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Kwan CT, Ching OHS, Yap PM, Fung SY, Tang HS, Tse WWV, Kwan CNF, Chow YHP, Yiu NC, Lee YP, Lau JWK, Fong AHT, Ren QW, Wu MZ, Wan EYF, Lee KCK, Leung CY, Li A, Montero D, Vardhanabhuti V, Hai JSH, Siu CW, Tse HF, Zingan V, Zhao X, Wang H, Pennell DJ, Mohiaddin R, Senior R, Yiu KH, Ng MY. Intraventricular 4D flow cardiovascular magnetic resonance for assessing patients with heart failure with preserved ejection fraction: a pilot study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2015-2027. [PMID: 37380904 DOI: 10.1007/s10554-023-02909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. Intraventricular four-dimensional flow (4D flow) phase-contrast cardiovascular magnetic resonance (CMR) can assess different components of left ventricular (LV) flow including direct flow, delayed ejection, retained inflow and residual volume. This could be utilised to identify HFpEF. This study investigated if intraventricular 4D flow CMR could differentiate HFpEF patients from non-HFpEF and asymptomatic controls. Suspected HFpEF patients and asymptomatic controls were recruited prospectively. HFpEF patients were confirmed using European Society of Cardiology (ESC) 2021 expert recommendations. Non-HFpEF patients were diagnosed if suspected HFpEF patients did not fulfil ESC 2021 criteria. LV direct flow, delayed ejection, retained inflow and residual volume were obtained from 4D flow CMR images. Receiver operating characteristic (ROC) curves were plotted. 63 subjects (25 HFpEF patients, 22 non-HFpEF patients and 16 asymptomatic controls) were included in this study. 46% were male, mean age 69.8 ± 9.1 years. CMR 4D flow derived LV direct flow and residual volume could differentiate HFpEF vs combined group of non-HFpEF and asymptomatic controls (p < 0.001 for both) as well as HFpEF vs non-HFpEF patients (p = 0.021 and p = 0.005, respectively). Among the 4 parameters, direct flow had the largest area under curve (AUC) of 0.781 when comparing HFpEF vs combined group of non-HFpEF and asymptomatic controls, while residual volume had the largest AUC of 0.740 when comparing HFpEF and non-HFpEF patients. CMR 4D flow derived LV direct flow and residual volume show promise in differentiating HFpEF patients from non-HFpEF patients.
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Affiliation(s)
- Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - On Hang Samuel Ching
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pui Min Yap
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sau Yung Fung
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wan Wai Vivian Tse
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Cheuk Nam Felix Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yin Hay Phoebe Chow
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Nga Ching Yiu
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yung Pok Lee
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jessica Wing Ka Lau
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ambrose Ho Tung Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka Chun Kevin Lee
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai, Hong Kong
| | - Chun Yu Leung
- Department of Medicine, Tseung Kwan O Hospital, Hong Hau, Hong Kong
| | - Andrew Li
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong
| | - David Montero
- School of Public Health, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jojo Siu Han Hai
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Xiaoxi Zhao
- Circle Cardiovascular Imaging Inc, Calgary, Canada
| | | | - Dudley John Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raad Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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Obermeier L, Vellguth K, Schlief A, Tautz L, Bruening J, Knosalla C, Kuehne T, Solowjowa N, Goubergrits L. CT-Based Simulation of Left Ventricular Hemodynamics: A Pilot Study in Mitral Regurgitation and Left Ventricle Aneurysm Patients. Front Cardiovasc Med 2022; 9:828556. [PMID: 35391837 PMCID: PMC8980692 DOI: 10.3389/fcvm.2022.828556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/03/2022] [Indexed: 12/30/2022] Open
Abstract
Background Cardiac CT (CCT) is well suited for a detailed analysis of heart structures due to its high spatial resolution, but in contrast to MRI and echocardiography, CCT does not allow an assessment of intracardiac flow. Computational fluid dynamics (CFD) can complement this shortcoming. It enables the computation of hemodynamics at a high spatio-temporal resolution based on medical images. The aim of this proposed study is to establish a CCT-based CFD methodology for the analysis of left ventricle (LV) hemodynamics and to assess the usability of the computational framework for clinical practice. Materials and Methods The methodology is demonstrated by means of four cases selected from a cohort of 125 multiphase CCT examinations of heart failure patients. These cases represent subcohorts of patients with and without LV aneurysm and with severe and no mitral regurgitation (MR). All selected LVs are dilated and characterized by a reduced ejection fraction (EF). End-diastolic and end-systolic image data was used to reconstruct LV geometries with 2D valves as well as the ventricular movement. The intraventricular hemodynamics were computed with a prescribed-motion CFD approach and evaluated in terms of large-scale flow patterns, energetic behavior, and intraventricular washout. Results In the MR patients, a disrupted E-wave jet, a fragmentary diastolic vortex formation and an increased specific energy dissipation in systole are observed. In all cases, regions with an impaired washout are visible. The results furthermore indicate that considering several cycles might provide a more detailed view of the washout process. The pre-processing times and computational expenses are in reach of clinical feasibility. Conclusion The proposed CCT-based CFD method allows to compute patient-specific intraventricular hemodynamics and thus complements the informative value of CCT. The method can be applied to any CCT data of common quality and represents a fair balance between model accuracy and overall expenses. With further model enhancements, the computational framework has the potential to be embedded in clinical routine workflows, to support clinical decision making and treatment planning.
