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Gondal MUR, Mehmood RS, Khan RP, Malik J. Atrial myopathy. Curr Probl Cardiol 2024; 49:102381. [PMID: 38191102 DOI: 10.1016/j.cpcardiol.2024.102381] [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: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
This paper delves into the progressive concept of atrial myopathy, shedding light on its development and its impact on atrial characteristics. It extensively explores the intricate connections between atrial myopathy, atrial fibrillation (AF), and strokes. Researchers have sought additional contributors to AF-related strokes due to the absence of a clear timing correlation between paroxysmal AF episodes and strokes in patients with cardiac implantable electronic devices. Through various animal models and human investigations, a close interrelation among aging, inflammation, oxidative stress, and stretching mechanisms has been identified. These mechanisms contribute to fibrosis, alterations in electrical properties, autonomic remodeling, and a heightened pro-thrombotic state. These interconnected factors establish a detrimental cycle, exacerbating atrial myopathy and elevating the risk of sustained AF and strokes. By emphasizing the significance of atrial myopathy and the risk of strokes that are distinct from AF, the paper also discusses methods for identifying patients with atrial myopathy. Moreover, it proposes an approach to incorporate the concept of atrial myopathy into clinical practice to guide anticoagulation decisions in individuals with AF.
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Affiliation(s)
| | - Raja Sadam Mehmood
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
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Mohammed H, Chen HB, Li Y, Sabor N, Wang JG, Wang G. Meta-Analysis of Pulse Transition Features in Non-Invasive Blood Pressure Estimation Systems: Bridging Physiology and Engineering Perspectives. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:1257-1281. [PMID: 38015673 DOI: 10.1109/tbcas.2023.3334960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The pulse transition features (PTFs), including pulse arrival time (PAT) and pulse transition time (PTT), hold significant importance in estimating non-invasive blood pressure (NIBP). However, the literature showcases considerable variations in terms of PTFs' correlation with blood pressure (BP), accuracy in NIBP estimation, and the comprehension of the relationship between PTFs and BP. This inconsistency is exemplified by the wide-ranging correlations reported across studies investigating the same feature. Furthermore, investigations comparing PAT and PTT have yielded conflicting outcomes. Additionally, PTFs have been derived from various bio-signals, capturing distinct characteristic points like the pulse's foot and peak. To address these inconsistencies, this study meticulously reviews a selection of such research endeavors while aligning them with the biological intricacies of blood pressure and the human cardiovascular system (CVS). Each study underwent evaluation, considering the specific signal acquisition locale and the corresponding recording procedure. Moreover, a comprehensive meta-analysis was conducted, yielding multiple conclusions that could significantly enhance the design and accuracy of NIBP systems. Grounded in these dual aspects, the study systematically examines PTFs in correlation with the specific study conditions and the underlying factors influencing the CVS. This approach serves as a valuable resource for researchers aiming to optimize the design of BP recording experiments, bio-signal acquisition systems, and the fine-tuning of feature engineering methodologies, ultimately advancing PTF-based NIBP estimation.
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Mele D, Beccari R, Pedrizzetti G. Effect of Aging on Intraventricular Kinetic Energy and Energy Dissipation. J Cardiovasc Dev Dis 2023; 10:308. [PMID: 37504564 PMCID: PMC10380306 DOI: 10.3390/jcdd10070308] [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: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
In recent years, analysis of kinetic energy (KE) and the rate of kinetic energy dissipation (KED) or energy loss (EL) within the cardiac chambers, obtained by cardiac imaging techniques, has gained increasing attention. Thus, there is a need to clarify the effect of physiological variables, specifically aging, on these energetic measures. To elucidate this aspect, we reviewed the literature on this topic. Overall, cardiac magnetic resonance and echocardiographic studies published so far indicate that aging affects the energetics of left and right intraventricular blood flow, although not all energy measures during the cardiac cycle seem to be affected by age in the same way. Current studies, however, have limitations. Additional large, multicenter investigations are needed to test the effect of physiological variables on intraventricular KE and KED/EL measures.
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Affiliation(s)
- Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
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Roos PR, Rijnberg FM, Westenberg JJM, Lamb HJ. Particle Tracing Based on
4D
Flow Magnetic Resonance Imaging: A Systematic Review into Methods, Applications, and Current Developments. J Magn Reson Imaging 2022; 57:1320-1339. [PMID: 36484213 DOI: 10.1002/jmri.28540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Particle tracing based on 4D Flow MRI has been applied as a quantitative and qualitative postprocessing technique to study temporally evolving blood flow patterns. PURPOSE To systematically review the various methods to perform 4D Flow MRI-based particle tracing, as well as the clinical value, clinical applications, and current developments of the technique. STUDY TYPE The study type is systematic review. SUBJECTS Patients with cardiovascular disease (such as Marfan, Fontan, Tetralogy of Fallot), healthy controls, and cardiovascular phantoms that received 4D Flow MRI with particle tracing. FIELD STRENGTH/SEQUENCE Three-dimensional three-directional cine phase-contrast MRI, at 1.5 T and 3 T. ASSESSMENT Two systematic searches were performed on the PubMed database using Boolean operators and the relevant key terms covering 4D Flow MRI and particle tracing. One systematic search was focused on particle tracing methods, whereas the other on applications. Additional articles from other sources were sought out and included after a similar inspection. Particle tracing methods, clinical applications, clinical value, and current developments were extracted. STATISTICAL TESTS The main results of the included studies are summarized, without additional statistical analysis. RESULTS Of 127 unique articles retrieved from the initial search, 56 were included (28 for methods and 54 for applications). Most articles that described particle tracing methods used an adaptive timestep, a fourth order Runge-Kutta integration method, and linear interpolation in the time dimension. Particle tracing was applied in heart chambers, aorta, venae cavae, Fontan circulation, pulmonary arteries, abdominal vasculature, peripheral arteries, carotid arteries, and cerebral vasculature. Applications were grouped as intravascular, intracardiac, flow stasis, and research. DATA CONCLUSIONS Particle tracing based on 4D Flow MRI gives unique insight into blood flow in several cardiovascular diseases, but the quality depends heavily on the MRI data quality. Further studies are required to evaluate the clinical value of the technique for different cardiovascular diseases. EVIDENCE LEVEL 5. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Paul R. Roos
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
| | - Friso M. Rijnberg
- Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands
| | | | - Hildo J. Lamb
- Department of Radiology Leiden University Medical Center Leiden The Netherlands
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Ashkir Z, Myerson S, Neubauer S, Carlhäll CJ, Ebbers T, Raman B. Four-dimensional flow cardiac magnetic resonance assessment of left ventricular diastolic function. Front Cardiovasc Med 2022; 9:866131. [PMID: 35935619 PMCID: PMC9355735 DOI: 10.3389/fcvm.2022.866131] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Left ventricular diastolic dysfunction is a major cause of heart failure and carries a poor prognosis. Assessment of left ventricular diastolic function however remains challenging for both echocardiography and conventional phase contrast cardiac magnetic resonance. Amongst other limitations, both are restricted to measuring velocity in a single direction or plane, thereby compromising their ability to capture complex diastolic hemodynamics in health and disease. Time-resolved three-dimensional phase contrast cardiac magnetic resonance imaging with three-directional velocity encoding known as '4D flow CMR' is an emerging technology which allows retrospective measurement of velocity and by extension flow at any point in the acquired 3D data volume. With 4D flow CMR, complex aspects of blood flow and ventricular function can be studied throughout the cardiac cycle. 4D flow CMR can facilitate the visualization of functional blood flow components and flow vortices as well as the quantification of novel hemodynamic and functional parameters such as kinetic energy, relative pressure, energy loss and vorticity. In this review, we examine key concepts and novel markers of diastolic function obtained by flow pattern analysis using 4D flow CMR. We consolidate the existing evidence base to highlight the strengths and limitations of 4D flow CMR techniques in the surveillance and diagnosis of left ventricular diastolic dysfunction.
