Changes of intracardiac flow dynamics measured by HyperDoppler in patients with aortic stenosis

Assessment of intracardiac flow dynamics has recently acquired significance due to the development of new measurement methods based on echocardiography. Recent studies have demonstrated that cardiac abnormalities are associated with changes in intracardiac vortical flows. Yet, no previous study assessed the impact of aortic stenosis (AS) on intracardiac vortices. to explore the clinical potential of additional information provided by quantifying intracardiac flow dynamics in patients with AS. One hundred twenty patients with severe AS, sixty patients with concentric remodelling (VR) and hundred controls (CTRL) were prospectively included and underwent non-invasive evaluation of intracardiac flow dynamics. In addition to standard echocardiography, fluid dynamics were assessed by means of HyperDoppler. Vortex depth (p<0.001), vortex length (p=0.003), vortex intensity (p<0.001) and vortex area (p=0.049) were significantly increased in AS compared to CTRL. In addition, mean energy dissipation was significantly higher in AS compared to CTRL (p<0.001) and VR (p=0.002). At ROC analysis, vortex depth showed the best discrimination capacity for AS (p<0.001). Changes in fluid dynamics-based HyperDoppler indices can be reliably assessed in patients with AS. Significant changes in vortex depth and intensity can selectively differentiate AS from both concentric remodelling and healthy controls, suggesting that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography to better characterize patients’ subsets.