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Affiliation(s)
- Lukas Obermeier
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Vellguth
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adriano Schlief
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lennart Tautz
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jan Bruening
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Titus Kuehne
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, Germany
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Impact of Mitral Regurgitation on the Flow in a Model of a Left Ventricle. Cardiovasc Eng Technol 2020; 11:708-718. [DOI: 10.1007/s13239-020-00490-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
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Ahmad Bakir A, Al Abed A, Stevens MC, Lovell NH, Dokos S. A Multiphysics Biventricular Cardiac Model: Simulations With a Left-Ventricular Assist Device. Front Physiol 2018; 9:1259. [PMID: 30271353 PMCID: PMC6142745 DOI: 10.3389/fphys.2018.01259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Computational models have become essential in predicting medical device efficacy prior to clinical studies. To investigate the performance of a left-ventricular assist device (LVAD), a fully-coupled cardiac fluid-electromechanics finite element model was developed, incorporating electrical activation, passive and active myocardial mechanics, as well as blood hemodynamics solved simultaneously in an idealized biventricular geometry. Electrical activation was initiated using a simplified Purkinje network with one-way coupling to the surrounding myocardium. Phenomenological action potential and excitation-contraction equations were adapted to trigger myocardial contraction. Action potential propagation was formulated within a material frame to emulate gap junction-controlled propagation, such that the activation sequence was independent of myocardial deformation. Passive cardiac mechanics were governed by a transverse isotropic hyperelastic constitutive formulation. Blood velocity and pressure were determined by the incompressible Navier-Stokes formulations with a closed-loop Windkessel circuit governing the circulatory load. To investigate heart-LVAD interaction, we reduced the left ventricular (LV) contraction stress to mimic a failing heart, and inserted a LVAD cannula at the LV apex with continuous flow governing the outflow rate. A proportional controller was implemented to determine the pump motor voltage whilst maintaining pump motor speed. Following LVAD insertion, the model revealed a change in the LV pressure-volume loop shape from rectangular to triangular. At higher pump speeds, aortic ejection ceased and the LV decompressed to smaller end diastolic volumes. After multiple cycles, the LV cavity gradually collapsed along with a drop in pump motor current. The model was therefore able to predict ventricular collapse, indicating its utility for future development of control algorithms and pre-clinical testing of LVADs to avoid LV collapse in recipients.
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Affiliation(s)
- Azam Ahmad Bakir
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, Australia
| | - Amr Al Abed
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, Australia
| | - Michael C Stevens
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, Australia.,Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, Australia
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington, NSW, Australia
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Govindarajan V, Mousel J, Udaykumar HS, Vigmostad SC, McPherson DD, Kim H, Chandran KB. Synergy between Diastolic Mitral Valve Function and Left Ventricular Flow Aids in Valve Closure and Blood Transport during Systole. Sci Rep 2018; 8:6187. [PMID: 29670148 PMCID: PMC5906696 DOI: 10.1038/s41598-018-24469-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022] Open
Abstract
Highly resolved three-dimensional (3D) fluid structure interaction (FSI) simulation using patient-specific echocardiographic data can be a powerful tool for accurately and thoroughly elucidating the biomechanics of mitral valve (MV) function and left ventricular (LV) fluid dynamics. We developed and validated a strongly coupled FSI algorithm to fully characterize the LV flow field during diastolic MV opening under physiologic conditions. Our model revealed that distinct MV deformation and LV flow patterns developed during different diastolic stages. A vortex ring that strongly depended on MV deformation formed during early diastole. At peak E wave, the MV fully opened, with a local Reynolds number of ~5500, indicating that the flow was in the laminar-turbulent transitional regime. Our results showed that during diastasis, the vortex structures caused the MV leaflets to converge, thus increasing mitral jet’s velocity. The vortex ring became asymmetrical, with the vortex structures on the anterior side being larger than on the posterior side. During the late diastolic stages, the flow structures advected toward the LV outflow tract, enhancing fluid transport to the aorta. This 3D-FSI study demonstrated the importance of leaflet dynamics, their effect on the vortex ring, and their influence on MV function and fluid transport within the LV during diastole.
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Affiliation(s)
- Vijay Govindarajan
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA
| | - John Mousel
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - H S Udaykumar
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Sarah C Vigmostad
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - David D McPherson
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA
| | - Hyunggun Kim
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, TX, USA. .,Department of Biomechatronic Engineering, Sungkyunkwan University, Suwon, Gyeonggi, Korea.
| | - Krishnan B Chandran
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA.
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6
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Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects. Int J Cardiovasc Imaging 2018; 34:905-920. [DOI: 10.1007/s10554-017-1291-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
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7
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Eriksson J, Zajac J, Alehagen U, Bolger AF, Ebbers T, Carlhäll CJ. Left ventricular hemodynamic forces as a marker of mechanical dyssynchrony in heart failure patients with left bundle branch block. Sci Rep 2017; 7:2971. [PMID: 28592851 PMCID: PMC5462838 DOI: 10.1038/s41598-017-03089-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/21/2017] [Indexed: 11/12/2022] Open
Abstract
Left bundle branch block (LBBB) causes left ventricular (LV) dyssynchrony which is often associated with heart failure. A significant proportion of heart failure patients do not demonstrate clinical improvement despite cardiac resynchronization therapy (CRT). How LBBB-related effects on LV diastolic function may contribute to those therapeutic failures has not been clarified. We hypothesized that LV hemodynamic forces calculated from 4D flow MRI could serve as a marker of diastolic mechanical dyssynchrony in LBBB hearts. MRI data were acquired in heart failure patients with LBBB or matched patients without LBBB. LV pressure gradients were calculated from the Navier-Stokes equations. Integration of the pressure gradients over the LV volume rendered the hemodynamic forces. The findings demonstrate that the LV filling forces are more orthogonal to the main LV flow direction in heart failure patients with LBBB compared to those without LBBB during early but not late diastole. The greater the conduction abnormality the greater the discordance of LV filling force with the predominant LV flow direction (r2 = 0.49). Such unique flow-specific measures of mechanical dyssynchrony may serve as an additional tool for considering the risks imposed by conduction abnormalities in heart failure patients and prove to be useful in predicting response to CRT.
