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Nguyen LA, Gencer U, Goudot G, Craiem D, Casciaro ME, Cheng C, Messas E, Mousseaux E, Soulat G. Flow quantification within the aortic ejection tract using 4D flow cardiac MRI in patients with bicuspid aortic valve: Implications for the assessment of aortic regurgitation. Diagn Interv Imaging 2024:S2211-5684(24)00194-3. [PMID: 39271367 DOI: 10.1016/j.diii.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/05/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the performance of four-dimensional (4D) flow cardiac MRI in quantifying aortic flow in patients with bicuspid aortic valve (BAV). MATERIALS AND METHODS Patients with BAV who underwent transthoracic echocardiography (TTE) and 4D flow cardiac MRI were prospectively included. Aortic flow was quantified using two-dimensional phase contrast velocimetry at the sinotubular junction and in the ascending aorta and using 4D flow in the regurgitant jet, in the left ventricular outflow tract, at the aortic annulus, the sinotubular junction, and the ascending aorta, with or without anatomical tracking. Flow quantification was compared with ventricular volumes, pulmonary flow using Pearson correlation test, bias and limits of agreement (LOA) using Bland Altman method, and with multiparametric transthoracic echocardiography quantification using weighted kappa test. RESULTS Eighty-eight patients (63 men, 25 women) with a mean age of 50.5 ± 14.8 (standard deviation) years (age range: 20.8-78.3) were included. Changes in flow with or without tracking were modest (< 5 mL). The best correlation was obtained at the aortic annulus for forward volume (r = 0.84; LOA [-28.4; 25.3] mL) and at the regurgitant jet and sinotubular junction for regurgitant volume (r = 0.68; LOA [-27.8; 33.8] and r = 0.69; LOA [-28.6; 24.2] mL). A combined approach for regurgitant fraction and net volume calculations using forward volume measured at ANN and regurgitant volume at sinotubular junction performed better than each level taken separately (r = 0.90; LOA [-20.7; 10.0] mL and r = 0.48, LOA [-33.8; 33.4] %). The agreement between transthoracic echocardiography and 4D flow cardiac MRI for aortic regurgitation grading was poor (kappa, 0.13 to 0.42). CONCLUSION In patients with BAV, aortic flow quantification by 4D flow cardiac MRI is the most accurate at the annulus for the forward volume, and at the sinotubular junction or directly in the jet for the regurgitant volume.
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Affiliation(s)
- Lan-Anh Nguyen
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Umit Gencer
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Guillaume Goudot
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, CP 1078 Buenos Aires, Argentina
| | - Mariano E Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, CP 1078 Buenos Aires, Argentina
| | - Charles Cheng
- Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Emmanuel Messas
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Elie Mousseaux
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Gilles Soulat
- Université Paris Cité, INSERM, PARCC, Paris 75015, France; Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
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Sundström E, Laudato M. Machine Learning-Based Segmentation of the Thoracic Aorta with Congenital Valve Disease Using MRI. Bioengineering (Basel) 2023; 10:1216. [PMID: 37892946 PMCID: PMC10604748 DOI: 10.3390/bioengineering10101216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Subjects with bicuspid aortic valves (BAV) are at risk of developing valve dysfunction and need regular clinical imaging surveillance. Management of BAV involves manual and time-consuming segmentation of the aorta for assessing left ventricular function, jet velocity, gradient, shear stress, and valve area with aortic valve stenosis. This paper aims to employ machine learning-based (ML) segmentation as a potential for improved BAV assessment and reducing manual bias. The focus is on quantifying the relationship between valve morphology and vortical structures, and analyzing how valve morphology influences the aorta's susceptibility to shear stress that may lead to valve incompetence. The ML-based segmentation that is employed is trained on whole-body Computed Tomography (CT). Magnetic Resonance Imaging (MRI) is acquired from six subjects, three with tricuspid aortic valves (TAV) and three functionally BAV, with right-left leaflet fusion. These are used for segmentation of the cardiovascular system and delineation of four-dimensional phase-contrast magnetic resonance imaging (4D-PCMRI) for quantification of vortical structures and wall shear stress. The ML-based segmentation model exhibits a high Dice score (0.86) for the heart organ, indicating a robust segmentation. However, the Dice score for the thoracic aorta is comparatively poor (0.72). It is found that wall shear stress is predominantly symmetric in TAVs. BAVs exhibit highly asymmetric wall shear stress, with the region opposite the fused coronary leaflets experiencing elevated tangential wall shear stress. This is due to the higher tangential velocity explained by helical flow, proximally of the sinutubal junction of the ascending aorta. ML-based segmentation not only reduces the runtime of assessing the hemodynamic effectiveness, but also identifies the significance of the tangential wall shear stress in addition to the axial wall shear stress that may lead to the progression of valve incompetence in BAVs, which could guide potential adjustments in surgical interventions.