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Affiliation(s)
- Zakariye Ashkir
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Carl-Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Cunha PS, Laranjo S, Heijman J, Oliveira MM. The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates. Front Cardiovasc Med 2022; 9:879984. [PMID: 35859594 PMCID: PMC9289204 DOI: 10.3389/fcvm.2022.879984] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/03/2022] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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7
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Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [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: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Sekine T, Nakaza M, Matsumoto M, Ando T, Inoue T, Sakamoto SI, Maruyama M, Obara M, Leonowicz O, Usuda J, Kumita S. 4D Flow MR Imaging of the Left Atrium: What is Non-physiological Blood Flow in the Cardiac System? Magn Reson Med Sci 2022; 21:293-308. [PMID: 35185085 PMCID: PMC9680542 DOI: 10.2463/mrms.rev.2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/30/2024] Open
Abstract
Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masatoki Nakaza
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Mitsuo Matsumoto
- Department of Thoracic Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Nagayama Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Mitsunori Maruyama
- Department of Cardiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | | | | | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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Elsayed A, Mauger CA, Ferdian E, Gilbert K, Scadeng M, Occleshaw CJ, Lowe BS, McCulloch AD, Omens JH, Govil S, Pushparajah K, Young AA. Right Ventricular Flow Vorticity Relationships With Biventricular Shape in Adult Tetralogy of Fallot. Front Cardiovasc Med 2022; 8:806107. [PMID: 35127866 PMCID: PMC8813860 DOI: 10.3389/fcvm.2021.806107] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Remodeling in adults with repaired tetralogy of Fallot (rToF) may occur due to chronic pulmonary regurgitation, but may also be related to altered flow patterns, including vortices. We aimed to correlate and quantify relationships between vorticity and ventricular shape derived from atlas-based analysis of biventricular shape. Adult rToF (n = 12) patients underwent 4D flow and cine MRI imaging. Vorticity in the RV was computed after noise reduction using a neural network. A biventricular shape atlas built from 95 rToF patients was used to derive principal component modes, which were associated with vorticity and pulmonary regurgitant volume (PRV) using univariate and multivariate linear regression. Univariate analysis showed that indexed PRV correlated with 3 modes (r = −0.55,−0.50, and 0.6, all p < 0.05) associated with RV dilatation and an increase in basal bulging, apical bulging and tricuspid annulus tilting with more severe regurgitation, as well as a smaller LV and paradoxical movement of the septum. RV outflow and inflow vorticity were also correlated with these modes. However, total vorticity over the whole RV was correlated with two different modes (r = −0.62,−0.69, both p < 0.05). Higher vorticity was associated with both RV and LV shape changes including longer ventricular length, a larger bulge beside the tricuspid valve, and distinct tricuspid tilting. RV flow vorticity was associated with changes in biventricular geometry, distinct from associations with PRV. Flow vorticity may provide additional mechanistic information in rToF remodeling. Both LV and RV shapes are important in rToF RV flow patterns.
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Affiliation(s)
- Ayah Elsayed
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Charlène A. Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Miriam Scadeng
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - Boris S. Lowe
- Department of Cardiology, Auckland District Health Board, Auckland, New Zealand
| | - Andrew D. McCulloch
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Jeffrey H. Omens
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Sachin Govil
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Kuberan Pushparajah
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Alistair A. Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King's College London, London, United Kingdom
- *Correspondence: Alistair A. Young
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10
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Evaluation of intraventricular flow by multimodality imaging: a review and meta-analysis. Cardiovasc Ultrasound 2021; 19:38. [PMID: 34876127 PMCID: PMC8653587 DOI: 10.1186/s12947-021-00269-8] [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: 08/05/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this systematic review was to evaluate current inter-modality agreement of noninvasive clinical intraventricular flow (IVF) assessment with 3 emerging imaging modalities: echocardiographic particle image velocimetry (EPIV), vector flow mapping (VFM), and 4-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). Methods We performed a systematic literature review in the databases EMBASE, Medline OVID and Cochrane Central for identification of studies evaluating left ventricular (LV) flow patterns using one of these flow visualization modalities. Of the 2224 initially retrieved records, 10 EPIV, 23 VFM, and 25 4D flow CMR studies were included in the final analysis. Results Vortex parameters were more extensively studied with EPIV, while LV energetics and LV transport mechanics were mainly studied with 4D flow CMR, and LV energy loss and vortex circulation were implemented by VFM studies. Pooled normative values are provided for these parameters. The meta- analysis for the values of two vortex morphology parameters, vortex length and vortex depth, failed to reveal a significant change between heart failure patients and healthy controls. Conclusion Agreement between the different modalities studying intraventricular flow is low and different methods of measurement and reporting were used among studies. A multimodality framework with a standardized set of flow parameters is necessary for implementation of noninvasive flow visualization in daily clinical practice. The full potential of noninvasive flow visualization in addition to diagnostics could also include guiding medical or interventional treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00269-8.
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11
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Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg 2021; 11:4193-4210. [PMID: 34476199 DOI: 10.21037/qims-20-1234] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) four-dimensional (4D) flow is a type of phase-contrast (PC) MRI that uses blood flow encoded in 3 directions, which is resolved relative to 3 spatial and temporal dimensions of cardiac circulation. It can be used to simultaneously quantify and visualize hemodynamics or morphology disorders. 4D flow MRI is more comprehensive and accurate than two-dimensional (2D) PC MRI and echocardiography. 4D flow MRI provides numerous hemodynamic parameters that are not limited to the basic 2D parameters, including wall shear stress (WSS), pulse wave velocity (PWV), kinetic energy, turbulent kinetic energy (TKE), pressure gradient, and flow component analysis. 4D flow MRI is widely used to image many parts of the body, such as the neck, brain, and liver, and has a wide application spectrum to cardiac diseases and large vessels. This present review aims to summarize the hemodynamic parameters of 4D flow MRI technology and generalize their usefulness in clinical practice in relation to the cardiovascular system. In addition, we note the improvements that have been made to 4D flow MRI with the application of new technologies. The application of new technologies can improve the speed of 4D flow, which would benefit clinical applications.
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Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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12
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Demirkiran A, van Ooij P, Westenberg JJM, Hofman MBM, van Assen HC, Schoonmade LJ, Asim U, Blanken CPS, Nederveen AJ, van Rossum AC, Götte MJW. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications. Eur Heart J Cardiovasc Imaging 2021; 23:154-165. [PMID: 34143872 PMCID: PMC8787996 DOI: 10.1093/ehjci/jeab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Identification of flow patterns within the heart has long been recognized as a potential contribution to the understanding of physiological and pathophysiological processes of cardiovascular diseases. Although the pulsatile flow itself is multi-dimensional and multi-directional, current available non-invasive imaging modalities in clinical practice provide calculation of flow in only 1-direction and lack 3-dimensional volumetric velocity information. Four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) has emerged as a novel tool that enables comprehensive and critical assessment of flow through encoding velocity in all 3 directions in a volume of interest resolved over time. Following technical developments, 4D flow CMR is not only capable of visualization and quantification of conventional flow parameters such as mean/peak velocity and stroke volume but also provides new hemodynamic parameters such as kinetic energy. As a result, 4D flow CMR is being extensively exploited in clinical research aiming to improve understanding of the impact of cardiovascular disease on flow and vice versa. Of note, the analysis of 4D flow data is still complex and accurate analysis tools that deliver comparable quantification of 4D flow values are a necessity for a more widespread adoption in clinic. In this article, the acquisition and analysis processes are summarized and clinical applications of 4D flow CMR on the heart including conventional and novel hemodynamic parameters are discussed. Finally, clinical potential of other emerging intra-cardiac 4D flow imaging modalities is explored and a near-future perspective on 4D flow CMR is provided.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Usman Asim
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Carmen P S Blanken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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13
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Sarashina-Motoi M, Iwano H, Motoi K, Ishizaka S, Chiba Y, Tsujinaga S, Murayama M, Nakabachi M, Yokoyama S, Nishino H, Okada K, Kaga S, Anzai T. Functional significance of intra-left ventricular vortices on energy efficiency in normal, dilated, and hypertrophied hearts. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:358-367. [PMID: 33098167 DOI: 10.1002/jcu.22938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the influence of changes in vortices within the left ventricle (LV) on energy efficiency (EE) in normal and diseased hearts. METHODS We performed vector flow mapping echocardiography in 36 normal participants (N), 36 patients with dilated cardiomyopathy (D), and 36 patients with LV hypertrophy (H). The circulation of the main anterior vortex was measured as a parameter of vortex strength. Energy loss (EL) was measured for one cardiac cycle, and EE was calculated as EL divided by stroke work (SW), which represents the loss of kinetic energy per unit of LV external work. RESULTS Circulation increased in the order of N, H, and D (N: 15 ± 4, D: 19 ± 8, H: 17 ± 6 × 10-3 m2 /s; analysis of variance [ANOVA] P < .01). Conversely, EE increased in the order of N, D, and H (N: 0.22 ± 0.07, D: 0.26 ± 0.16, H: 0.30 ± 0.16 10-5 J/mm Hg mL m s; ANOVA P = .04), suggesting worst EE in group H. We found a positive correlation between circulation and SW only in group N, and positive correlation between circulation and EE only in diseased groups (D: R = 0.55, P < .01; H: R = 0.44, P < .01). Multivariable analyses revealed that circulation was the independent determinant of EE in groups D and H. CONCLUSIONS Enhanced vortices could be associated with effective increase in LV external work in normal hearts. Conversely, they were associated with loss of EE without an optimal increase in external work in failing hearts, regardless of the LV morphology.
