Intra-Cardiac Kinetic Energy and Ventricular Flow Analysis in Bicuspid Aortic Valve: Impact on Left Ventricular Function, Dilation Severity, and Surgical Referral

Intra-cardiac kinetic energy (KE) and ventricular flow analysis (VFA), as derived from 4D-flow MRI, can be used to understand the physiological burden placed on the left ventricle (LV) due to bicuspid aortic valve (BAV). Our hypothesis was that the KE of each VFA component would impact the surgical referral outcome depending on LV function decrement, BAV phenotype, and aortic dilation severity. A total of 11 healthy controls and 49 BAV patients were recruited. All subjects underwent cardiac magnetic resonance imaging (MRI) examination. The LV mass was inferior in the controls than in the BAV patients (90 ± 26 g vs. 45 ± 17 g, p = 0.025), as well as the inferior ascending aorta diameter indexed (15.8 ± 2.5 mm/m2 vs. 19.3 ± 3.5 mm/m2, p = 0.005). The VFA KE was higher in the BAV group; significant increments were found for the maximum KE and mean KE in the VFA components (p < 0.05). A total of 14 BAV subjects underwent surgery after the scans. When comparing BAV nonsurgery vs. surgery-referred cohorts, the maximum KE and mean KE were elevated (p < 0.05). The maximum and mean KE were also associated with surgical referral (r = 0.438, p = 0.002 and r = 0.371, p = 0.009, respectively). In conclusion, the KE from VFA components significantly increased in BAV patients, including in BAV patients undergoing surgery.