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Affiliation(s)
- Elias Sundström
- Department of Engineering Mechanics, FLOW Research Center, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
| | - Marco Laudato
- Department of Engineering Mechanics, FLOW Research Center, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
- Department of Engineering Mechanics, The Marcus Wallenberg Laboratory for Sound and Vibration Research, KTH Royal Institute of Technology, Teknikringen 8, 10044 Stockholm, Sweden
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Jonnagiri R, Sundström E, Gutmark E, Anderson S, Pednekar AS, Taylor MD, Tretter JT, Gutmark-Little I. Influence of aortic valve morphology on vortical structures and wall shear stress. Med Biol Eng Comput 2023; 61:1489-1506. [PMID: 36763231 DOI: 10.1007/s11517-023-02790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Abstract
The aim of this paper is to assess the association between valve morphology and vortical structures quantitatively and to highlight the influence of valve morphology/orientation on aorta's susceptibility to shear stress, both proximal and distal. Four-dimensional phase-contrast magnetic resonance imaging (4D PCMRI) data of 6 subjects, 3 with tricuspid aortic valve (TAV) and 3 with functionally bicuspid aortic values (BAV) with right-left coronary leaflet fusion, were processed and analyzed for vorticity and wall shear stress trends. Computational fluid dynamics (CFD) has been used with moving TAV and BAV valve designs in patient-specific aortae to compare with in vivo shear stress data. Vorticity from 4D PCMRI data about the aortic centerline demonstrated that TAVs had a higher number of vortical flow structures than BAVs at peak systole. Coalescing of flow structures was shown to be possible in the arch region of all subjects. Wall shear stress (WSS) distribution from CFD results at the aortic root is predominantly symmetric for TAVs but highly asymmetric for BAVs with the region opposite the raphe (fusion location of underdeveloped leaflets) being subjected to higher WSS. Asymmetry in the size and number of leaflets in BAVs and TAVs significantly influence vortical structures and WSS in the proximal aorta for all valve types and distal aorta for certain valve orientations of BAV. Analysis of vortical structures using 4D PCMRI data (on the left side) and wall shear stress data using CFD (on the right side).
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Affiliation(s)
- Raghuvir Jonnagiri
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | - Elias Sundström
- Department of Engineering Mechanics, Royal Institute of Technology, 10044, Stockholm, Sweden
| | - Ephraim Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Shae Anderson
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Amol S Pednekar
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Michael D Taylor
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Justin T Tretter
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Iris Gutmark-Little
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45267, USA.,Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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Federspiel JM, Lux C, Burkhard K, Kettner M, Verhoff MA, Tschernig T, Ramsthaler F. Retrograde dye perfusion of the proximal aorta - A postmortem technical study. Heliyon 2022; 8:e12475. [PMID: 36636207 PMCID: PMC9830167 DOI: 10.1016/j.heliyon.2022.e12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 10/24/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Multiple cardiovascular conditions can lead to unexpected fatality, which is defined as sudden cardiac death. One of these potentially underlying conditions is aortic regurgitation, which can be caused by discrete changes of the geometry of the proximal aorta. To analyze aortic valve competency and furthermore to elucidate underlying pathological alterations of the coronary arteries and the vasa vasorum a perfusion method to simulate a diastolic state was designed. Material and methods A postmortem approach with retrograde perfusion of the ascending aorta with methylene blue was applied to three bodies. The procedure comprised cannulation of the brachiocephalic trunk, clamping of the aortic arch between brachiocephalic trunk and left carotid artery, infusion of 250 ml of methylene blue, and optical clearing of the superficial tissue layers after perfusion. Organs were examined directly following perfusion and after optical clearing. Results Assessment and visualization of aortic valve competency and the vasa vasorum were possible in all three instances. Visualization of the coronary perfusion was impaired by postmortem thrombus formation. Optical clearing did not provide additional information. Discussion The method presented here is a time- and cost-efficient way of visualizing aortic valve competency and the vasa vasorum. The visualization of the vasa vasorum highlights the potential of this method in basic research on diseases of the great arteries and coronaries. However, for a time-efficient functional analysis of the coronaries, other methods must be applied.
