Yi Jeong-Eun, Park Sungho, Kwon Osung, Han Dongyeop, Huh Hyungkyu, Lee Bae Young
Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, South Korea.
Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Echocardiography. 2025 Sep;42(9):e70280. doi: 10.1111/echo.70280.
Identifying factors associated with left ventricular (LV) remodeling is important for risk stratification of patients with moderate aortic stenosis (AS). The aim of this preliminary study was to explore aortic hemodynamics in these patients and assess their relationships with LV remodeling using four-dimensional (4D) flow magnetic resonance imaging (MRI).
Data from 17 patients with moderate AS involving the tricuspid aortic valves and normal LV ejection fraction (EF > 55%) were analyzed. All patients underwent 4D flow MRI of the ascending aorta and cardiac magnetic resonance (CMR) on the same day within 1 month of being diagnosed with moderate AS by transthoracic Doppler echocardiography. 4D flow MRI aortic parameters, including turbulent kinetic energy (TKE), both total and peak; peak wall shear stress (WSS); and the vortex and helix flow severity, were assessed. CMR measures comprised LV structure and function, late gadolinium enhancement (LGE), myocardial native T1 mapping, and extracellular volume fraction.
The minimum and maximum values of total TKE, peak TKE, and peak WSS were 39.4/160.3 mJ, 876.6/2059.6 J/m, and 2.0/4.9 Pa, respectively. More than 50% of the patients had vortex and helix flow of Grade 2. Peak TKE significantly correlated with LV end-diastolic volume index (r = 0.675, p = 0.003), LV end-systolic volume index (r = 0.666, p = 0.003), and LV mass index (r = 0.653, p = 0.004). LGE was not observed, and peak TKE also showed an inverse correlation with native T1 value (r = -0.571, p = 0.017).
Among patients with moderate AS, 4D flow MRI revealed heterogeneous aortic hemodynamic profiles and peak TKE was a significant hemodynamic parameter related to early LV remodeling. However, these findings need to be confirmed in further studies with larger sample sizes and a long-term serial follow-up data.
识别与左心室（LV）重构相关的因素对于中度主动脉瓣狭窄（AS）患者的风险分层很重要。这项初步研究的目的是探讨这些患者的主动脉血流动力学，并使用四维（4D）血流磁共振成像（MRI）评估其与LV重构的关系。
分析了17例中度AS累及三尖瓣主动脉瓣且左心室射血分数正常（EF>55%）患者的数据。所有患者在经胸多普勒超声心动图诊断为中度AS后的1个月内，于同一天接受升主动脉的4D血流MRI和心脏磁共振（CMR）检查。评估了4D血流MRI主动脉参数，包括湍流动能（TKE），包括总和峰值；峰值壁面剪应力（WSS）；以及涡流和螺旋流严重程度。CMR测量包括LV结构和功能、延迟钆增强（LGE）、心肌固有T1映射和细胞外容积分数。
总TKE、峰值TKE和峰值WSS的最小值和最大值分别为39.4/160.3 mJ、876.6/2059.6 J/m和2.0/4.9 Pa。超过50%的患者有2级涡流和螺旋流。峰值TKE与LV舒张末期容积指数显著相关（r = 0.675，p = 0.003）、LV收缩末期容积指数（r = 0.666，p = 0.003）和LV质量指数（r = 0.653，p = 0.004）。未观察到LGE，峰值TKE也与固有T1值呈负相关（r = -0.571，p = 0.017）。
在中度AS患者中，4D血流MRI显示主动脉血流动力学特征存在异质性，峰值TKE是与早期LV重构相关的重要血流动力学参数。然而，这些发现需要在样本量更大且有长期连续随访数据的进一步研究中得到证实。
