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Ma Z, Zhou Y, Li P, He W, Li M. Clinical application of four-dimensional flow cardiovascular magnetic resonance in Marfan syndrome: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102177. [PMID: 37913934 DOI: 10.1016/j.cpcardiol.2023.102177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
This study aims to fill this gap by assessing the application of 4D flow CMR in MFS through a systematic review and meta-analysis. We conducted a comprehensive search of databases from their inception to May 1, 2023. Eligibility criteria were established based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of studies was assessed using the Newcastle-Ottawa Scale (NOS), with studies scoring above five deemed high quality. Meta-analyses were performed using Stata 15.1 software. Nine studies were analyzed. Findings indicate MFS patients had increased vortex flow in the descending aorta (DAo), larger aortic root diameter (ARD) and Z-scores, lower inner wall shear stress (WSS) in the proximal descending aorta (pDAo), reduced in-plane rotational flow (IRF) in the aortic arch and proximal descending aorta (pDAo), and increased pulse wave velocity (PWV) in the ascending aorta (AAo) and DAo compared to healthy subjects. No significant difference in systolic flow reversal ratio was observed. Sensitivity analysis showed no heterogeneity and Egger's test revealed no publication bias. This meta-analysis underscores the effectiveness of 4D flow CMR in detecting MFS, particularly through indicators such as vortex flow, WSS, IRF, ARD, and PWV. The findings provide insights into diagnosing cardiovascular diseases and predicting cardiovascular events in MFS patients. Further case-control studies are needed to establish measurement standards and explore potential indicators for improved diagnosis and treatment of MFS.
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Affiliation(s)
- Zixuan Ma
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Yuanxin Zhou
- Second Clinical College, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Pengpu Li
- College of Pharmacy, GuangZhou Medical University, Guangzhou, Guangdong, 510182, China
| | - Wenkai He
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
| | - Mingyan Li
- Department of Cardiology, Guangzhou Institute of Cardiovascular Disease, Guangdong Key Laboratory of Vascular Diseases, The Second Affiliated Hospital, Guangzhou Medical University, No. 63 South Asian Games Road, Panyu District, Guangzhou, Guangdong, 510260, China.
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van Andel MM, van Ooij P, de Waard V, Gottwald LM, van Kimmenade RR, Scholte AJ, Dickinson MG, Zwinderman AH, Mulder BJ, Nederveen AJ, Groenink M. Abnormal aortic hemodynamics are associated with risk factors for aortic complications in patients with marfan syndrome. IJC HEART & VASCULATURE 2022; 43:101128. [PMID: 36268203 PMCID: PMC9576530 DOI: 10.1016/j.ijcha.2022.101128] [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: 06/19/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
Background It is difficult to assess the risk for aortic dissection beyond the aortic root in patients with Marfan syndrome (MFS). To aid risk assessment in these patients, we investigated aortic flow and wall shear stress (WSS) by 4D flow magnetic resonance imaging (MRI) in patients with MFS and compared the results with healthy volunteers. We hypothesized that MFS patients with a high-risk profile for aortic dissection would show abnormal hemodynamics in aortic regions associated with aortic dissection. Methods MFS patients (n = 55) and healthy subjects (n = 25), matched for age and sex, prospectively underwent 4D flow MRI. 4D flow maps were constructed to detect elevated (defined as higher than the three-dimensional 95 % confidence interval) and deviant directed (defined as vector angle differences higher than 120°) WSS in MFS patients as compared to the controls. Univariate and multivariate associations with risk factors for aortic dissection in MFS patients were assessed. Results The maximum incidence for elevated WSS was 20 % (CI 9 %-31 %) and found in the ascending aorta. The maximum for deviant directed WSS was 39 % (CI 26 %-52 %) and found in the inner descending aorta. Significantly more male patients had deviant directed WSS in the inner proximal descending aorta (63 % vs 24 %, p = 0.014). Multivariate analysis showed that deviant directed WSS was associated with male sex (p = 0.019), and a haplo-insufficient FBN1 mutation type (p = 0.040). In 60 % of MFS patients with a previous aortic root replacement surgery, abnormal hemodynamics were found in the ascending aorta. No significant differences between hemodynamics were found in the descending aorta between operated and non-operated patients. Conclusion Deviant directed WSS in the proximal descending aorta is associated with known risk factors for aortic dissection in MFS patients, namely male sex and a haploinsufficient FBN1 mutation type.