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Affiliation(s)
- Jan M. Federspiel
- Institute for Legal Medicine, Saarland University, Campus Homburg, Kirrberger Straße, Building 49.1, 66421, Homburg/Saar, Germany,Corresponding author.
| | - Constantin Lux
- Institute for Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt, Germany
| | - Katrin Burkhard
- Institute for Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt, Germany
| | - Mattias Kettner
- Institute for Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt, Germany
| | - Marcel A. Verhoff
- Institute for Legal Medicine, University Hospital Frankfurt, Goethe University, Kennedyallee 104, 60596 Frankfurt, Germany
| | - Thomas Tschernig
- Institute for Anatomy, Saarland University, Medical Campus, Kirrberger Straße, Building 61, Homburg/Saar, Germany
| | - Frank Ramsthaler
- Institute for Legal Medicine, Saarland University, Campus Homburg, Kirrberger Straße, Building 49.1, 66421, Homburg/Saar, Germany
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Gao SA, Polte CL, Lagerstrand KM, Bech-Hanssen O. The usefulness of left ventricular volume and aortic diastolic flow reversal for grading chronic aortic regurgitation severity - Using cardiovascular magnetic resonance as reference. Int J Cardiol 2021; 340:59-65. [PMID: 34474096 DOI: 10.1016/j.ijcard.2021.08.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Echocardiographic evaluation of chronic aortic regurgitation (AR) severity can lead to diagnostic ambiguity due to few feasible parameters or incongruent findings. The aim of the present study was to improve the diagnostic usefulness of left ventricular (LV) enlargement and aortic end-diastolic flow velocity (EDFV) using cardiovascular magnetic resonance (CMR) as reference. Patients (n = 120) were recruited either prospectively (n = 45) or retrospectively (n = 75). Severe AR (CMR regurgitant fraction > 33%) was present in 51% and 93% of the patients had LV ejection fraction ≥ 50%. EDFV and LV end-diastolic volume index (EDVI) were assessed by echocardiography using the traditional (excluding trabeculae) and recommended approach (including trabeculae). The patients were randomised to a derivation (n = 60) or a test group (n = 60). EDVI (traditional/recommended) to rule in (>99/118 ml/m2) and rule out severe AR (≤75/87 ml/m2) were identified using ROC analyses in the derivation group. The corresponding thresholds for EDFV were >17 cm/s and ≤10 cm/s. In the test group, the positive/negative likelihood ratios to rule in/rule out severe AR using EDVI were 10.0/0.14 (traditional), 6.2/0.11 (recommended), and using EDFV were 10.2/0.08. To rule in and rule out severe AR using derived cut-off values instead of >2 SD reduced the false positives by 92%, whereas using EDFV ≤10 cm/s instead of ≤20 cm/s reduced the false negatives by 94%. In conclusion, EDVI and EDFV as quantitative parameters are useful to rule in or rule out severe chronic AR. Importantly, other causes of LV enlargement have to be considered.
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Affiliation(s)
- Sinsia A Gao
- Department of Clinical Physiology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Christian L Polte
- Department of Clinical Physiology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Lagerstrand KM, Truedsson F, Gao SA, Johansson A, Bech-Hanssen O, Polte CL, Johnsson ÅA. Importance of through-plane heart motion correction for the assessment of aortic regurgitation severity using phase contrast magnetic resonance imaging. Magn Reson Imaging 2021; 84:69-75. [PMID: 34560232 DOI: 10.1016/j.mri.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To elucidate the influence of through-plane heart motion on the assessment of aortic regurgitation (AR) severity using phase contrast magnetic resonance imaging (PC-MRI). APPROACH A patient cohort with chronic AR (n = 34) was examined with PC-MRI. The regurgitant volume (RVol) and fraction (RFrac) were extracted from the PC-MRI data before and after through-plane heart motion correction and was then used for assessment of AR severity. RESULTS The flow volume errors were strongly correlated to aortic diameter (R = 0.80, p < 0.001) with median (IQR 25%;75%): 16 (14; 17) ml for diameter>40mm, compared with 9 (7; 10) ml for normal aortic size (p < 0.001). RVol and RFrac were underestimated (uncorrected:64 ± 37 ml and 39 ± 17%; corrected:76 ± 37 ml and 44 ± 15%; p < 0.001) and ~ 20% of the patients received lower severity grade without correction. CONCLUSION Through-plane heart motion introduces relevant flow volume errors, especially in patients with aortic dilatation that may result in underestimation of the severity grade in patients with chronic AR.