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Affiliation(s)
- Miwa Sarashina-Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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14
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Nakaza M, Matsumoto M, Sekine T, Inoue T, Ando T, Ogawa M, Obara M, Leonowicz O, Kumita S, Usuda J. Dual-VENC 4D Flow MRI Can Detect Abnormal Blood Flow in the Left Atrium That Potentially Causes Thrombosis Formation after Left Upper Lobectomy. Magn Reson Med Sci 2021; 21:433-443. [PMID: 33790138 PMCID: PMC9316132 DOI: 10.2463/mrms.mp.2020-0170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of the current study was to clarify the blood flow pattern in the left atrium (LA), potentially causing the formation of thrombosis after left upper lobectomy (LUL). The blood flow in the LA was evaluated and compared between LUL patients with and without thrombosis. For the evaluation, we applied highly accelerated 4D flow MRI with dual-velocity encoding (VENC) scheme, which was expected to be able to capture slow flow components in the LA accurately. Methods: Eight volunteers and 18 patients subjected to LUL underwent dual-VENC 4D Flow MRI. Eight patients had a history of thrombosis. We measured the blood flow velocity and stasis ratio (proportion in the volume that did not exceed 10 cm/s in any cardiac phase) in the LA and left superior pulmonary vein (LSPV) stump. For visual assessment, the presence of each collision of the blood flow from pulmonary veins and vortex flow in the LA were evaluated. Each acquired value was compared between healthy participants and LUL patients, and in LUL patients with and without thrombosis. Results: In LUL patients, blood flow velocity near the inflow part of the left superior pulmonary vein (Lt Upp) and mean velocity in the LA were lower, and stasis ratio in the LA was higher compared with healthy volunteers (Lt Upp 9.10 ± 3.09 vs.13.23 ± 14.19 cm/s, mean velocity in the LA 9.81 ± 2.49 vs. 11.40 ± 1.15 cm/s, and stasis ratio 25.28 ± 18.64 vs. 4.71 ± 3.03%, P = 0.008, 0.037, and < 0.001). There was no significant difference in any quantification values between LUL patients with and without thrombosis. For visual assessment, the thrombus formation was associated with no collision pattern (62.5% vs. 10%, P = 0.019) and not with vortex flow pattern (50% vs. 30%, P = 0.751). Conclusion: The net blood flow velocity was not associated with the thrombus formation. In contrast, a specific blood flow pattern, the absence of blood flow collision from pulmonary veins, correlates to the thrombus formation in the LA.
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Affiliation(s)
| | | | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School.,Department of Radiology, Nippon Medical School Musashi Kosugi Hopital
| | - Tatsuya Inoue
- Department of Respiratory Surgery, Nippon Medical School
| | | | | | | | | | | | - Jitsuo Usuda
- Department of Respiratory Surgery, Nippon Medical School
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15
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Feng L, Gao H, Qi N, Danton M, Hill NA, Luo X. Fluid-structure interaction in a fully coupled three-dimensional mitral-atrium-pulmonary model. Biomech Model Mechanobiol 2021; 20:1267-1295. [PMID: 33770307 PMCID: PMC8298265 DOI: 10.1007/s10237-021-01444-6] [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] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022]
Abstract
This paper aims to investigate detailed mechanical interactions between the pulmonary haemodynamics and left heart function in pathophysiological situations (e.g. atrial fibrillation and acute mitral regurgitation). This is achieved by developing a complex computational framework for a coupled pulmonary circulation, left atrium and mitral valve model. The left atrium and mitral valve are modelled with physiologically realistic three-dimensional geometries, fibre-reinforced hyperelastic materials and fluid–structure interaction, and the pulmonary vessels are modelled as one-dimensional network ended with structured trees, with specified vessel geometries and wall material properties. This new coupled model reveals some interesting results which could be of diagnostic values. For example, the wave propagation through the pulmonary vasculature can lead to different arrival times for the second systolic flow wave (S2 wave) among the pulmonary veins, forming vortex rings inside the left atrium. In the case of acute mitral regurgitation, the left atrium experiences an increased energy dissipation and pressure elevation. The pulmonary veins can experience increased wave intensities, reversal flow during systole and increased early-diastolic flow wave (D wave), which in turn causes an additional flow wave across the mitral valve (L wave), as well as a reversal flow at the left atrial appendage orifice. In the case of atrial fibrillation, we show that the loss of active contraction is associated with a slower flow inside the left atrial appendage and disappearances of the late-diastole atrial reversal wave (AR wave) and the first systolic wave (S1 wave) in pulmonary veins. The haemodynamic changes along the pulmonary vessel trees on different scales from microscopic vessels to the main pulmonary artery can all be captured in this model. The work promises a potential in quantifying disease progression and medical treatments of various pulmonary diseases such as the pulmonary hypertension due to a left heart dysfunction.
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Affiliation(s)
- Liuyang Feng
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK.
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
| | - Nan Qi
- Institute of Marine Science and Technology, Shandong University, Shangdong, 266237, People's Republic of China
| | - Mark Danton
- Department of Cardiac Surgery, Royal Hospital for Children, Glasgow, UK
| | - Nicholas A Hill
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8SQ, UK
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16
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Dietrich S, Aigner CS, Kolbitsch C, Mayer J, Ludwig J, Schmidt S, Schaeffter T, Schmitter S. 3D Free-breathing multichannel absolute B 1 + Mapping in the human body at 7T. Magn Reson Med 2020; 85:2552-2567. [PMID: 33283915 DOI: 10.1002/mrm.28602] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To introduce and investigate a method for free-breathing three-dimensional (3D) B 1 + mapping of the human body at ultrahigh field (UHF), which can be used to generate homogenous flip angle (FA) distributions in the human body at UHF. METHODS A 3D relative B 1 + mapping sequence with a radial phase-encoding (RPE) k-space trajectory was developed and applied in 11 healthy subjects at 7T. An RPE-based actual flip angle mapping method was applied with a dedicated B 1 + shim setting to calibrate the relative B 1 + maps yielding absolute B 1 + maps of the individual transmit channels. The method was evaluated in a motion phantom and by multidimensional in vivo measurements. Additionally, 3D gradient echo scans with and without static phase-only B 1 + shims were used to qualitatively validate B 1 + shim predictions. RESULTS The phantom validation revealed good agreement for B 1 + maps between dynamic measurement and static reference acquisition. The proposed 3D method was successfully validated in vivo by comparing magnitude and phase distributions with a 2D Cartesian reference. 3D B 1 + maps free from visible motion artifacts were successfully acquired for 11 subjects with body mass indexes ranging from 19 kg/m2 to 34 kg/m2 . 3D respiration-resolved absolute B 1 + maps indicated FA differences between inhalation and exhalation up to 15% for one channel and up to 24% for combined channels for shallow breathing. CONCLUSION The proposed method provides respiration-resolved absolute 3D B 1 + maps of the human body at UHF, which enables the investigation and development of 3D B 1 + shimming and parallel transmission methods to further enhance body imaging at UHF.