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Affiliation(s)
- Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jakub Zajac
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, California, USA
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Division of Media and Information Technology, Department of Science and Technology/Swedish e-Science Research Centre (SeRC), Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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8
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Cibis M, Bustamante M, Eriksson J, Carlhäll CJ, Ebbers T. Creating hemodynamic atlases of cardiac 4D flow MRI. J Magn Reson Imaging 2017; 46:1389-1399. [PMID: 28295788 PMCID: PMC5655727 DOI: 10.1002/jmri.25691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/14/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose Hemodynamic atlases can add to the pathophysiological understanding of cardiac diseases. This study proposes a method to create hemodynamic atlases using 4D Flow magnetic resonance imaging (MRI). The method is demonstrated for kinetic energy (KE) and helicity density (Hd). Materials and Methods Thirteen healthy subjects underwent 4D Flow MRI at 3T. Phase‐contrast magnetic resonance cardioangiographies (PC‐MRCAs) and an average heart were created and segmented. The PC‐MRCAs, KE, and Hd were nonrigidly registered to the average heart to create atlases. The method was compared with 1) rigid, 2) affine registration of the PC‐MRCAs, and 3) affine registration of segmentations. The peak and mean KE and Hd before and after registration were calculated to evaluate interpolation error due to nonrigid registration. Results The segmentations deformed using nonrigid registration overlapped (median: 92.3%) more than rigid (23.1%, P < 0.001), and affine registration of PC‐MRCAs (38.5%, P < 0.001) and affine registration of segmentations (61.5%, P < 0.001). The peak KE was 4.9 mJ using the proposed method and affine registration of segmentations (P = 0.91), 3.5 mJ using rigid registration (P < 0.001), and 4.2 mJ using affine registration of the PC‐MRCAs (P < 0.001). The mean KE was 1.1 mJ using the proposed method, 0.8 mJ using rigid registration (P < 0.001), 0.9 mJ using affine registration of the PC‐MRCAs (P < 0.001), and 1.0 mJ using affine registration of segmentations (P = 0.028). The interpolation error was 5.2 ± 2.6% at mid‐systole, 2.8 ± 3.8% at early diastole for peak KE; 9.6 ± 9.3% at mid‐systole, 4.0 ± 4.6% at early diastole, and 4.9 ± 4.6% at late diastole for peak Hd. The mean KE and Hd were not affected by interpolation. Conclusion Hemodynamic atlases can be obtained with minimal user interaction using nonrigid registration of 4D Flow MRI. Level of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2017;46:1389–1399.
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Affiliation(s)
- Merih Cibis
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mariana Bustamante
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Division of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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9
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Eriksson J, Bolger AF, Ebbers T, Carlhäll CJ. Assessment of left ventricular hemodynamic forces in healthy subjects and patients with dilated cardiomyopathy using 4D flow MRI. Physiol Rep 2016; 4:4/3/e12685. [PMID: 26841965 PMCID: PMC4758930 DOI: 10.14814/phy2.12685] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We hypothesized that the direction of global left ventricular (LV) hemodynamic forces during diastolic filling are concordant with the main flow axes in normal LVs, but that this pattern would be altered in dilated and dysfunctional LVs. Therefore, we aimed to assess the LV hemodynamic filling forces in a group of healthy subjects and compare them to the results from a group of patients with dilated cardiomyopathy (DCM). Ten healthy subjects and 10 DCM patients were enrolled. Morphological short‐ (SAx) and long‐axis (LAx) images and 4D flow MRI data were acquired at 1.5T. The LV pressure gradients were computed from the 4D flow data using the Navier–Stokes equations. By integrating the pressure gradients over the LV volume at each time frame, the magnitude and direction of the global hemodynamic force was calculated over the cardiac cycle. The hemodynamic forces acting in the SAx‐ and LAx‐directions were used to calculate the “SAx‐max/LAx‐max”‐ratio for the early (E‐wave) and late (A‐wave) diastolic filling. In the LAx‐plane, the temporal progression of the hemodynamic force followed a consistent pattern in the healthy subjects. The “SAx‐max/LAx‐max”‐ratio was significantly larger at both E‐wave (0.53 ± 0.15 vs. 0.23 ± 0.12, P < 0.0001) and A‐wave (0.44 ± 0.21 vs. 0.26 ± 0.09, P < 0.03) in the DCM patients compared to the healthy subjects. 4D flow MRI data allow quantification of LV hemodynamic forces acting on the LV myocardial wall. The LV hemodynamic filling forces showed a similar temporal progression among healthy subjects, whereas DCM patients had forces that were more heterogeneous in their direction and magnitude during diastole.
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Affiliation(s)
- Jonatan Eriksson
- Divsion of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Divsion of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Medicine, University of California, San Francisco, California
| | - Tino Ebbers
- Divsion of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden Division of Media and Information Technology, Department of Science and Technology/Swedish e-Science Research Centre (SeRC), Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Divsion of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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10
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Calkoen EE, Roest AAW, Kroft LJM, van der Geest RJ, Jongbloed MRM, van den Boogaard PJ, Blom NA, Hazekamp MG, de Roos A, Westenberg JJM. Characterization and improved quantification of left ventricular inflow using streamline visualization with 4DFlow MRI in healthy controls and patients after atrioventricular septal defect correction. J Magn Reson Imaging 2014; 41:1512-20. [PMID: 25143314 DOI: 10.1002/jmri.24735] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/05/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate trans-left atrioventricular valve (LAVV) blood flow and optimize left ventricular inflow quantification in healthy controls and patients after atrioventricular septal defect (AVSD) correction. MATERIALS AND METHODS Twenty-five patients after AVSD correction and 25 controls underwent 4DFlow MRI. Using streamline visualization in four- and two-chamber views, inflow direction at early and late filling was defined at the annulus level and at the peak inflow velocity (PIV) level. Trans-LAVV flow volume and velocity were assessed from a static 2D-multiplanar-reformat (MPR), a 4D-MPR tracking LAVV annulus and a 4D-MPR tracking the PIV-level, angulated perpendicular to the inflow. RESULTS In patients, on average 9° more laterally directed inflow was found at the PIV-level compared to controls. In controls, 4DFlow velocity mapping with LAVV annulus tracking resulted in lower absolute error with aortic flow (3 (1-8) mL) than with static 2D-MPR (7 (4-16) mL, P = 0.001). In patients, 4D-MPR tracking the PIV-level, resulted in lower absolute error with aortic flow (2 (1-4) mL) than with 4D-MPR LAVV annulus tracking (6 (2-10) mL, P = 0.003). CONCLUSION Streamline visualization of 4DFlow MRI data revealed dynamic trans-LAVV inflow and more lateral flow after AVSD correction. Streamline visualization improved trans-LAVV flow quantification as the positioning and angulation of the measurement plane was optimized, allowing an accurate assessment of left ventricular inflow.