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Affiliation(s)
- Kerstin M Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Frida Truedsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sinsia A Gao
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alexander Johansson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian L Polte
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Truedsson F, Polte CL, Gao SA, Johnsson ÅA, Bech-Hanssen O, Lagerstrand KM. Importance of complex blood flow in the assessment of aortic regurgitation severity using phase contrast magnetic resonance imaging. Int J Cardiovasc Imaging 2021; 37:3561-3572. [PMID: 34273066 PMCID: PMC8604828 DOI: 10.1007/s10554-021-02341-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate if and how complex flow influences the assessment of aortic regurgitation (AR) using phase contrast MRI in patients with chronic AR. Patients with moderate (n = 15) and severe (n = 28) chronic AR were categorized into non-complex flow (NCF) or complex flow (CF) based on the presence of systolic backward flow volume. Phase contrast MRI was performed repeatedly at the level of the sinotubular junction (Ao1) and 1 cm distal to the sinotubular junction (Ao2). All AR patients were assessed to have non-severe AR or severe AR (cut-off values: regurgitation volume (RVol) ≥ 60 ml and regurgitation fraction (RF) ≥ 50%) in both measurement positions. The repeatability was significantly lower, i.e. variation was larger, for patients with CF than for NCF (≥ 12 ± 12% versus ≥ 6 ± 4%, P ≤ 0.03). For patients with CF, the repeatability was significantly lower at Ao2 compared to Ao1 (≥ 21 ± 20% versus ≥ 12 ± 12%, P ≤ 0.02), as well as the assessment of regurgitation (RVol: 42 ± 34 ml versus 54 ± 42 ml, P < 0.001; RF: 30 ± 18% versus 34 ± 16%, P = 0.01). This was not the case for patients with NCF. The frequency of patients that changed in AR grade from severe to non-severe when the position of the measurement changed from Ao1 to Ao2 was higher for patients with CF compared to NCF (RVol: 5/26 (19%) versus 1/17 (6%), P = 0.2; RF: 4/26 (15%) versus 0/17 (0%), P = 0.09). Our study shows that complex flow influences the quantification of chronic AR, which can lead to underestimation of AR severity when using PC-MRI.
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Affiliation(s)
- Frida Truedsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden. .,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden. .,Sahlgrenska University Hospital, MR-Centre, Bruna stråket 13, 413 45, Gothenburg, Sweden.
| | - Christian L Polte
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Sinsia A Gao
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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Assessment of hemodynamic responses to exercise in aortic coarctation using MRI-ergometry in combination with computational fluid dynamics. Sci Rep 2020; 10:18894. [PMID: 33144605 PMCID: PMC7609559 DOI: 10.1038/s41598-020-75689-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
In patients with aortic coarctation it would be desirable to assess pressure gradients as well as information about blood flow profiles at rest and during exercise. We aimed to assess the hemodynamic responses to physical exercise by combining MRI-ergometry with computational fluid dynamics (CFD). MRI was performed on 20 patients with aortic coarctation (13 men, 7 women, mean age 21.5 ± 13.7 years) at rest and during ergometry. Peak systolic pressure gradients, wall shear stress (WSS), secondary flow degree (SFD) and normalized flow displacement (NFD) were calculated using CFD. Stroke volume was determined based on MRI. On average, the pressure gradient was 18.0 ± 16.6 mmHg at rest and increased to 28.5 ± 22.6 mmHg (p < 0.001) during exercise. A significant increase in cardiac index was observed (p < 0.001), which was mainly driven by an increase in heart rate (p < 0.001). WSS significantly increased during exercise (p = 0.006), whereas SFD and NFD remained unchanged. The combination of MRI-ergometry with CFD allows assessing pressure gradients as well as flow profiles during physical exercise. This concept has the potential to serve as an alternative to cardiac catheterization with pharmacological stress testing and provides hemodynamic information valuable for studying the pathophysiology of aortic coarctation.
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Reiber JHC, Pereira GTR, Bezerra HG, De Sutter J, Schoenhagen P, Stillman AE, Van de Veire NRL. Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2019; 35:1175-1188. [DOI: 10.1007/s10554-019-01579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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