15 The role of cardiac MRI in assessing bicuspid aortic valve disease and associated myocardial fibrosis. (1st November 2021)

• Record Type: Journal Article
• Authors: Chatrath, Nikhil; Bhatia, Raghav; Fyyaz, Saad; Maclachlan, Hamish; Sharma, Sanjay; Tome, Maite; Papadakis, Michael
• Is Part Of: Heart. Volume 107(2021)Supplement 3
• Page Start: A15
• Page End: A15
• Publication Date: 2021-11-01
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2021-BSCMR.15
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Bicuspid aortic valve (BAV) is the most common congenital cardiovascular abnormality. Cardiac MRI (CMR) is commonly used to screen for aortic dilatation and associated abnormalities. Sudden death has been reported, often due to aortic stenosis (AS) or dissection, but it has been hypothesised that areas of fibrosis may be a substrate for arrythmias in patients with BAV. Methods: The aim of this study was to review the CMR findings of consecutive patients with BAV including patterns of late gadolinium enhancement (LGE). Valve morphology was described according to recent international guidance 1 . The prevalence of aortic dilatation, left ventricular hypertrophy (LVH), AS, aortic regurgitation (AR) and the distribution of late gadolinium enhancement (LGE) was noted. Results: 217 patients with BAV had CMR performed at a single-centre between May 2011 and September 2021; mean age 46 years (IQR 32–62), 74.6% male (n=162). 6.5% (n=14) had an aortic valve replacement (AVR). 25.8% (n=56) had at least moderate AS and 17.5% (n=38) at least moderate AR, quantified by flow measurements. Valve morphology could be established in 161 cases; 89.4% (n=144) demonstrated a fused BAV, the majority demonstrating right-left cusp fusion (73%; n=105). 164 had a full aortogram performed, of which 9.8% (n=16) had evidence of aortic coarctation. When indexed to body surface area, 28.7% (n=47) had dilatation at the sinus of Valsalva, 39.0% (n=64%) at the sino-tubular junction and 56.2% (n=94) at the ascending aorta. Delayed enhancement images were acquired in 116 studies and LGE was identified in 20.7% (n=24) of these. In 45.8% (n=11), the LGE could be attributed to other causes, most commonly infarction, with significant coronary artery disease confirmed on angiography (n=9). In the remaining subjects, none of whom had evidence of AS or LVH, there was mid-wall LGE in 13 subjects; predominantly in the basal septum (n=7), lateral wall (n=3), inferior RV insertion point (n=2) and anterior wall (n=1). Conclusion: This study highlights the multiple roles of CMR in the assessment of individuals with BAV. Further larger-scale studies are required to analyse patterns of LGE to try and better understand the distribution of fibrosis in these patients, and to correlate these findings with clinical outcomes. Reference: Michelena HI, Della Corte A, Evangelista A, et al . International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg . 2021;162 (3):e383–e414. doi:10.1016/j.jtcvs.2021.06.019