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Affiliation(s)
- Emmeline E Calkoen
- Division of Paediatric Cardiology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Division of Paediatric Cardiology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Nico A Blom
- Division of Paediatric Cardiology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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11
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Cardiovascular Function and Flow by 4-Dimensional Magnetic Resonance Imaging Techniques. J Thorac Imaging 2014; 29:185-96. [DOI: 10.1097/rti.0000000000000068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Zajac J, Eriksson J, Dyverfeldt P, Bolger AF, Ebbers T, Carlhäll CJ. Turbulent kinetic energy in normal and myopathic left ventricles. J Magn Reson Imaging 2014; 41:1021-9. [DOI: 10.1002/jmri.24633] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/12/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jakub Zajac
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Clinical Physiology; UHL, County Council of Östergötland; Linköping Sweden
| | - Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
| | - Ann F. Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Department of Medicine; University of California San Francisco; San Francisco CA USA
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Division of Media and Information Technology, Department of Science and Technology/Swedish e-Science Research Centre (SeRC); Linköping University; Linköping Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Center for Medical Image Science and Visualization (CMIV); Linköping University; Linköping Sweden
- Department of Clinical Physiology; UHL, County Council of Östergötland; Linköping Sweden
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Mehregan F, Tournoux F, Muth S, Pibarot P, Rieu R, Cloutier G, Garcia D. Doppler vortography: a color Doppler approach to quantification of intraventricular blood flow vortices. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:210-21. [PMID: 24210865 PMCID: PMC3864856 DOI: 10.1016/j.ultrasmedbio.2013.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 05/11/2023]
Abstract
We propose a new approach to quantification of intracardiac vorticity based on conventional color Doppler images -Doppler vortography. Doppler vortography relies on the centrosymmetric properties of the vortices. Such properties induce particular symmetries in the Doppler flow data that can be exploited to describe the vortices quantitatively. For this purpose, a kernel filter was developed to derive a parameter, the blood vortex signature (BVS), that allows detection of the main intracardiac vortices and estimation of their core vorticities. The reliability of Doppler vortography was assessed in mock Doppler fields issued from simulations and in vitro data. Doppler vortography was also tested in patients and compared with vector flow mapping by echocardiography. Strong correlations were obtained between Doppler vortography-derived and ground-truth vorticities (in silico: r2 = 0.98, in vitro: r2 = 0.86, in vivo: r2 = 0.89). Our results indicate that Doppler vortography is a potentially promising echocardiographic tool for quantification of vortex flow in the left ventricle.
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Affiliation(s)
- Forough Mehregan
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
| | - François Tournoux
- Department of Echocardiography, CHUM, University of Montreal Hospital, Canada
| | - Stéphan Muth
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
| | - Philippe Pibarot
- Department of Medicine, Laval University, and Québec Heart & Lung Institute
| | - Régis Rieu
- Aix-Marseille University, CNRS, UMR 7287, ISM GIBoc, Marseille, France
| | - Guy Cloutier
- CRCHUM, Research Center, University of Montreal Hospital, Canada
- LBUM, Laboratory of Biorheology and Medical Ultrasonics
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Canada
| | - Damien Garcia
- RUBIC, Research Unit of Biomechanics and Imaging in Cardiology
- CRCHUM, Research Center, University of Montreal Hospital, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Canada
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Eriksson J, Bolger AF, Ebbers T, Carlhäll CJ. Four-dimensional blood flow-specific markers of LV dysfunction in dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 14:417-24. [PMID: 22879457 PMCID: PMC3626338 DOI: 10.1093/ehjci/jes159] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims Patients with mild heart failure (HF) who are clinically compensated may have normal left ventricular (LV) stroke volume (SV). Despite this, altered intra-ventricular flow patterns have been recognized in these subjects. We hypothesized that, compared with normal LVs, flow in myopathic LVs would demonstrate a smaller proportion of inflow volume passing directly to ejection and diminished the end-diastolic preservation of the inflow kinetic energy (KE). Methods and results In 10 patients with dilated cardiomyopathy (DCM) (49 ± 14 years, six females) and 10 healthy subjects (44 ± 17 years, four females), four-dimensional MRI velocity and morphological data were acquired. A previously validated method was used to separate the LV end-diastolic volume (EDV) into four flow components based on the blood's locations at the beginning and end of the cardiac cycle. KE was calculated over the cardiac cycle for each component. The EDV was larger (P = 0.021) and the ejection fraction smaller (P < 0.001) in DCM compared with healthy subjects; the SV was equivalent (DCM: 77 ± 19, healthy: 79 ± 16 mL). The proportion of the total LV inflow that passed directly to ejection was smaller in DCM (P = 0.000), but the end-diastolic KE/mL of the direct flow was not different in the two groups (NS). Conclusion Despite equivalent LVSVs, HF patients with mild LV remodelling demonstrate altered diastolic flow routes through the LV and impaired preservation of inflow KE at pre-systole compared with healthy subjects. These unique flow-specific changes in the flow route and energetics are detectable despite clinical compensation, and may prove useful as subclinical markers of LV dysfunction.