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Affiliation(s)
- Sebastian Dietrich
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Christoph S Aigner
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Johannes Mayer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Juliane Ludwig
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Simon Schmidt
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
- Department of Medical Engineering, Technische Universität Berlin, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
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17
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Sundin J, Engvall J, Nylander E, Ebbers T, Bolger AF, Carlhäll CJ. Improved Efficiency of Intraventricular Blood Flow Transit Under Cardiac Stress: A 4D Flow Dobutamine CMR Study. Front Cardiovasc Med 2020; 7:581495. [PMID: 33324686 PMCID: PMC7724031 DOI: 10.3389/fcvm.2020.581495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: The effects of heart rate, inotropy, and lusitropy on multidimensional flow patterns and energetics within the human heart remain undefined. Recently, reduced volume and end-diastolic kinetic energy (KE) of the portion of left ventricular (LV) inflow passing directly to outflow, Direct flow (DF), have been shown to reflect inefficient LV pumping and to be a marker of LV dysfunction in heart failure patients. In this study, we hypothesized that increasing heart rate, inotropy, and lusitropy would result in an increased efficiency of intraventricular blood flow transit. Therefore, we sought to investigate LV 4D blood flow patterns and energetics with dobutamine infusion. Methods: 4D flow and morphological cardiovascular magnetic resonance (CMR) data were acquired in twelve healthy subjects: at rest and with dobutamine infusion to achieve a target heart rate ~60% higher than the resting heart rate. A previously validated method was used for flow analysis: pathlines were emitted from the end-diastolic (ED) LV blood volume and traced forward and backward in time to separate four functional LV flow components. For each flow component, KE/mL blood volume at ED was calculated. Results: With dobutamine infusion there was an increase in heart rate (64%, p < 0.001), systolic blood pressure (p = 0.02) and stroke volume (p = 0.01). Of the 4D flow parameters, the most efficient flow component (DF), increased its proportion of EDV (p < 0.001). The EDV proportion of Residual volume, the blood residing in the ventricle over at least two cardiac cycles, decreased (p < 0.001). The KE/mL at ED for all flow components increased (p < 0.001). DF had the largest absolute and relative increase while Residual volume had the smallest absolute and relative increase. Conclusions: This study demonstrates that it is feasible to compare 4D flow patterns within the normal human heart at rest and with stress. At higher heart rate, inotropy and lusitropy, elicited by dobutamine infusion, the efficiency of intraventricular blood flow transit improves, as quantified by an increased relative volume and pre-systolic KE of the most efficient DF component of the LV volume. The change in these markers may allow a novel assessment of LV function and LV dysfunction over a range of stress.
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Affiliation(s)
- Jonathan Sundin
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carl-Johan Carlhäll
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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18
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Early changes of pulmonary arterial hemodynamics in patients with systemic sclerosis: flow pattern, WSS, and OSI analysis with 4D flow MRI. Eur Radiol 2020; 31:4253-4263. [PMID: 33211148 DOI: 10.1007/s00330-020-07301-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 09/15/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To study the pulmonary artery (PA) hemodynamics in patients with systemic sclerosis (SSc) using 4D flow MRI (4D-flow). METHODS Twenty-three patients with SSc (M/F: 2/21, 57 ± 15 years, 3 manifest PA hypertension (PAH) by right heart catheterization) and 10 control subjects (M/F: 1/9, 55 ± 17 years) underwent 4D-flow for the in vivo measurement of 3D blood flow velocities in the PA. Data analysis included area-averaged flow quantification at the main PA, 3D wall shear stress (WSS), oscillatory shear index (OSI) calculation along the PA surface, and Reynolds number. The composite outcome of all-cause death and major adverse cardiac events was also investigated. RESULTS The maximum PA flow at the systole did not differ, but the minimum flow at the diastole was significantly greater in patients with SSc compared with that in control subjects (7.7 ± 16.0 ml/s vs. ‑ 13.0 ± 17.3 ml/s, p < 0.01). The maximum WSS at the peak systole was significantly lower and OSI was significantly greater in patients with SSc compared with those in control subjects (maximum WSS: 1.04 ± 0.20 Pa vs. 1.33 ± 0.34 Pa, p < 0.01, OSI: 0.139 ± 0.031 vs. 0.101 ± 0.037, p < 0.01). The cumulative event-free rate for the composite event was significantly lower in patients with minimum flow in main PA ≤ 9.22 ml/s (p = 0.012) and in patients with Reynolds number ≤ 2560 (p < 0.001). CONCLUSIONS 4D-flow has the potential to detect changes of PA hemodynamics noninvasively and predict the outcome in patients with SSc at the stage before manifest PAH. KEY POINTS • The WSS at the peak systolic phase was significantly lower (p < 0.05), whereas OSI was greater (p < 0.01) in patients with SSc without manifest PAH than in controls. • The hemodynamic change detected by 4D-flow may help patient management even at the stage before manifest PAH in SSc. • The minimum PA flow and Reynolds number by 4D-flow will serve as a predictive marker for SSc.
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19
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Left Ventricular Blood Flow Kinetic Energy Assessment by 4D Flow Cardiovascular Magnetic Resonance: A Systematic Review of the Clinical Relevance. J Cardiovasc Dev Dis 2020; 7:jcdd7030037. [PMID: 32927744 PMCID: PMC7569817 DOI: 10.3390/jcdd7030037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background: There is an emerging body of evidence that supports the potential clinical value of left ventricular (LV) intracavity blood flow kinetic energy (KE) assessment using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR). The aim of this systematic review is to summarize studies evaluating LV intracavity blood flow KE quantification methods and its potential clinical significance. Methods: A systematic review search was carried out on Medline, Pubmed, EMBASE and CINAHL. Results: Of the 677 articles screened, 16 studies met eligibility. These included six (37%) studies on LV diastolic function, another six (37%) studies on heart failure or cardiomyopathies, three (19%) studies on ischemic heart disease or myocardial infarction and finally, one (6%) study on valvular heart disease, namely, mitral regurgitation. One of the main strengths identified by these studies is high reproducibility of LV blood flow KE hemodynamic assessment (mean coefficient of variability = 6 ± 2%) for the evaluation of LV diastolic function. Conclusions: The evidence gathered in this systematic review suggests that LV blood flow KE has great promise for LV hemodynamic assessment. Studies showed increased diagnostic confidence at no cost of additional time. Results were highly reproducible with low intraobserver variability.
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20
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Kräuter C, Reiter U, Reiter C, Nizhnikava V, Masana M, Schmidt A, Fuchsjäger M, Stollberger R, Reiter G. Automated mitral valve vortex ring extraction from 4D-flow MRI. Magn Reson Med 2020; 84:3396-3408. [PMID: 32557819 PMCID: PMC7540523 DOI: 10.1002/mrm.28361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/30/2023]
Abstract
Purpose To present and validate a method for automated extraction and analysis of the temporal evolution of the mitral valve (MV) vortex ring from MR 4D‐flow data. Methods The proposed algorithm uses the divergence‐free part of the velocity vector field for Q criterion‐based identification and tracking of MV vortex ring core and region within the left ventricle (LV). The 4D‐flow data of 20 subjects (10 healthy controls, 10 patients with ischemic heart disease) were used to validate the algorithm against visual analysis as well as to assess the method’s sensitivity to manual LV segmentation. Quantitative MV vortex ring parameters were analyzed with respect to both their differences between healthy subjects and patients and their correlation with transmitral peak velocities. Results The algorithm successfully extracted MV vortex rings throughout the entire cardiac cycle, which agreed substantially with visual analysis (Cohen’s kappa = 0.77). Furthermore, vortex cores and regions were robustly detected even if a static end‐diastolic LV segmentation mask was applied to all frames (Dice coefficients 0.82 ± 0.08 and 0.94 ± 0.02 for core and region, respectively). Early diastolic MV vortex ring vorticity, kinetic energy and circularity index differed significantly between healthy controls and patients. In contrast to vortex shape parameters, vorticity and kinetic energy correlated strongly with transmitral peak velocities. Conclusion An automated method for temporal MV vortex ring extraction demonstrating robustness with respect to LV segmentation strategies is introduced. Quantitative vortex parameter analysis indicates importance of the MV vortex ring for LV diastolic (dys)function.
