133 |
Sinus of Valsalva Diameter (mm) | 32.77 ± 3.44 | 36.68 ± 5.10 | 34.78 ± 2.69 | 0.796 |
Ascending Aorta Diameter (mm) | 35.58 ± 2.96 | 39.86 ± 7 .51 | 40.30 ± 6.10 | 0.070 |
z-score sinus of Valsalva diameter | 0.01 ± 0.84 | 1.41 ± 1.29 | 0.82 ± 1.11 | 0.001 |
z-score ascending aorta diameter | 0.02 ± 0.71 | 2.87 ± 1.71 | 3.03 ± 1.4 | < 0.001 |
Peak velocity and flow eccentricity
Total population | BAV phenotype | Ascending aorta morphotype (only BAV) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Plane | Measurements | CONTROLS (n = 20) | BAV (n = 101) |
p
| RL-BAV (n = 78) | RN-BAV (n = 23) |
p
| Non-dilated (n = 24) | Root (n = 11) | Ascending (n = 66) |
p
|
Prox | Peak velocity magnitude (cm/s) | 111.7 ± 21.9 | 133.9 ± 28.3 | 0.004 | 128.5 ± 27.7 | 152.4 ± 22.2 | 0.001 | 122.6 ± 26.8 | 134.0 ± 23.9 | 138.0 ± 28.8 | 0.073 |
Peak TP velocity (cm/s) | 97.3 ± 19 | 113.0 ± 23.8 | 0.020 | 111.2 ± 24.4 | 119.3 ± 21.2 | 0.112 | 106.8 ± 26.1 | 113.4 ± 22.0 | 115.2 ± 23.2 | 0.343 | |
Jet angle (°) | 24.3 ± 6.2 | 25.7 ± 12.1 | 0.666 | 23.3 ± 11.3 | 33.8 ± 11.8 | < 0.0001 | 21.1 ± 14.0 | 24.2 ± 13.8 | 27.7 ± 10.8 | 0.042 | |
Normalized displacement | 0.04 ± 0.02 | 0.15 ± 0.07 | < 0.001 | 0.15 ± 0.06 | 0.12 ± 0.06 | 0.045 | 0.10 ± 0.06 | 0.12 ± 0.05 | 0.16 ± 0.05 | < 0.0001 | |
IRF (cm2/s) | −22.9 ± 65.9 | 139.1 ± 143.5 | < 0.001 | 123.0 ± 128.4 | 193.4 ± 178.3 | 0.024 | 54.2 ± 124.3 | 162.3 ± 162.4 | 166.1 ± 136.5 | 0.001 | |
WSSmag,avg (N/m2) | 0.52 ± 0.09 | 0.56 ± 0.16 | 0.764 | 0.55 ± 0.15 | 0.57 ± 0.17 | 0.789 | 0.53 ± 0.14 | 0.55 ± 0.18 | 0.56 ± 0.15 | 0.608 | |
WSSax,avg (N/m2) | 0.41 ± 0.11 | 0.18 ± 0.12 | < 0.001 | 0.19 ± 0.11 | 0.13 ± 0.09 | 0.046 | 0.26 ± 0.14 | 0.21 ± 0.11 | 0.14 ± 0.08 | 0.001 | |
WSScirc,avg (N/m2) | −0.03 ± 0.11 | 0.30 ± 0.20 | < 0.001 | 0.29 ± 0.18 | 0.31 ± 0.35 | 0.590 | 0.18 ± 0.22 | 0.32 ± 0.20 | 0.33 ± 0.18 | 0.007 | |
Mid | Peak velocity magnitude (cm/s) | 93.1 ± 24.3 | 118.8 ± 31.1 | 0.002 | 116.8 ± 32.3 | 125.8 ± 26.0 | 0.232 | 110.4 ± 22.7 | 114.5 ± 30.1 | 122.6 ± 33.5 | 0.282 |
