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Assadi H, Uthayachandran B, Li R, Wardley J, Nyi TH, Grafton-Clarke C, Swift AJ, Solana AB, Aben JP, Thampi K, Hewson D, Sawh C, Greenwood R, Hughes M, Kasmai B, Zhong L, Flather M, Vassiliou VS, Garg P. Kat-ARC accelerated 4D flow CMR: clinical validation for transvalvular flow and peak velocity assessment. Eur Radiol Exp 2022; 6:46. [PMID: 36131185 PMCID: PMC9492816 DOI: 10.1186/s41747-022-00299-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/24/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow. METHODS This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived. Thirty-five patients who had a clinical CMR scan were included. CMR protocol included cine and 4D flow using Kat-ARC acceleration factor 6. No respiratory navigation was applied. For validation, the agreement between mitral net flow (MNF) and the aortic net flow (ANF) was investigated. Additionally, we checked the agreement between peak aortic valve velocity derived by 4D flow and that derived by continuous-wave Doppler echocardiography in 20 patients. RESULTS The median age of our patient population was 63 years (interquartile range [IQR] 54-73), and 18/35 (51%) were male. Seventeen (49%) patients had mitral regurgitation, and seven (20%) patients had aortic regurgitation. Mean acquisition time was 8 ± 4 min. MNF and ANF were comparable: 60 mL (51-78) versus 63 mL (57-77), p = 0.310). There was an association between MNF and ANF (rho = 0.58, p < 0.001). Peak aortic valve velocity by Doppler and 4D flow were comparable (1.40 m/s, [1.30-1.75] versus 1.46 m/s [1.25-2.11], p = 0.602) and also correlated with each other (rho = 0.77, p < 0.001). CONCLUSIONS Kat-ARC accelerated 4D flow CMR quantified transvalvular flow in accordance with the conservation of mass principle and is primed for clinical translation.
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Affiliation(s)
- Hosamadin Assadi
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Bhalraam Uthayachandran
- grid.8241.f0000 0004 0397 2876Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Rui Li
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - James Wardley
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Tha H. Nyi
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Ciaran Grafton-Clarke
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Andrew J. Swift
- grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | | | | | - Kurian Thampi
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - David Hewson
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Chris Sawh
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Richard Greenwood
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Marina Hughes
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Bahman Kasmai
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Liang Zhong
- grid.419385.20000 0004 0620 9905National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Marcus Flather
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Vassilios S. Vassiliou
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK
| | - Pankaj Garg
- grid.8273.e0000 0001 1092 7967University of East Anglia, Norwich Medical School, Norfolk, UK ,grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk, UK ,grid.31410.370000 0000 9422 8284Department of Infection, Immunity and Cardiovascular disease, University of Sheffield Medical School and Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Baiocchi M, Barsoum S, Khodaei S, de la Torre Hernandez JM, Valentino SE, Dunford EC, MacDonald MJ, Keshavarz-Motamed Z. Effects of Choice of Medical Imaging Modalities on a Non-invasive Diagnostic and Monitoring Computational Framework for Patients With Complex Valvular, Vascular, and Ventricular Diseases Who Undergo Transcatheter Aortic Valve Replacement. Front Bioeng Biotechnol 2021; 9:643453. [PMID: 34307316 PMCID: PMC8297508 DOI: 10.3389/fbioe.2021.643453] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Due to the high individual differences in the anatomy and pathophysiology of patients, planning individualized treatment requires patient-specific diagnosis. Indeed, hemodynamic quantification can be immensely valuable for accurate diagnosis, however, we still lack precise diagnostic methods for numerous cardiovascular diseases including complex (and mixed) valvular, vascular, and ventricular interactions (C3VI) which is a complicated situation made even more challenging in the face of other cardiovascular pathologies. Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. In a recent paper, we developed a non-invasive and Doppler-based diagnostic and monitoring computational mechanics framework for C3VI, called C3VI-DE that uses input parameters measured reliably using Doppler echocardiography. In the present work, we have developed another computational-mechanics framework for C3VI (called C3VI-CT). C3VI-CT uses the same lumped-parameter model core as C3VI-DE but its input parameters are measured using computed tomography and a sphygmomanometer. Both frameworks can quantify: (1) global hemodynamics (metrics of cardiac function); (2) local hemodynamics (metrics of circulatory function). We compared accuracy of the results obtained using C3VI-DE and C3VI-CT against catheterization data (gold standard) using a C3VI dataset (N = 49) for patients with C3VI who undergo TAVR in both pre and post-TAVR with a high variability. Because of the dataset variability and the broad range of diseases that it covers, it enables determining which framework can yield the most accurate results. In contrast with C3VI-CT, C3VI-DE tracks both the cardiac and vascular status and is in great agreement with cardiac catheter data.
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Affiliation(s)
- Melissa Baiocchi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Shirley Barsoum
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | | | | | - Emily C Dunford
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | | | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.,School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/12/2023] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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