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Affiliation(s)
- Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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15
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Lampropoulos K, Budts W, Van de Bruaene A, Troost E, van Melle JP. Visualization of the intracavitary blood flow in systemic ventricles of Fontan patients by contrast echocardiography using particle image velocimetry. Cardiovasc Ultrasound 2012; 10:5. [PMID: 22348378 PMCID: PMC3316136 DOI: 10.1186/1476-7120-10-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow patterns in univentricular hearts may have clinical value. Therefore, it is our objective to asses and characterize vortex flow patterns with Fontan circulation in comparison with healthy controls. METHODS Twenty-three patients (8 Fontan and 15 normal patients) underwent echocardiography with intravenous contrast agent (Sonovue®) administration. Dedicated software was used to perform particle image velocimetry (PIV) and to visualize intracavitary flow in the systemic ventricles of the patients. Vortex parameters including vortex depth, length, width, and sphericity index were measured. Vortex pulsatility parameters including relative strength, vortex relative strength, and vortex pulsation correlation were also measured. RESULTS The data from this study show that it is feasible to perform particle velocimetry in Fontan patients. Vortex length (VL) was significantly lower (0.51 ± 0.09 vs 0.65 ± 0.12, P = 0.010) and vortex width (VW) (0.32 ± 0.06 vs 0.27 ± 0.04, p = 0.014), vortex pulsation correlation (VPC) (0.26 ± 0.25 vs -0.22 ± 0.87, p = 0.05) were significantly higher in Fontan patients. Sphericity index (SI) (1.66 ± 0.48 vs 2.42 ± 0.62, p = 0.005), relative strength (RS) (0.77 ± 0.33 vs 1.90 ± 0.47, p = 0.0001), vortex relative strength (VRS) (0.18 ± 0.13 vs 0.43 ± 0.14, p = 0.0001) were significantly lower in the Fontan patients group. CONCLUSIONS PIV using contrast echocardiography is feasible in Fontan patients. Fontan patients had aberrant flow patterns as compared to normal hearts in terms of position, shape and sphericity of the main vortices. The vortex from the Fontan group was consistently shorter, wider and rounder than in controls. Whether vortex characteristics are related with clinical outcome is subject to further investigation.
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Affiliation(s)
- Konstantinos Lampropoulos
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiology, Polyclinic General Hospital of Athens, Athens, Greece
- Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Werner Budts
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Alexander Van de Bruaene
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Els Troost
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Joost P van Melle
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Congenital and structural cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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16
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Intuitive visualization and quantification of intraventricular convection in acute ischemic left ventricular failure during early diastole using color Doppler-based echocardiographic vector flow mapping. Int J Cardiovasc Imaging 2011; 28:1035-47. [DOI: 10.1007/s10554-011-9932-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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17
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Eriksson J, Dyverfeldt P, Engvall J, Bolger AF, Ebbers T, Carlhäll CJ. Quantification of presystolic blood flow organization and energetics in the human left ventricle. Am J Physiol Heart Circ Physiol 2011; 300:H2135-41. [PMID: 21421820 DOI: 10.1152/ajpheart.00993.2010] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intracardiac blood flow patterns are potentially important to cardiac pumping efficiency. However, these complex flow patterns remain incompletely characterized both in health and disease. We hypothesized that normal left ventricular (LV) blood flow patterns would preferentially optimize a portion of the end-diastolic volume (LVEDV) for effective and rapid systolic ejection by virtue of location near and motion towards the LV outflow tract (LVOT). Three-dimensional cine velocity and morphological data were acquired in 12 healthy persons and 1 patient with dilated cardiomyopathy using MRI. A previously validated method was used for analysis in which the LVEDV was separated into four functional flow components based on the blood's locations at the beginning and end of the cardiac cycle. Each component's volume, kinetic energy (KE), site, direction, and linear momentum relative to the LVOT were calculated. Of the four components, the LV inflow that passes directly to outflow in a single cardiac cycle (Direct Flow) had the largest volume. At the time of isovolumic contraction, Direct Flow had the greatest amount of KE and the most favorable combination of distance, angle, and linear momentum relative to the LVOT. Atrial contraction boosted the late diastolic KE of the ejected components. We conclude that normal diastolic LV flow creates favorable conditions for ensuing ejection, defined by proximity and energetics, for the Direct Flow, and that atrial contraction augments the end-diastolic KE of the ejection volume. The correlation of Direct Flow characteristics with ejection efficiency might be a relevant investigative target in cardiac failure.
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Affiliation(s)
- Jonatan Eriksson
- Dept. of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping Univ., SE-581 85 Linköping .
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18
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Affiliation(s)
- Carl Johan Carlhäll
- Department of Clinical Physiology, University Hospital and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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19
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Eriksson J, Carlhäll CJ, Dyverfeldt P, Engvall J, Bolger AF, Ebbers T. Semi-automatic quantification of 4D left ventricular blood flow. J Cardiovasc Magn Reson 2010; 12:9. [PMID: 20152026 PMCID: PMC2831022 DOI: 10.1186/1532-429x-12-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/12/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The beating heart is the generator of blood flow through the cardiovascular system. Within the heart's own chambers, normal complex blood flow patterns can be disturbed by diseases. Methods for the quantification of intra-cardiac blood flow, with its 4D (3D+time) nature, are lacking. We sought to develop and validate a novel semi-automatic analysis approach that integrates flow and morphological data. METHOD In six healthy subjects and three patients with dilated cardiomyopathy, three-directional, three-dimensional cine phase-contrast cardiovascular magnetic resonance (CMR) velocity data and balanced steady-state free-precession long- and short-axis images were acquired. The LV endocardium was segmented from the short-axis images at the times of isovolumetric contraction (IVC) and isovolumetric relaxation (IVR). At the time of IVC, pathlines were emitted from the IVC LV blood volume and traced forwards and backwards in time until IVR, thus including the entire cardiac cycle. The IVR volume was used to determine if and where the pathlines left the LV. This information was used to automatically separate the pathlines into four different components of flow: Direct Flow, Retained Inflow, Delayed Ejection Flow and Residual Volume. Blood volumes were calculated for every component by multiplying the number of pathlines with the blood volume represented by each pathline. The accuracy and inter- and intra-observer reproducibility of the approach were evaluated by analyzing volumes of LV inflow and outflow, the four flow components, and the end-diastolic volume. RESULTS The volume and distribution of the LV flow components were determined in all subjects. The calculated LV outflow volumes [ml] (67 +/- 13) appeared to fall in between those obtained by through-plane phase-contrast CMR (77 +/- 16) and Doppler ultrasound (58 +/- 10), respectively. Calculated volumes of LV inflow (68 +/- 11) and outflow (67 +/- 13) were well matched (NS). Low inter- and intra-observer variability for the assessment of the volumes of the flow components was obtained. CONCLUSIONS This semi-automatic analysis approach for the quantification of 4D blood flow resulted in accurate LV inflow and outflow volumes and a high reproducibility for the assessment of LV flow components.