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Affiliation(s)
- Corina Kräuter
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria.,Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Volha Nizhnikava
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Marc Masana
- Computer Vision Center, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Rudolf Stollberger
- Institute of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.,Research & Development, Siemens Healthcare Diagnostics, Graz, Austria
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21
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Rutkowski DR, Barton GP, François CJ, Aggarwal N, Roldán-Alzate A. Sex Differences in Cardiac Flow Dynamics of Healthy Volunteers. Radiol Cardiothorac Imaging 2020; 2. [PMID: 32666051 DOI: 10.1148/ryct.2020190058] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose The purpose of this study was to further understand the relationship between cardiac function and flow, on the basis of sex, by quantifying cardiac flow characteristics and relating them to cardiac muscle performance in young adults. Materials and Methods In this cross-sectional study, cardiac four-dimensional flow (4D flow) magnetic resonance imaging (MRI) and two-dimensional cine MRI were performed on 20 male and 19 female volunteers aged 20-35. Velocity-based metrics of flow, kinetic energy, vorticity, and efficiency indices were quantified, as well as cardiac strain metrics. Results* Peak systolic blood kinetic energy (male: 4.76 ± 2.66 mJ; female: 3.36 ± 1.43 mJ; p=0.047) was significantly higher in the male left ventricle (LV) than in the female LV. Peak systolic vorticity index (male: 0.008 ± 0.005 rad-m2/ml-s; female: 0.014 ± 0.007 rad-m2/ml-s; p=0.007), peak diastolic vorticity index (male: 0.007 ± 0.006 rad-m2/ml-s; female: 0.014 ± 0.010 rad-m2/ml-s; p=0.015), and cycle-average vorticity (male: 0.006 ± 0.001 rad-m2/ml-s; female: 0.011 ± 0.002 rad/s; p=0.001) were all significantly higher in the LV of women than they were in the LV of men. Radial, circumferential, and long-axis strain metrics were significantly higher in the female LV than in the male LV (p<0.05). Circumferential systolic and diastolic strain rates displayed moderate correlation to peak systolic (r=-0.38, p=0.022) and diastolic vorticity (r=0.40, p=0.015) values, respectively. *Results are reported as mean ± standard deviation. Conclusion Left ventricular vorticity metrics were observed to be higher in women than in men and displayed moderate correlation to cardiac strain metrics. The methods and results of this study may be used to further understand the sex-based cardiac efficiency relationship between cardiac function and flow.
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Affiliation(s)
- David R Rutkowski
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Gregory P Barton
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Christopher J François
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Niti Aggarwal
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
| | - Alejandro Roldán-Alzate
- Departments of Mechanical Engineering (D.R.R., A.R.A.), Radiology (D.R.R., G.P.B., C.J.F., A.R.A.), Medical Physics (G.P.B.), Cardiovascular Medicine (N.A.), and Biomedical Engineering (A.R.A.), University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705
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22
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Ordovas K. Sex Differences in Advanced Cardiac MRI Assessment. Radiol Cardiothorac Imaging 2020; 2:e190250. [PMID: 33778540 PMCID: PMC7977802 DOI: 10.1148/ryct.2020190250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 06/12/2023]
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23
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Atrial Failure as a Clinical Entity. J Am Coll Cardiol 2020; 75:222-232. [DOI: 10.1016/j.jacc.2019.11.013] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/09/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
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24
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Efficacy of "Pinggan Formula" in Controlling Acute Type B Aortic Dissection Perioperative Blood Pressure: A Randomized Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6432953. [PMID: 31827555 PMCID: PMC6885174 DOI: 10.1155/2019/6432953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 12/05/2022]
Abstract
Objective To explore a new treatment that can proceed from the whole, control blood pressure smoothly and coordinate the treatment of multiple factors causing blood pressure fluctuations. Method We conducted a single-center, double-blinded, and randomized controlled clinical trial. 48 patients with acute Type B aortic dissection were randomly assigned into two groups: the experimental group, who received pinggan formula treatment, and the control group, who received placebo treatment. The drug was taken orally after meals three times a day. Only when the patients' blood pressure fluctuated, conventional antihypertensive drugs were given to maintain the blood pressure within the target range and the dosage was recorded to convert the DDD value. Meanwhile, the international standardized score was used to evaluate the defecation, sleep, pain, anxiety, and depression of patients in the two groups during the hospitalization. Result Univariate analysis was conducted on variables that might affect the assessment results, and it was found that grouping factors had a significant impact on the outcome variables, that is, after the intervention, the mean value of DDDs used in the perioperative period in the control group was 2.19 (0.38, 4.00). (P=0.0219), defecation score (2.13 (1.59, 2.67); P < 0.0001), sleep score (0.95 (0.40, 1.50); P=0.0014), pain score (1.77 (0.61, 2.93); P=0.0045), depression score (4.04 (2.95, 5.12); and P < 0.0001) were significantly higher than that of the experimental group, and the difference was statistically significant. Conclusion Pinggan formula has a clear therapeutic regulation effect on the overall hemodynamics of acute Stanford type B aortic dissection during the perioperative period and can be recommended as an auxiliary drug for conventional antihypertensive drugs at the current stage.
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25
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Abstract
The authors discuss the concept of atrial myopathy; its relationship to aging, electrophysiological remodeling, and autonomic remodeling; the interplay between atrial myopathy, AF, and stroke; and suggest how to identify patients with atrial myopathy and how to incorporate atrial myopathy into decisions about anticoagulation. Atrial myopathy seen in animal models of AF and in patients with AF is the result of a combination of factors that lead to electrical and structural remodeling in the atrium. Although AF may lead to the initiation and/or progression of this myopathy, the presence of AF is by no means essential to the development or the maintenance of the atrial myopathic state. Methods to identify atrial myopathy include atrial electrograms, tissue biopsy, cardiac imaging, and certain serum biomarkers. A promising modality is 4-dimensional flow cardiac magnetic resonance. The concept of atrial myopathy may help guide oral anticoagulant therapy in selected groups of patients with AF, particularly those with low to intermediate risk of strokes and those who have undergone successful AF ablation. This review highlights the need for prospective randomized trials to test these hypotheses.
This paper discusses the evolving concept of atrial myopathy by presenting how it develops and how it affects the properties of the atria. It also reviews the complex relationships among atrial myopathy, atrial fibrillation (AF), and stroke. Finally, it discusses how to apply the concept of atrial myopathy in the clinical setting—to identify patients with atrial myopathy and to be more selective in anticoagulation in a subset of patients with AF. An apparent lack of a temporal relationship between episodes of paroxysmal AF and stroke in patients with cardiac implantable electronic devices has led investigators to search for additional factors that are responsible for AF-related strokes. Multiple animal models and human studies have revealed a close interplay of atrial myopathy, AF, and stroke via various mechanisms (e.g., aging, inflammation, oxidative stress, and stretch), which, in turn, lead to fibrosis, electrical and autonomic remodeling, and a pro-thrombotic state. The complex interplay among these mechanisms creates a vicious cycle of ever-worsening atrial myopathy and a higher risk of more sustained AF and strokes. By highlighting the importance of atrial myopathy and the risk of strokes independent of AF, this paper reviews the methods to identify patients with atrial myopathy and proposes a way to incorporate the concept of atrial myopathy to guide anticoagulation in patients with AF.
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Key Words
- 4D, 4 dimensional
- AF, atrial fibrillation
- APD, action potential duration
- CMR, cardiac magnetic resonance
- CRP, C-reactive protein
- Ca2+, calcium
- Cx, connexin
- GDF, growth differentiation factor
- IL, interleukin
- K+, potassium
- LA, left atrial
- LAA, left atrial appendage
- NADPH, nicotinamide adenine dinucleotide phosphate
- NOX2, catalytic, membrane-bound subunit of NADPH oxidase
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- OAC, oral anticoagulant
- ROS, reactive oxygen species
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- atrial fibrillation
- atrial myopathy
- electrophysiology
- thrombosis
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Affiliation(s)
- Mark J Shen
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Cardiac Electrophysiology, Prairie Heart Institute of Illinois, HSHS St. John's Hospital, Springfield, Illinois
| | - Rishi Arora
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - José Jalife
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan.,Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), and CIBERCV, Madrid, Spain
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26
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Garcia J, Sheitt H, Bristow MS, Lydell C, Howarth AG, Heydari B, Prato FS, Drangova M, Thornhill RE, Nery P, Wilton SB, Skanes A, White JA. Left atrial vortex size and velocity distributions by 4D flow MRI in patients with paroxysmal atrial fibrillation: Associations with age and CHA
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‐VASc risk score. J Magn Reson Imaging 2019; 51:871-884. [DOI: 10.1002/jmri.26876] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Julio Garcia
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Department of RadiologyUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
- Libin Cardiovascular Institute of Alberta Calgary AB Canada
- Alberta Children's Hospital Research Institute
| | - Hana Sheitt
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
| | - Michael S. Bristow
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Department of MedicineUniversity of Calgary Calgary AB Canada
| | - Carmen Lydell
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Diagnostic ImagingUniversity of Calgary Calgary AB Canada
| | - Andrew G. Howarth
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
| | - Bobak Heydari
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
| | - Frank S. Prato
- Department of Medical BiophysicsSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
| | - Maria Drangova
- Department of Medical BiophysicsSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
- Imaging Research Laboratories, Robarts Research InstituteSchulich School of Medicine & Dentistry, The University of Western Ontario London Ontario Canada
| | | | - Pablo Nery
- Division of Cardiology, Department of MedicineUniversity of Ottawa Heart Institute Ottawa ON Canada
| | - Stephen B. Wilton
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
| | - Allan Skanes
- Department of MedicineUniversity of Western Ontario London ON Canada
| | - James A. White
- Department of Cardiac SciencesUniversity of Calgary Calgary AB Canada
- Stephenson Cardiac Imaging CentreUniversity of Calgary AB Canada
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27
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Abstract
OBJECTIVE This study investigated the intraventricular flow dynamics in ischaemic heart disease patients. PATIENTS AND METHODS Fourteen patients with normal ejection fraction and 16 patients with reduced ejection fraction were compared with 20 healthy individuals. Phase-contrast MRI was used to assess intraventricular flow variables and speckle-tracking echocardiography to assess myocardial strain and left ventricular (LV) dyssynchrony. Infarct size was acquired using delayed-enhancement MRI. RESULTS The results obtained showed no significant differences in intraventricular flow variables between the healthy group and the patients with normal ejection fraction group, whereas considerable reductions in kinetic energy (KE) fluctuation index, E' (P<0.001) and vortex KE (P=0.003) were found in the patients with reduced ejection fraction group. In multivariate analysis, only vortex KE and infarct size were significantly related to LV ejection fraction (P<0.001); furthermore, vortex KE was correlated negatively with energy dissipation, energy dissipation index (r=-0.44, P=0.021). CONCLUSION This study highlights that flow energetic indices have limited applicability as early predictors of LV progressive dysfunction, whereas vortex KE could be an alternative to LV performance.