Peak TP velocity (cm/s) | 89.7 ± 24.3 | 100.7 ± 27.7 | 0.060 | 101.0 ± 30.3 | 99.5 ± 16.5 | 0.833 | 99.0 ± 22.7 | 95.8 ± 22.8 | 102.0 ± 30.1 | 0.877 | |
Jet angle (°) | 10.2 ± 5.9 | 28.7 ± 11.4 | < 0.001 | 28.3 ± 12.0 | 30.1 ± 8.8 | 0.384 | 23.0 ± 10.6 | 25.4 ± 10.3 | 31.4 ± 11.0 | 0.001 | |
Normalized displacement | 0.03 ± 0.01 | 0.09 ± 0.06 | < 0.001 | 0.09 ± 0.06 | 0.09 ± 0.04 | 0.639 | 0.07 ± 0.06 | 0.06 ± 0.04 | 0.11 ± 0.06 | 0.001 | |
IRF (cm2/s) | 35.1 ± 50.7 | 199.6 ± 190.3 | < 0.001 | 186.2 ± 177.4 | 245.0 ± 227.4 | 0.046 | 101.1 ± 94.4 | 190.8 ± 200.2 | 236.9 ± 203.5 | 0.003 | |
WSSmag,avg (N/m2) | 0.54 ± 0.15 | 0.58 ± 0.21 | 0.516 | 0.57 ± 0.21 | 0.59 ± 0.22 | 0.907 | 0.55 ± 0.16 | 0.56 ± 0.21 | 0.59 ± 0.23 | 0.888 | |
WSSax,avg (N/m2) | 0.46 ± 0.14 | 0.29 ± 0.14 | < 0.001 | 0.30 ± 0.13 | 0.23 ± 0.11 | 0.019 | 0.37 ± 0.17 | 0.30 ± 0.12 | 0.25 ± 0.10 | 0.010 | |
WSScirc,avg (N/m2) | 0.06 ± 0.07 | 0.29 ± 0.22 | < 0.001 | 0.27 ± 0.20 | 0.34 ± 0.26 | 0.038 | 0.17 ± 0.17 | 0.28 ± 0.24 | 0.33 ± 0.21 | 0.004 | |
SFRR (%) | 3.99 ± 3.74 | 20.9 ± 13.5 | < 0.001 | 21.4 ± 14.6 | 19.2 ± 8.7 | 0.777 | 12.3 ± 12.7 | 15.0 ± 11.7 | 25.0 ± 12.3 | < 0.0001 | |
Dist | Peak velocity magnitude (cm/s) | 96.3 ± 21.6 | 106.1 ± 30.0 | 0.195 | 105.0 ± 30.2 | 109.8 ± 29.4 | 0.439 | 105.7 ± 20.4 | 107.5 ± 30.7 | 106.0 ± 33.0 | 0.991 |
Peak TP velocity (cm/s) | 87.4 ± 18.1 | 85.6 ± 23.6 | 0.886 | 86.7 ± 23.3 | 81.8 ± 24.7 | 0.388 | 91.1 ± 19.0 | 88.3 ± 22.4 | 83.1 ± 25.1 | 0.374 | |
Jet angle (°) | 23.0 ± 9.0 | 24.0 ± 10.6 | 0.690 | 25.1 ± 10.8 | 20.4 ± 9.5 | 0.138 | 19.5 ± 6.6 | 24.1 ± 9.1 | 25.6 ± 11.6 | 0.051 | |
Normalized displacement | 0.03 ± 0.01 | 0.06 ± 0.04 | 0.027 | 0.06 ± 0.04 | 0.05 ± 0.03 | 0.749 | 0.05 ± 0.03 | 0.06 ± 0.05 | 0.06 ± 0.04 | 0.813 | |
IRF (cm2/s) | 36.6 ± 35.3 | 120.9 ± 140.0 | 0.013 | 96.2 ± 117.8 | 204.7 ± 176.1 | 0.002 | 60.7 ± 70.8 | 106.1 ± 178.3 | 145.2 ± 146.7 | 0.005 | |
WSSmag,avg (N/m2) | 0.58 ± 0.13 | 0.50 ± 0.18 | 0.053 | 0.48 ± 0.16 | 0.53 ± 0.20 | 0.333 | 0.48 ± 0.15 | 0.53 ± 0.18 | 0.49 ± 0.18 | 0.767 | |
