ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2023
Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- Backward Aortic Flow Is Associated with Impaired Left Ventricular Mechanics in Young Adults with Bicuspid Aortic Valve: A Prospective Cardiovascular Magnetic Resonance Study.Journal of clinical medicine · 2026Article
- Aortic and cardiovascular remodelling after thoracic endovascular aortic repair for blunt traumatic aortic injury in younger patients: A narrative review of physiological and clinical outcomes.Experimental physiology · 2026Review
- Hemodynamic characteristics of dilated ascending aorta in patients with bicuspid aortic valve.Journal of cardiothoracic surgery · 2025Article
- Emerging imaging and circulating biomarkers in relation to underlying mechanisms in Bicuspid Aortic Valve aortopathy.International journal of cardiology. Heart & vasculature · 2025Review
- Aortopathy associated with bicuspid aortic valve: advances in clinical and hemodynamics research.Frontiers in physiology · 2025Review
- Multiyear Interval Changes in Aortic Wall Shear Stress in Patients with Bicuspid Aortic Valve Assessed by 4D Flow MRI.Journal of magnetic resonance imaging : JMRI · 2024Article
- Automated Quantification of Simple and Complex Aortic Flow Using 2D Phase Contrast MRI.Medicina (Kaunas, Lithuania) · 2024Article
- Early safety and feasibility of a first-in-class biomimetic transcatheter aortic valve - DurAVR.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2023Article
- Aortic flow is associated with aging and exercise capacity.European heart journal open · 2023Article
- Aortic flow is abnormal in HFpEF.Wellcome open research · 2023Article
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundBicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole.
methods510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole.
resultsBAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1).
conclusion4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
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