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28
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Mele D, Smarrazzo V, Pedrizzetti G, Capasso F, Pepe M, Severino S, Luisi GA, Maglione M, Ferrari R. Intracardiac Flow Analysis: Techniques and Potential Clinical Applications. J Am Soc Echocardiogr 2019; 32:319-332. [DOI: 10.1016/j.echo.2018.10.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 01/20/2023]
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29
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Impact of Age and Diastolic Function on Novel, 4D flow CMR Biomarkers of Left Ventricular Blood Flow Kinetic Energy. Sci Rep 2018; 8:14436. [PMID: 30258186 PMCID: PMC6158175 DOI: 10.1038/s41598-018-32707-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/06/2018] [Indexed: 01/01/2023] Open
Abstract
Two-dimensional (2D) methods of assessing mitral inflow velocities are pre-load dependent, limiting their reliability for evaluating diastolic function. Left ventricular (LV) blood flow kinetic energy (KE) derived from four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) may offer improvements. It remains unclear whether 4D LV blood flow KE parameters are associated with physiological factors, such as age when compared to 2D mitral inflow velocities. Fifty-three healthy volunteers underwent standard CMR, plus 4D flow acquisition. LV blood flow KE parameters demonstrated good reproducibility with mean coefficient of variation of 6 ± 2% and an accuracy of 99% with a precision of 97%. The LV blood flow KEiEDV E/A ratio demonstrated good association to the 2D mitral inflow E/A ratio (r = 0.77, P < 0.01), with both decreasing progressively with advancing age (P < 0.01). Furthermore, peak E-wave KEiEDV and A-wave KEiEDV displayed a stronger association to age than the corresponding 2D metrics, peak E-wave and A-wave velocity (r = −0.51 vs −0.17 and r = 0.65 vs 0.46). Peak E-wave KEiEDV decreases whilst peak A-wave KEiEDV increases with advancing age. This study presents values for various LV blood flow KE parameters in health, as well as demonstrating that they show stronger and independent correlations to age than standard diastolic metrics.
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30
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Wong J, Chabiniok R, Tibby SM, Pushparajah K, Sammut E, Celermajer D, Giese D, Hussain T, Greil GF, Schaeffter T, Razavi R. Exploring kinetic energy as a new marker of cardiac function in the single ventricle circulation. J Appl Physiol (1985) 2018; 125:889-900. [PMID: 29369740 DOI: 10.1152/japplphysiol.00580.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ventricular volumetric ejection fraction (VV EF) is often normal in patients with single ventricle circulations despite them experiencing symptoms related to circulatory failure. We sought to determine if kinetic energy (KE) could be a better marker of ventricular performance. KE was prospectively quantified using four-dimensional flow MRI in 41 patients with a single ventricle circulation (aged 0.5-28 yr) and compared with 43 healthy volunteers (aged 1.5-62 yr) and 14 patients with left ventricular (LV) dysfunction (aged 28-79 yr). Intraventricular end-diastolic blood was tracked through systole and divided into ejected and residual blood components. Two ejection fraction (EF) metrics were devised based on the KE of the ejected component over the total of both the ejected and residual components using 1) instantaneous peak KE to assess KE EF or 2) summating individual peak particle energy (PE) to assess PE EF. KE EF and PE EF had a smaller range than VV EF in healthy subjects (97.9 ± 0.8 vs. 97.3 ± 0.8 vs. 60.1 ± 5.2%). LV dysfunction caused a fall in KE EF ( P = 0.01) and PE EF ( P = 0.0001). VV EF in healthy LVs and single ventricle hearts was equivalent; however, KE EF and PE EF were lower ( P < 0.001) with a wider range indicating a spectrum of severity. Those reporting the greatest symptomatic impairment (New York Heart Association II) had lower PE EF than asymptomatic subjects ( P = 0.0067). KE metrics are markers of healthy cardiac function. PE EF may be useful in grading dysfunction. NEW & NOTEWORTHY Kinetic energy (KE) represents the useful work of the heart in ejecting blood. This article details the utilization of KE indexes to assess cardiac function in health and a variety of pathophysiological conditions. KE ejection fraction and particle energy ejection fraction (PE EF) showed a narrow range in health and a lower wider range in disease representing a spectrum of severity. PE EF was altered by functional status potentially offering the opportunity to grade dysfunction.
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Affiliation(s)
- James Wong
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Radomir Chabiniok
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom.,Inria, Paris-Saclay University, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Paris-Saclay University, Palaiseau, France
| | - Shane M Tibby
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Eva Sammut
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - David Celermajer
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Daniel Giese
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Gerald F Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, The Rayne Institute, St. Thomas' Hospital , London , United Kingdom
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Crandon S, Elbaz MSM, Westenberg JJM, van der Geest RJ, Plein S, Garg P. Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: A systematic review. Int J Cardiol 2017; 249:486-493. [PMID: 28964555 PMCID: PMC5687937 DOI: 10.1016/j.ijcard.2017.07.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 07/10/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR. METHODS A systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as 'highly clinically applicable' for scores of 67-100%, 'potentially clinically applicable' for 34-66% and 'less clinically applicable' for 0-33%. RESULTS Of the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were 'highly clinically applicable', 9 (20%) were 'potentially clinically applicable' and 8 (18%) were 'less clinically applicable'. CONCLUSIONS There are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices. PROSPERO=CRD42016051438.
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Affiliation(s)
- Saul Crandon
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom
| | | | | | | | - Sven Plein
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom.
| | - Pankaj Garg
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom
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32
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Cibis M, Lindahl TL, Ebbers T, Karlsson LO, Carlhäll CJ. Left Atrial 4D Blood Flow Dynamics and Hemostasis following Electrical Cardioversion of Atrial Fibrillation. Front Physiol 2017; 8:1052. [PMID: 29311980 PMCID: PMC5732934 DOI: 10.3389/fphys.2017.01052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Electrical cardioversion in patients with atrial fibrillation is followed by a transiently impaired atrial mechanical function, termed atrial stunning. During atrial stunning, a retained risk of left atrial thrombus formation exists, which may be attributed to abnormal left atrial blood flow patterns. 4D Flow cardiovascular magnetic resonance (CMR) enables blood flow assessment from the entire three-dimensional atrial volume throughout the cardiac cycle. We sought to investigate left atrial 4D blood flow patterns and hemostasis during left atrial stunning and after left atrial mechanical function was restored. Methods: 4D Flow and morphological CMR data as well as blood samples were collected in fourteen patients at two time-points: 2–3 h (Time-1) and 4 weeks (Time-2) following cardioversion. The volume of blood stasis and duration of blood stasis were calculated. In addition, hemostasis markers were analyzed. Results: From Time-1 to Time-2: Heart rate decreased (61 ± 7 vs. 56 ± 8 bpm, p = 0.01); Maximum change in left atrial volume increased (8 ± 4 vs. 22 ± 15%, p = 0.009); The duration of stasis (68 ± 11 vs. 57 ± 8%, p = 0.002) and the volume of stasis (14 ± 9 vs. 9 ± 7%, p = 0.04) decreased; Thrombin-antithrombin complex (TAT) decreased (5.2 ± 3.3 vs. 3.3 ± 2.2 μg/L, p = 0.008). A significant correlation was found between TAT and the volume of stasis (r2 = 0.69, p < 0.001) at Time-1 and between TAT and the duration of stasis (r2 = 0.34, p = 0.04) at Time-2. Conclusion: In this longitudinal study, left atrial multidimensional blood flow was altered and blood stasis was elevated during left atrial stunning compared to the restored left atrial mechanical function. The coagulability of blood was also elevated during atrial stunning. The association between blood stasis and hypercoagulability proposes that assessment of left atrial 4D flow can add to the pathophysiological understanding of thrombus formation during atrial fibrillation related atrial stunning.