WSSax,avg (N/m2) | 0.36 ± 0.13 | 0.24 ± 0.12 | 0.001 | 0.25 ± 0.12 | 0.22 ± 0.10 | 0.356 | 0.28 ± 0.16 | 0.27 ± 0.11 | 0.22 ± 0.09 | 0.082 | |
WSScirc,avg (N/m2) | 0.07 ± 0.05 | 0.22 ± 0.19 | < 0.001 | 0.19 ± 0.17 | 0.29 ± 0.22 | 0.046 | 0.13 ± 0.13 | 0.19 ± 0.24 | 0.25 ± 0.19 | 0.020 | |
SFRR (%) | 2.63 ± 3.47 | 10.9 ± 9.0 | < 0.001 | 11.5 ± 9.6 | 9.1 ± 5.8 | 0.469 | 9.3 ± 11.6 | 8.3 ± 5.5 | 11.9 ± 8.3 | 0.026 |
In-plane rotational flow and systolic flow reversal ratio
WSS and regional WSS maps
Correlates of root or ascending-morphotypes
Root morphotype | Univariate adjusted correlates of root morphotype | Multivariable adjusted correlates of root morphotype | ||
OR | p-value | OR | p-value | |
Age | 0.99 (0.96–1.02) | 0.530 | ||
BSA | 0.17 (0.02–1.45) | 0.104 | 0.08 | 0.291 |
BAV phenotype (RN vs RL) | 1.41 (1.17–2.28) | 0.005 | 1.35 | 0.998 |
Sex (male) | 1.59 (1.32–1.95) | 0.050 | 1.25 | 0.011 |
Proximal peak velocity magnitude (cm/s) | 1.01 (0.98–1.22) | 0.719 | ||
Proximal jet angle (°) | 1.03 (0.95–1.51) | 0.490 | ||
Ln Proximal normalized displacement | 1.98 (1.01–2.93) | 0.040 | 1.1 | 0.009 |
Ln Proximal IRF (cm2/s) | 1.22 (1.02–1.45) | 0.002 | 0.79 | 0.940 |
Ln Proximal WSSmag,avg (N/m2) | 1.54 (0.09–4.52) | 0.761 | ||
Ln Proximal WSSax,avg (N/m2) | 1.621 (0.93–2.95) | 0.081 | 1.13 | 0.003 |
Ln Proximal WSScirc,avg (N/m2) | 2.76 (0.41–4.71) | 0.243 | 0.02 | 0.673 |
Ascending morphotype | Univariate adjusted correlates of ascending morphotype | Multivariable adjusted correlates of ascending morphotype | ||
OR | p-value | OR | p-value | |
Age | 0.99 (0.96–1.03) | 0.917 | ||
BSA | 2.51 (0.30–2.17) | 0.398 | ||
BAV phenotype (RN vs RL) | 1.99 (1.61–3.48) | 0.026 | 1.73 | 0.04 |
Sex (male) | 0.82 (0.32–2.10) | 0.678 | ||
Mid jet angle (°) | 1.09 (1.03–1.14) | 0.001 | 1.025 | 0.353 |
Ln Mid normalized displacement | 2.85 (1.56–5.23) | 0.001 | 1.510 | 0.270 |
Ln Mid IRF (cm2/s) | 2.98 (1.54–5.78) | 0.001 | 1.195 | 0.802 |
Ln Mid WSSax,avg (N/m2) | 0.14 (0.04–0.48) | 0.221 | 0.960 | 0.950 |
Ln Mid WSScirc,avg (N/m2) | 1.51 (1.16–3.68) | 0.002 | 1.61 | 0.011 |
Mid SFRR (%) | 1.12 (1.06–1.19) | 0.001 | 1.11 | 0.001 |