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Affiliation(s)
- Mitzi M. van Andel
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pim van Ooij
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lukas M. Gottwald
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Arthur J. Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Michael G. Dickinson
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Aeilko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Barbara J.M. Mulder
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Maarten Groenink
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands,Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands,Corresponding author at: Amsterdam UMC, University of Amsterdam, Department of Cardiology and Radiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Shit S, Zimmermann J, Ezhov I, Paetzold JC, Sanches AF, Pirkl C, Menze BH. SRflow: Deep learning based super-resolution of 4D-flow MRI data. Front Artif Intell 2022; 5:928181. [PMID: 36034591 PMCID: PMC9411720 DOI: 10.3389/frai.2022.928181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Exploiting 4D-flow magnetic resonance imaging (MRI) data to quantify hemodynamics requires an adequate spatio-temporal vector field resolution at a low noise level. To address this challenge, we provide a learned solution to super-resolve in vivo 4D-flow MRI data at a post-processing level. We propose a deep convolutional neural network (CNN) that learns the inter-scale relationship of the velocity vector map and leverages an efficient residual learning scheme to make it computationally feasible. A novel, direction-sensitive, and robust loss function is crucial to learning vector-field data. We present a detailed comparative study between the proposed super-resolution and the conventional cubic B-spline based vector-field super-resolution. Our method improves the peak-velocity to noise ratio of the flow field by 10 and 30% for in vivo cardiovascular and cerebrovascular data, respectively, for 4 × super-resolution over the state-of-the-art cubic B-spline. Significantly, our method offers 10x faster inference over the cubic B-spline. The proposed approach for super-resolution of 4D-flow data would potentially improve the subsequent calculation of hemodynamic quantities.
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Affiliation(s)
- Suprosanna Shit
- Department of Informatics, Technical University of Munich, Munich, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- *Correspondence: Suprosanna Shit
| | - Judith Zimmermann
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Germany
| | | | - Augusto F. Sanches
- Institute of Neuroradiology, University Hospital LMU Munich, Munich, Germany
| | - Carolin Pirkl
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Bjoern H. Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
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Stengl R, Ágg B, Pólos M, Mátyás G, Szabó G, Merkely B, Radovits T, Szabolcs Z, Benke K. Potential predictors of severe cardiovascular involvement in Marfan syndrome: the emphasized role of genotype-phenotype correlations in improving risk stratification-a literature review. Orphanet J Rare Dis 2021; 16:245. [PMID: 34059089 PMCID: PMC8165977 DOI: 10.1186/s13023-021-01882-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Marfan syndrome (MFS) is a genetically determined systemic connective tissue disorder, caused by a mutation in the FBN1 gene. In MFS mainly the cardiovascular, musculoskeletal and ocular systems are affected. The most dangerous manifestation of MFS is aortic dissection, which needs to be prevented by a prophylactic aortic root replacement. MAIN BODY The indication criteria for the prophylactic procedure is currently based on aortic diameter, however aortic dissections below the threshold defined in the guidelines have been reported, highlighting the need for a more accurate risk stratification system to predict the occurrence of aortic complications. The aim of this review is to present the current knowledge on the possible predictors of severe cardiovascular manifestations in MFS patients, demonstrating the wide range of molecular and radiological differences between people with MFS and healthy individuals, and more importantly between MFS patients with and without advanced aortic manifestations. These differences originating from the underlying common molecular pathological processes can be assessed by laboratory (e.g. genetic testing) and imaging techniques to serve as biomarkers of severe aortic involvement. In this review we paid special attention to the rapidly expanding field of genotype-phenotype correlations for aortic features as by collecting and presenting the ever growing number of correlations, future perspectives for risk stratification can be outlined. CONCLUSIONS Data on promising biomarkers of severe aortic complications of MFS have been accumulating steadily. However, more unifying studies are required to further evaluate the applicability of the discussed predictors with the aim of improving the risk stratification and therefore the life expectancy and quality of life of MFS patients.
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Affiliation(s)
- Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary.
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gábor Mátyás
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People With Rare Diseases, Wagistrasse 25, 8952, CH-Schlieren-Zurich, Switzerland
| | - Gábor Szabó
- Department of Cardiac Surgery, University of Halle, Halle, Germany
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
- Department of Cardiac Surgery, University of Halle, Halle, Germany
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Catapano F, Pambianchi G, Cundari G, Rebelo J, Cilia F, Carbone I, Catalano C, Francone M, Galea N. 4D flow imaging of the thoracic aorta: is there an added clinical value? Cardiovasc Diagn Ther 2020; 10:1068-1089. [PMID: 32968661 DOI: 10.21037/cdt-20-452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Four-dimensional (4D) flow MRI has emerged as a powerful non-invasive technique in cardiovascular imaging, enabling to analyse in vivo complex flow dynamics models by quantifying flow parameters and derived features. Deep knowledge of aortic flow dynamics is fundamental to better understand how abnormal flow patterns may promote or worsen vascular diseases. In the perspective of an increasingly personalized and preventive medicine, growing interest is focused on identifying those quantitative functional features which are early predictive markers of pathological evolution. The thoracic aorta and its spectrum of diseases, as the first area of application and development of 4D flow MRI and supported by an extensive experimental validation, represents the ideal model to introduce this technique into daily clinical practice. The purpose of this review is to describe the impact of 4D flow MRI in the assessment of the thoracic aorta and its most common affecting diseases, providing an overview of the actual clinical applications and describing the potential role of derived advanced hemodynamic measures in tailoring follow-up and treatment.
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Affiliation(s)
- Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Francesco Cilia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.,Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Moon MR. Invited Commentary. Ann Thorac Surg 2019; 109:1440-1441. [PMID: 31843637 DOI: 10.1016/j.athoracsur.2019.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Marc R Moon
- Division of Cardiothoracic Surgery, Washington University in St Louis School of Medicine, 3108 Queeny Tower, 1 Barnes-Jewish Hospital Plaza, St Louis, MO 63110-1013.
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