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Affiliation(s)
- Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Carl Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Applied Thermodynamics and Fluid Mechanics, Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology, Linköping University Hospital, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, University of California, San Francisco, California, USA
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Applied Thermodynamics and Fluid Mechanics, Department of Management and Engineering, Linköping University, Linköping, Sweden
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20
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Rubinshtein R, Glockner JF, Feng D, Araoz PA, Kirsch J, Syed IS, Oh JK. Comparison of magnetic resonance imaging versus Doppler echocardiography for the evaluation of left ventricular diastolic function in patients with cardiac amyloidosis. Am J Cardiol 2009; 103:718-23. [PMID: 19231340 DOI: 10.1016/j.amjcard.2008.10.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 11/29/2022]
Abstract
To assess the role of magnetic resonance imaging (MRI) in the assessment of diastolic function, diastolic mitral inflow parameters using MRI and transthoracic Doppler echocardiography (echocardiography) were compared in patients with cardiac amyloidosis. Thirty-eight patients (age 60 +/- 12 years; 32% women) in sinus rhythm with cardiac amyloidosis (biopsy-proven systemic amyloidosis and positive echocardiographic and contrast-enhanced cardiac MRI findings) were evaluated. Cine phase-contrast MRI images of mitral inflow were obtained in the left ventricle to quantify diastolic blood flow. MRI measurements of diastolic parameters were compared (Spearman's rank correlation) with echocardiographic diastolic mitral inflow velocity parameters. Additional analysis was performed comparing MRI findings in patients with a restrictive echocardiographic diastolic filling pattern (n = 23) versus those without (n = 15). For the 38 patients, early diastolic (E) peak velocity was 61 +/- 26 cm/s using MRI versus 79 +/- 21 using echocardiography (Spearman's rank correlation 0.55, p = 0.0004), and late diastolic (A) peak velocity was 46 +/- 22 cm/s using MRI versus 47 +/- 22 cm/s using echocardiography (Spearman's rank correlation 0.54, p = 0.0005). E/A ratio was 1.55 +/- 0.9 using MRI and 2.25 +/- 1.4 using echocardiography (Spearman's rank correlation 0.75, p <0.0001). Deceleration times in both modalities showed good correlation (MRI, 180 +/- 44 ms vs echocardiography, 179 +/- 49; Spearman's rank correlation 0.61, p = 0.0001). MRI E/A ratio for peak velocities was significantly higher in patients with restrictive echocardiographic patterns (1.95 +/- 1.0) versus those without (0.93 +/- 0.3; p = 0.0003). Two of 23 patients with a restrictive echocardiographic pattern had an MRI E/A ratio <1. In conclusion, mitral inflow peak velocities, deceleration times, and E/A ratios detected using phase-contrast MRI in patients with cardiac amyloidosis showed moderately good correlation with echocardiography and identified most patients with restrictive echocardiographic patterns.
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Affiliation(s)
- Ronen Rubinshtein
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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Nguyen TD, de Rochefort L, Spincemaille P, Cham MD, Weinsaft JW, Prince MR, Wang Y. Effective motion-sensitizing magnetization preparation for black blood magnetic resonance imaging of the heart. J Magn Reson Imaging 2009; 28:1092-100. [PMID: 18972350 DOI: 10.1002/jmri.21568] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the effectiveness of flow signal suppression of a motion-sensitizing magnetization preparation (MSPREP) sequence and to optimize a 2D MSPREP steady-state free precession (SSFP) sequence for black blood imaging of the heart. MATERIALS AND METHODS Using a flow phantom, the effect of varying field of speed (FOS), b-value, voxel size, and flow pattern on the flow suppression was investigated. In seven healthy volunteers, black blood images of the heart were obtained at 1.5T with MSPREP-SSFP and double inversion recovery fast spin echo (DIR-FSE) techniques. Myocardium and blood signal-to-noise ratio (SNR) and myocardium-to-blood contrast-to-noise ratio (CNR) were measured. The optimal FOS that maximized the CNR for MSPREP-SSFP was determined. RESULTS Phantom data demonstrated that the flow suppression was induced primarily by the velocity encoding effect. In humans, FOS=10-20 cm/s was found to maximize the CNR for short-axis (SA) and four-chamber (4C) views. Compared to DIR-FSE, MSPREP-SSFP provided similar blood SNR efficiency in the SA basal and mid-views and significantly lower blood SNR efficiency in the SA apical (P=0.02) and 4C (P=0.01) views, indicating similar or better blood suppression. CONCLUSION Velocity encoding is the primary flow suppression mechanism of the MSPREP sequence and 2D MSPREP-SSFP black blood imaging of the heart is feasible in healthy subjects.
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Affiliation(s)
- Thanh D Nguyen
- Department of Radiology, Weill Medical College of Cornell University, New York, New York 10022, USA.
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22
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Westenberg JJM, Roes SD, Ajmone Marsan N, Binnendijk NMJ, Doornbos J, Bax JJ, Reiber JHC, de Roos A, van der Geest RJ. Mitral Valve and Tricuspid Valve Blood Flow: Accurate Quantification with 3D Velocity-encoded MR Imaging with Retrospective Valve Tracking. Radiology 2008; 249:792-800. [PMID: 18849503 DOI: 10.1148/radiol.2492080146] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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24
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Wise RG, Al-Shafei AIM, Carpenter TA, Hall LD, Huang CLH. Simultaneous measurement of blood and myocardial velocity in the rat heart by phase contrast MRI using sparseq-space sampling. J Magn Reson Imaging 2005; 22:614-27. [PMID: 16193471 DOI: 10.1002/jmri.20423] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To measure cardiac blood flow patterns and ventricular wall velocities through the cardiac cycle in anesthetized Wistar Kyoto (WKY) rats. MATERIALS AND METHODS A gradient-echo cine pulse sequence incorporating pulsed field gradients (PFGs) provided phase contrast (PC) motion encoding. We achieved a range of velocity sensitivity that was sufficient to measure simultaneously the large flow velocities within the cardiac chambers and aortic outflow tract (up to 70 cm s(-1) during systole), and the comparatively small velocities of the cardiac wall (0-3 cm s(-1)). A scheme of sparsely sampling q-space combined with a probability-based method of velocity calculation permitted such measurements along three orthogonal axes, and yielded velocity vector maps in all four chambers of the heart and the aorta, in both longitudinal and transverse sections, for up to 12 time-points in the cardiac cycle. RESULTS Left ventricular systole was associated with a symmetrical laminar flow pattern along the cardiac axis, with no appearance of turbulence. In contrast, blood showed a swirling motion within the right ventricle (RV) in the region of the pulmonary outflow tract. During left ventricular diastole a plume of blood entered the left ventricle (LV) from the left atrium. The ventricular flow patterns could also be correlated with measurements of left ventricular wall motion. The greatest velocities of the ventricular walls occurred in the transverse cardiac plane and were maximal during diastolic refilling. The cardiac wall motion in the longitudinal axis demonstrated a caudal-apical movement that may also contribute to diastolic refilling. CONCLUSION The successful measurements of blood and myocardial velocity during normal myocardial function may be extended to quantify pathological cardiac changes in animal models of human cardiac disease.