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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, Linköping University, Linköping, Sweden
| | - Tomas L Lindahl
- Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine (IKE), 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, Linköping University, Linköping, Sweden
| | - Lars O Karlsson
- Departments of Cardiology, 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, Linköping University, Linköping, Sweden.,Departments of Clinical Physiology, Medical and Health Sciences, Linköping University, Linköping, Sweden
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33
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Garcia J, van der Palen RLF, Bollache E, Jarvis K, Rose MJ, Barker AJ, Collins JD, Carr JC, Robinson J, Rigsby CK, Markl M. Distribution of blood flow velocity in the normal aorta: Effect of age and gender. J Magn Reson Imaging 2017; 47:487-498. [PMID: 28556277 DOI: 10.1002/jmri.25773] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/10/2017] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To apply flow distribution analysis in the entire aorta across a wide age range from pediatric to adult subjects. MATERIAL AND METHODS In all, 98 healthy subjects (age 9-78 years, 41 women) underwent 4D flow MRI at 1.5T and 3T for the assessment of 3D blood flow in the thoracic aorta. Subjects were categorized into age groups: group 1 (n = 9, 5 women): 9-15 years; group 2 (n = 13, 8 women): 16-20 years; group 3 (n = 27, 14 women): 21-39 years; group 4 (n = 40, 11 women): 40-59 years; group 5 (n = 9, 3 women): >60 years. Data analysis included the 3D segmentation of the aorta, aortic valve peak velocity, mid-ascending aortic diameter, and calculation of flow velocity distribution descriptors (mean, median, standard deviation, incidence of velocities >1 m/s, skewness, and kurtosis of aortic velocity magnitude). Ascending aortic diameter was normalized by body surface area. RESULTS Age was significantly associated with normalized aortic diameter (R = 0.73, P < 0.001), skewness (R = 0.76, P < 0.001), and kurtosis (R = 0.74, P < 0.001), all adjusted by heart rate. Aortic peak velocity and velocity distribution descriptors, adjusted by heart rate, were significantly different between age groups (P < 0.001, analysis of covariance). Skewness and kurtosis significantly increased (P < 0.001) during adulthood (>40 years) as compared with childhood (<21 years). Men and women revealed significant differences (P ≤ 0.05) for peak velocity, incidence, mean, median, standard deviation, and skewness, all adjusted by heart rate. CONCLUSION Aortic hemodynamics significantly change with age and gender, indicating the importance of age- and gender-matched control cohorts for the assessment of the impact of cardiovascular disease on aortic blood flow. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:487-498.
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Affiliation(s)
- Julio Garcia
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Michael J Rose
- Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Cynthia K Rigsby
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Imaging, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Division of Pediatric Cardiology, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Markl M, Lee DC, Furiasse N, Carr M, Foucar C, Ng J, Carr J, Goldberger JJ. Left Atrial and Left Atrial Appendage 4D Blood Flow Dynamics in Atrial Fibrillation. Circ Cardiovasc Imaging 2017; 9:e004984. [PMID: 27613699 DOI: 10.1161/circimaging.116.004984] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial 4D flow magnetic resonance imaging was used for the characterization of left atrial (LA) and left atrial appendage (LAA) flow dynamics in patients with atrial fibrillation (AF). METHODS AND RESULTS 4D flow magnetic resonance imaging measured in vivo 3D blood flow velocities in 60 AF patients and 15 controls. Anatomic maps of LA and LAA stasis and velocity were calculated to quantify atrial peak velocity, mean velocity, and stasis (velocities <0.1 m/s). In a substudy with 30 AF patients, 4D flow metrics were compared with Doppler transesophageal echocardiography. For all 15 controls, LAA mean and peak velocities were consistently lower (by 21%/12%; P<0.001) while LAA stasis was higher (by 58%; P<0.001) compared with the LA. In contrast, lower LAA velocity and increased LAA stasis were only found in a fraction (38 of 60) of AF patients. In AF patients, increased CHA2DS2-VASc score was associated with significantly (P<0.043) reduced LA velocities and elevated stasis. There was a heterogeneous expression of atrial flow dynamics, and 25% to 68% of AF patients demonstrated flow in the normal range: 25%/68% for LA/LAA stasis and 38%/60% for LA/LAA peak velocities. Transesophageal echocardiography velocities modestly but significantly (P<0.05) correlated with 4D flow-based LA velocities (r=0.41) and stasis (r=-0.39). CONCLUSIONS AF resulted in overall impaired but individually variable flow dynamics in both the LA and LAA. AF patients demonstrated atrial flow in the normal range, despite elevated CHA2DS2-VASc score.
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Affiliation(s)
- Michael Markl
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.).
| | - Daniel C Lee
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - Nicholas Furiasse
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - Maria Carr
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - Charles Foucar
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - Jason Ng
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - James Carr
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
| | - Jeffrey J Goldberger
- From the Department of Radiology, Feinberg School of Medicine (M.M., D.C.L., M.C., J.C.), Department of Biomedical Engineering, McCormick School of Engineering (M.M.), Division of Cardiology, Feinberg School of Medicine (D.C.L., N.F., C.F., J.N., J.J.G.), and Feinberg Cardiovascular Research Institute (D.C.L., J.N., J.J.G.), Northwestern University, Chicago, IL; and Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL (J.J.G.)
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Nakashima K, Itatani K, Kitamura T, Oka N, Horai T, Miyazaki S, Nie M, Miyaji K. Energy dynamics of the intraventricular vortex after mitral valve surgery. Heart Vessels 2017; 32:1123-1129. [DOI: 10.1007/s00380-017-0967-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
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Parikh JD, Kakarla J, Keavney B, O’Sullivan JJ, Ford GA, Blamire AM, Hollingsworth KG, Coats L. 4D flow MRI assessment of right atrial flow patterns in the normal heart - influence of caval vein arrangement and implications for the patent foramen ovale. PLoS One 2017; 12:e0173046. [PMID: 28282389 PMCID: PMC5345792 DOI: 10.1371/journal.pone.0173046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate atrial flow patterns in the normal adult heart, to explore whether caval vein arrangement and patency of the foramen ovale (PFO) may be associated with flow pattern. MATERIALS AND METHODS Time-resolved, three-dimensional velocity encoded magnetic resonance imaging (4D flow) was employed to assess atrial flow patterns in thirteen healthy subjects (6 male, 40 years, range 25-50) and thirteen subjects (6 male, 40 years, range 21-50) with cryptogenic stroke and patent foramen ovale (CS-PFO). Right atrial flow was defined as vortical, helico-vortical, helical and multiple vortices. Time-averaged and peak systolic and diastolic flows in the caval and pulmonary veins and their anatomical arrangement were compared. RESULTS A spectrum of right atrial flow was observed across the four defined categories. The right atrial flow patterns were strongly associated with the relative position of the caval veins. Right atrial flow patterns other than vortical were more common (p = 0.015) and the separation between the superior and inferior vena cava greater (10±5mm versus 3±3mm, p = 0.002) in the CS-PFO group. In the left atrium all subjects except one had counter-clockwise vortical flow. Vortex size varied and was associated with left lower pulmonary vein flow (systolic r = 0.61, p = 0.001, diastolic r = 0.63 p = 0.002). A diastolic vortex was less common and time-averaged left atrial velocity was greater in the CS-PFO group (17±2cm/sec versus 15±1, p = 0.048). One CS-PFO subject demonstrated vortical retrograde flow in the descending aortic arch; all other subjects had laminar descending aortic flow. CONCLUSION Right atrial flow patterns in the normal heart are heterogeneous and are associated with the relative position of the caval veins. Patterns, other than 'typical' vortical flow, are more prevalent in the right atrium of those with cryptogenic stroke in the context of PFO. Left atrial flow patterns are more homogenous in normal hearts and show a relationship with flow arising from the left pulmonary veins.
