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4D Flow Assessment of Vorticity in Right Ventricular Diastolic Dysfunction. Bioengineering (Basel) 2017; 4:bioengineering4020030. [PMID: 28952510 PMCID: PMC5590481 DOI: 10.3390/bioengineering4020030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
Diastolic dysfunction, a leading cause of heart failure in the US, is a complex pathology which manifests morphological and hemodynamic changes in the heart and circulatory system. Recent advances in time-resolved phase-contrast cardiac magnetic resonance imaging (4D Flow) have allowed for characterization of blood flow in the right ventricle (RV) and right atrium (RA), including calculation of vorticity and qualitative visual assessment of coherent flow patterns. We hypothesize that right ventricular diastolic dysfunction (RVDD) is associated with changes in vorticity and right heart blood flow. This paper presents background on RVDD, and 4D Flow tools and techniques used for quantitative and qualitative analysis of cardiac flows in the normal and disease states. In this study, 20 patients with RVDD and 14 controls underwent cardiac 4D Flow and echocardiography. A method for determining the time-step for peak early diastole using 4D Flow data is described. Spatially integrated early diastolic vorticity was extracted from the RV, RA, and combined RV/RA regions of each subject using a range of vorticity thresholding and scaling methods. Statistically significant differences in vorticity were found in the RA and combined RA/RV in RVDD subjects compared to controls when vorticity vectors were both thresholded and scaled by cardiac index.
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Fenster BE, Browning J, Schroeder JD, Schafer M, Podgorski CA, Smyser J, Silveira LJ, Buckner JK, Hertzberg JR. Vorticity is a marker of right ventricular diastolic dysfunction. Am J Physiol Heart Circ Physiol 2015; 309:H1087-93. [PMID: 26254331 DOI: 10.1152/ajpheart.00278.2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/04/2015] [Indexed: 11/22/2022]
Abstract
Right ventricular diastolic dysfunction (RVDD) is an important prognostic indicator in pulmonary arterial hypertension (PAH). RV vortex rings have been observed in healthy subjects, but their significance in RVDD is unknown. Vorticity, the local spinning motion of an element of fluid, may be a sensitive measure of RV vortex dynamics. Using four-dimensional (4D) flow cardiac magnetic resonance imaging (CMR), we investigated the relationship between right heart vorticity with echocardiographic indexes of RVDD. Thirteen (13) PAH subjects and 10 controls underwent same-day 4D flow CMR and echocardiography. RV diastolic function was assessed using trans-tricuspid valve (TV) early (E) and late (A) velocities, E/A ratio, and e' and a' tissue Doppler velocities. RV and right atrial (RA) integrated mean vorticity was calculated for E and A-wave filling periods using 4D datasets. Compared with controls, A-wave vorticity was significantly increased in RVDD subjects in both the RV [2343 (1,559-3,295) vs. 492 (267-2,649) 1/s, P = 0.028] and RA [30 (27-44) vs. 9 (5-27) 1/s, P = 0.005]. RA E vorticity was significantly decreased [13 (7-22) vs. 28 (15-31) 1/s, P = 0.038] in RVDD. E-wave vorticity correlated TV e', E-,and TV E/A (P < 0.05), and A-wave vorticity associated with both TV A and E/A (P < 0.02). RVDD is associated with alterations in E- and A-wave vorticity, and vorticity correlates with multiple echocardiographic markers of RVDD. Vorticity may be a robust noninvasive research tool for the investigation of RV fluid and tissue mechanical interactions in PAH.
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Affiliation(s)
- Brett E Fenster
- Division of Cardiology, National Jewish Health, Denver, Colorado;
| | - James Browning
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado
| | - Joyce D Schroeder
- Division of Cardiology, National Jewish Health, Denver, Colorado; Department of Mechanical Engineering, University of Colorado, Boulder, Colorado; Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Michal Schafer
- Division of Cardiology, National Jewish Health, Denver, Colorado
| | | | - Jamie Smyser
- Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Lori J Silveira
- Division of Cardiology, National Jewish Health, Denver, Colorado; Department of Mechanical Engineering, University of Colorado, Boulder, Colorado; Division of Radiology, National Jewish Health, Denver, Colorado; and Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - J Kern Buckner
- Division of Cardiology, National Jewish Health, Denver, Colorado
| | - Jean R Hertzberg
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado
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Utsunomiya H, Nakatani S, Nishihira M, Kanzaki H, Kyotani S, Nakanishi N, Kihara Y, Kitakaze M. Value of Estimated Right Ventricular Filling Pressure in Predicting Cardiac Events in Chronic Pulmonary Arterial Hypertension. J Am Soc Echocardiogr 2009; 22:1368-74. [DOI: 10.1016/j.echo.2009.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Indexed: 11/28/2022]
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