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Affiliation(s)
- Richard G Wise
- Department of Human Anatomy and Genetics, University of Oxford, Oxford, UK.
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Ivancevic MK, Zimine I, Foxall D, Lecoq G, Righetti A, Didier D, Vallée JP. Inflow effect in first-pass cardiac and renal MRI. J Magn Reson Imaging 2003; 18:372-6. [PMID: 12938136 DOI: 10.1002/jmri.10363] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To estimate the effect of the inflow effect on the arterial input function in vivo in cardiac and renal MR perfusion imaging using fast gradient echo (GRE) sequences and contrast media. MATERIALS AND METHODS The MR exam protocol was designed to acquire images at different phases of the cardiac cycle. The arterial input was thus influenced by various blood flow velocities. RESULTS It was found that the inflow effect was negligible in the left ventricle of the heart, while it was significantly higher in the aorta for the kidney perfusion measurement. This was principally due to the higher through-the-plane component of the blood flow velocity in the aorta than in the left ventricle. CONCLUSION The inflow effect can be neglected in the heart cavity, but should be taken into account in renal perfusion.
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Affiliation(s)
- Marko K Ivancevic
- Radiology Department, Geneva University Hospital, Geneva, Switzerland.
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Fyrenius A, Wigström L, Ebbers T, Karlsson M, Engvall J, Bolger AF. Three dimensional flow in the human left atrium. Heart 2001; 86:448-55. [PMID: 11559688 PMCID: PMC1729920 DOI: 10.1136/heart.86.4.448] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Abnormal flow patterns in the left atrium in atrial fibrillation or mitral stenosis are associated with an increased risk of thrombosis and systemic embolisation; the characteristics of normal atrial flow that avoid stasis have not been well defined. OBJECTIVES To present a three dimensional particle trace visualisation of normal left atrial flow in vivo, constructed from flow velocities in three dimensional space. METHODS Particle trace visualisation of time resolved three dimensional magnetic resonance imaging velocity measurements was used to provide a display of intracardiac flow without the limitations of angle sensitivity or restriction to imaging planes. Global flow patterns of the left atrium were studied in 11 healthy volunteers. RESULTS In all subjects vortical flow was observed in the atrium during systole and diastolic diastasis (mean (SD) duration of systolic vortex, 280 (77) ms; and of diastolic vortex, 256 (118) ms). The volume incorporated and recirculated within the vortices originated predominantly from the left pulmonary veins. Inflow from the right veins passed along the vortex periphery, constrained between the vortex and the atrial wall. CONCLUSIONS Global left atrial flow in the normal human heart comprises consistent patterns specific to the phase of the cardiac cycle. Separate paths of left and right pulmonary venous inflow and vortex formation may have beneficial effects in avoiding left atrial stasis in the normal subject in sinus rhythm.
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Affiliation(s)
- A Fyrenius
- Department of Medicine and Care, Clinical Physiology, Linköping University, Linköping, Sweden
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Bittoun J, Jolivet O, Herment A, Itti E, Durand E, Mousseaux E, Tasu JP. Multidimensional MR mapping of multiple components of velocity and acceleration by fourier phase encoding with a small number of encoding steps. Magn Reson Med 2000; 44:723-30. [PMID: 11064407 DOI: 10.1002/1522-2594(200011)44:5<723::aid-mrm10>3.0.co;2-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous studies have shown that the multi-step approach of velocity or acceleration encoding is highly efficient in terms of the signal-to-noise ratio per unit time. This work describes a multidimensional extension of this method for simultaneously measuring multiple components of velocity and acceleration with a few encoding steps. N flow dimensions were encoded with an ND-matrix, obtained by combining the various flow-encoding gradients. The small matrix obtained with as few as two encoding steps can be extended by zero-filling in all N dimensions and using ND-Fourier transformation to obtain the maximum of the resulting peak in the ND-matrix, which gives simultaneously all the components of velocity and/or acceleration. The processing time was shortened by using a method of phase computation that gives the same precision as Fourier transformation, but is much faster. A rotating disk was used to show that the velocity-to-noise ratio increases with the number of dimensions acquired, demonstrating the efficiency of multidimensional flow measurements. The feasibility of the method is illustrated by 3D maps of the myocardium velocity, and 2D measurement of velocity and acceleration in the ascending aorta-both obtained by multidimensional phase encoding in volunteers.
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Affiliation(s)
- J Bittoun
- Unité de Recherche en Résonance Magnétique Médicale, CNRS, Université Paris-Sud, Le Kremlin-Bicêtre, France.
