The Impact of a Bicuspid Aortic Valve on Aortic Geometry and Function in Patients with Aortic Coarctation: A Comprehensive CMR Study

Objectives: An isolated bicuspid aortic valve (BAV) is associated with structural and functional abnormalities of the aorta and the left ventricle (LV). Although approximately 50% of patients with aortic coarctation (CoA) have a BAV, less is known about its impact on LV function and aortic geometry, and function in CoA patients. In this cardiovascular magnetic resonance imaging (CMR) study, we therefore analyzed markers of LV and aortic function and aortic geometry in a large cohort of CoA patients with a BAV and compared them with CoA patients with a tricuspid aortic valve.

Methods: We included 52 patients with a BAV (17.7 ± 9.5 years) and 55 patients with a tricuspid aortic valve (18.7 ± 11.2 years). LV volumes, mass, and ejection fraction, as well as aortic distensibility, pulse wave velocity (PWV) was measured from cine CMR and phase-contrast CMR images. CMR feature tracking was performed to measure longitudinal, circumferential, and radial strain and strain rate of the LV. Aortic arch geometry was assessed and defined as Romanic, gothic, and crenel.

Result: LV volumes, mass, and ejection fraction, as well as aortic distensibility and PWV, did not significantly differ between the BAV and the tricuspid aortic valve group. There was also no significant difference for LV global longitudinal, radial, and circumferential strain and strain rate between both groups. Patients with a BAV had more commonly a gothic aortic arch compared with non-BAV patients, but this difference was not statistically significant (20 vs. 14, p = 0.3). PWV in the descending aorta was higher than in the aortic arch in both patient groups (p < 0.001). Global circumferential strain and strain rate (GCS and GCSR, respectively) and radial strain and strain rate (GRS and GRSR, respectively) correlated well with LV ejection fraction (GCS: r = −0.70, p < 0.001; GCSR: r = −0.61, p < 0.001; GRS: r = 0.35, p < 0.001; GRSR: r = 0.37, p < 0.001).

Conclusion: Our data suggest that the presence of a BAV in CoA patients does not adversely impact LV and aortic function. The correlation of global circumferential and radial strain values with LV ejection fraction demonstrates that CMR feature tracking might be helpful to assess ventricular function in CoA patients.

Publication History

Article published online:
21 February 2021