Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of intracardiac flows has acquired increasing significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have demonstrated abnormalities in cardiac function, which are related to pathological intracardiac vortical flows. This study investigates the additional information provided by quantifying intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods One hundred twenty patients with severe AS (65 females – 54%), 60 patients with concentric remodelling (VR) (7 females – 12%) and 100 healthy controls (CTRL) (32 females – 32%) were prospectively enrolled to undergo a non-invasive evaluation of intracardiac flow dynamics. Echocardiographic assessments were performed, and apical three chamber views were recorded by means of MyLab™ X8 Platform. The HyperDoppler software adapted to an Esaote echo-scanner without contrast injection was used to assess vortex properties in all the patients. Results Vortex depth, vortex length, vortex intensity and vortex area were all significantly increased in SAo compared to CTRL (p<0.001, p = 0.003, p<0.001 and p = 0,049, respectively). Only vortex depth and vortex intensity (p<0.001 and p = 0.013, respectively) were significantly increased in SAo compared with VR. The mean energy dissipation of SAo group was significantly increased compared to control group (p<0.001) and VR (p = 0.002). Finally, the ROC Curve, generated to assess the capability of vortex depth to discriminate patients with and without severe aortic stenosis, showed an AUC of 0.751 (cutoff value ≥ 0.354; sensitivity, 73%; specificity, 73%). Conclusions There is a significant change of vortex localization, vorticity and energy parameters in patients with Sao. In particular, vortex depth, vortex intensity and energy dissipation are all significantly increased in SAo compared to CTRL and vortex depth can independently differentiate patients with SAo to those with only concentric remodelling and to CTRLs with high accuracy. These findings indicate that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography, helping to distinguish within the heterogeneous population of patients with severe AS.