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Wigström L, Ebbers T, Fyrenius A, Karlsson M, Engvall J, Wranne B, Bolger AF. Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI. Magn Reson Med 1999; 41:793-9. [PMID: 10332856 DOI: 10.1002/(sici)1522-2594(199904)41:4<793::aid-mrm19>3.0.co;2-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The flow patterns in the human heart are complex and difficult to visualize using conventional two-dimensional (2D) modalities, whether they depict a single velocity component (Doppler echocardiography) or all three components in a few slices (2D phase contrast MRI). To avoid these shortcomings, a temporally resolved 3D phase contrast technique was used to derive data describing the intracardiac velocity fields in normal volunteers. The MRI data were corrected for phase shifts caused by eddy currents and concomitant gradient fields, with improvement in the accuracy of subsequent flow visualizations. Pathlines describing the blood pathways through the heart were generated from the temporally resolved velocity data, starting from user-specified locations and time frames. Flow trajectories were displayed as 3D particle traces, with simultaneous demonstration of morphologic 2D slices. This type of visualization is intuitive and interactive and may extend our understanding of dynamic and previously unrecognized patterns of intracardiac flow.
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Affiliation(s)
- L Wigström
- Department of Clinical Physiology, Linköping University, Sweden.
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Buonocore MH, Bogren HG. Analysis of flow patterns using MRI. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1999; 15:99-103. [PMID: 10453408 DOI: 10.1023/a:1006205206534] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes new software programs for analysis and visualization of blood flow patterns derived from time-resolved 3D velocity data sets. Using the programs, data can be displayed in cross-sectional or 3D perspective view. Particle paths revealing the flow patterns are computed by forward and backward time integration of the velocity field. Vector arrowmaps are computed as short-duration paths starting from uniformly spaced points over the lumen volume. Background, divergence, and local boundary correction is done to improve the realism of the paths. The programs have been used to visualize flow patterns from non-gated and cardiac-gated 3D velocity enclosed data in over 35 subjects. Arrowmaps are preferred for revealing local regions of different blood flow characteristics within the vessel, while particle paths are preferred for revealing global organization of the flow. They are complementary display strategies. Advanced data handling and display features are essential for analyzing and visualizing large velocity encoded data sets.
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Affiliation(s)
- M H Buonocore
- Department of Radiology, University of California Davis Medical Center, Sacramento 95817, USA
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30
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Wigstr�m L, Ebbers T, Fyrenius A, Karlsson M, Engvall J, Wranne B, Bolger AF. Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI. Magn Reson Med 1999. [DOI: 10.1002/(sici)1522-2594(199904)41:4%3c793::aid-mrm19%3e3.0.co;2-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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31
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Abstract
A customized computer program (MRIView) is described for visualizing and quantifying complex blood flow patterns in major vessels, using nongated and cardiac-gated three-dimensional (3D) velocity data obtained with MR velocity-encoded phase pulse sequences. Streamlines, arrows, and particle paths (collectively referred to as "paths") can be computed interactively, using both forward and backward time integration of the velocity field. The program provides interactive cross-sectional and 3D perspective visualization of the paths, with quantification and statistical analysis of average speed, through-plane velocity, cross-sectional area, and flow. Normal flow patterns in the carotid artery, basilar artery tip, ascending aorta, coronary arteries, descending aorta, and renal arteries, as well as abnormal flow patterns in basilar tip aneurysms, have been investigated. The program revealed flow patterns in these regions with features that are well known from Doppler ultrasound and other features that have not been reported previously. The association between specific abnormal flow patterns and development of atherosclerosis suggests that particle paths can be used to assess risk of plaque formation and progression, as well as to evaluate flow dynamics and vascular patency before and after vascular interventions.
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Affiliation(s)
- M H Buonocore
- Department of Radiology, UC Davis Medical Center, Sacramento 95817, USA
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Abstract
Several magnetic resonance imaging methods for measuring blood flow have greatly enhanced the capability of magnetic resonance imaging as a physiologic tool in cardiology. This article concentrates on phase-related techniques. Magnetic resonance velocity mapping is a flexible, robust, and accurate method of obtaining functional information in the cardiovascular system. It has the potential to contribute significantly to clinical decision making, and it should be a routine part of cardiovascular imaging whenever information on flow is required.
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Affiliation(s)
- R H Mohiaddin
- Magnetic Resonance Unit, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, National Heart and Lung Institute, London, United Kingdom
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Mohiaddin RH, Gatehouse PD, Henien M, Firmin DN. Cine MR Fourier velocimetry of blood flow through cardiac valves: comparison with Doppler echocardiography. J Magn Reson Imaging 1997; 7:657-63. [PMID: 9243384 DOI: 10.1002/jmri.1880070408] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Noninvasive measurement of blood flow velocity through the cardiac valves has important clinical applications. A wide variety of MR methods are available for flow measurement. The aim of this study was to investigate the ability of cine MR Fourier velocimetry to measure flow through healthy cardiac valves and to compare MR and Doppler peak velocity measurements. Ten healthy volunteers (age mean +/- SD, 24 +/- 4 years) without history of valvular disease were studied. Four of the subjects were females. In each subject, aortic, pulmonary, mitral, and tricuspid valves were evaluated with MR and Doppler imaging. A whole-body mobile MR machine was used, operating at .5-T with actively shielded magnetic field gradient coils on all three axes capable of 20 mT/m at a slew rate of 60 mT/ m/msec. The heart rate during MR and Doppler studies was not significantly different. The mean difference between the two studies was 2 beats/min, with a 95% confidence interval of -22 beats/min, +25 beats/ min. Peak systolic flow velocity in the aortic and pulmonary valves and peak diastolic flow velocity in the mitral and tricuspid valves measured with MRI and Doppler echocardiography correlated well. The mean difference between the two measurements (MR-Doppler) was 63 mm/sec, with a 95% confidence interval of -180 mm/sec, +310 mm/sec. The agreement between two observers interpreting the same MR velocity maps was close. The mean difference between their two measurements was 23 mm/sec, with a 95% confidence interval of -20 mm/sec, +60 mm/sec. There was no significant difference between MR and Doppler imaging or between the two MR observers. MR Fourier velocimetry has the necessary ease, reliability, and speed to measure blood flow through the cardiac valves, although measurement of late diastolic flow in the atrioventricular valves is limited. Measurement of peak blood velocity through the cardiac valves by this method showed satisfactory agreement with Doppler, but its clinical application for assessing diseased cardiac valves must be established.
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Affiliation(s)
- R H Mohiaddin
- Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom.
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