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Affiliation(s)
- Jehill D. Parikh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jayant Kakarla
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - John J. O’Sullivan
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gary A. Ford
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Andrew M. Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Louise Coats
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Ellulu MS, Abed Y. Effect of socio-demographic factors and obesity on blood pressure among adults based on health status in Gaza, Palestine. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0780-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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38
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Kamphuis VP, Westenberg JJM, van der Palen RLF, Blom NA, de Roos A, van der Geest R, Elbaz MSM, Roest AAW. Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2016; 33:1069-1081. [PMID: 27888419 PMCID: PMC5489572 DOI: 10.1007/s10554-016-1031-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
Knowledge of normal and abnormal flow patterns in the human cardiovascular system increases our understanding of normal physiology and may help unravel the complex pathophysiological mechanisms leading to cardiovascular disease. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as a suitable technique that enables visualization of in vivo blood flow patterns and quantification of parameters that could potentially be of prognostic value in the disease process. In this review, current image processing tools that are used for comprehensive visualization and quantification of blood flow and energy distribution in the heart and great vessels will be discussed. Also, imaging biomarkers extracted from 4D flow CMR will be reviewed that have been shown to distinguish between normal and abnormal flow patterns. Furthermore, current applications of 4D flow CMR in the heart and great vessels will be discussed, showing its potential as an additional diagnostic modality which could aid in disease management and timing of surgical intervention.
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Affiliation(s)
- Vivian P Kamphuis
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed S M Elbaz
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno A W Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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39
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McCormick ME, Manduchi E, Witschey WRT, Gorman RC, Gorman JH, Jiang YZ, Stoeckert CJ, Barker AJ, Yoon S, Markl M, Davies PF. Spatial phenotyping of the endocardial endothelium as a function of intracardiac hemodynamic shear stress. J Biomech 2016; 50:11-19. [PMID: 27916240 DOI: 10.1016/j.jbiomech.2016.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 02/02/2023]
Abstract
Despite substantial evidence for the central role of hemodynamic shear stress in the functional integrity of vascular endothelial cells, hemodynamic and molecular regulation of the endocardial endothelium lining the heart chambers remains understudied. We propose that regional differences in intracardiac hemodynamics influence differential endocardial gene expression leading to phenotypic heterogeneity of this cell layer. Measurement of intracardiac hemodynamics was performed using 4-dimensional flow MRI in healthy humans (n=8) and pigs (n=5). Local wall shear stress (WSS) and oscillatory shear indices (OSI) were calculated in three distinct regions of the LV - base, mid-ventricle (midV), and apex. In both the humans and pigs, WSS values were significantly lower in the apex and midV relative to the base. Additionally, both the apex and midV had greater oscillatory shear indices (OSI) than the base. To investigate regional phenotype, endocardial endothelial cells (EEC) were isolated from an additional 8 pigs and RNA sequencing was performed. A false discovery rate of 0.10 identified 1051 differentially expressed genes between the base and apex, and 321 between base and midV. Pathway analyses revealed apical upregulation of genes associated with translation initiation. Furthermore, tissue factor pathway inhibitor (TFPI; mean 50-fold) and prostacyclin synthase (PTGIS; 5-fold), genes prominently associated with antithrombotic protection, were consistently upregulated in LV apex. These spatio-temporal WSS values in defined regions of the left ventricle link local hemodynamics to regional heterogeneity in endocardial gene expression.
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Affiliation(s)
- Margaret E McCormick
- Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Elisabetta Manduchi
- Institute for Biomedical Informatics and Departments of, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Yi-Zhou Jiang
- Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian J Stoeckert
- Institute for Biomedical Informatics and Departments of, University of Pennsylvania, Philadelphia, PA, USA; Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alex J Barker
- Departments of Radiology, Northwestern University, Chicago, IL, USA
| | - Samuel Yoon
- Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Markl
- Departments of Radiology, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Peter F Davies
- Institute for Medicine and Engineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Accuracy and limitations of vector flow mapping: left ventricular phantom validation using stereo particle image velocimetory. J Echocardiogr 2016; 15:57-66. [PMID: 27848215 PMCID: PMC5429903 DOI: 10.1007/s12574-016-0321-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/11/2016] [Accepted: 10/24/2016] [Indexed: 10/26/2022]
Abstract
BACKGROUND The accuracy of vector flow mapping (VFM) was investigated in comparison to stereo particle image velocimetry (stereo-PIV) measurements using a left ventricular phantom. VFM is an echocardiographic approach to visualizing two-dimensional flow dynamics by estimating the azimuthal component of flow from the mass-conservation equation. VFM provides means of visualizing cardiac flow, but there has not been a study that compared the flow estimated by VFM to the flow data acquired by other methods. METHODS A reproducible three-dimensional cardiac blood flow was created in an optically and acoustically transparent left-ventricle phantom, that allowed color-flow mapping (CFM) data and stereo-PIV to be simultaneously acquired on the same plane. A VFM algorithm was applied to the CFM data, and the resulting VFM estimation and stereo-PIV data were compared to evaluate the accuracy of VFM. RESULTS The velocity fields acquired by VFM and stereo-PIV were in excellent agreement in terms of the principle flow features and time-course transitions of the main vortex characteristics, i.e., the overall correlation of VFM and PIV vectors was R = 0.87 (p < 0.0001). The accuracy of VFM was suggested to be influenced by both CFM signal resolution and the three-dimensional flow, which violated the algorithm's assumption of planar flow. Statistical analysis of the vectors revealed a standard deviation of discrepancy averaging at 4.5% over the CFM velocity range for one cardiac cycle, and that value fluctuated up to 10% depending on the phase of the cardiac cycle. CONCLUSIONS VFM provided fairly accurate two-dimensional-flow information on cardio-hemodynamics. These findings on VFM accuracy provide the basis for VFM-based diagnosis.
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Left Atrial 4-Dimensional Flow Magnetic Resonance Imaging: Stasis and Velocity Mapping in Patients With Atrial Fibrillation. Invest Radiol 2016; 51:147-54. [PMID: 26488375 DOI: 10.1097/rli.0000000000000219] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Left atrial (LA) 4-dimensional flow magnetic resonance imaging (MRI) was used to derive anatomic maps of LA stasis, peak velocity, and time-to-peak (TTP) velocity in patients with atrial fibrillation (AF) and to identify relationships between LA flow with LA volume and patient characteristics. MATERIALS AND METHODS Four-dimensional flow MRI for the in vivo assessment of time-resolved 3-dimensional LA blood flow velocities was performed in 111 subjects: 42 patients with a history of AF and in sinus rhythm (AF-sinus), 39 patients with persistent AF (AF-afib), 10 young healthy volunteers (HVs), and 20 age-appropriate controls (CTRL). Data analysis included the 3-dimensional segmentation of the LA and the calculation of LA stasis, peak velocity, and TTP maps. Regional LA flow dynamics were quantified by calculating mean stasis, peak velocity, and TTP in the LA center region and the region adjacent to the LA wall. RESULTS A sensitivity analysis identified thresholds for global LA stasis (<0.1 m/s) and peak velocity (top 5% LA velocities), which detected significant differences between AF patients and controls for global LA stasis (HV, 25% ± 5%; CTRL, 29% ± 10%; AF-sinus, 41% ± 13%; AF-afib, 52% ± 17%) and peak velocity (HV, 0.43 ± 0.02 m/s; CTRL, 0.37 ± 0.04 m/s; AF-sinus, 0.33 ± 0.05 m/s; AF-afib, 0.30 ± 0.05 m/s). Regional analysis revealed significantly increased stasis at both LA center and wall for AF patients compared with age-appropriate controls (29%-84% difference, P < 0.006) and for AF-afib versus AF-sinus patients (22%-30% difference, P < 0.004). In addition, stasis close to the LA wall was significantly elevated (P < 0.001) compared with the LA center for all subject groups. Multiple regressions revealed significant (RAdj = 0.45-0.50, P < 0.001) relationships between impaired global LA flow (reduced velocity and increased stasis) with age (|β| = 0.27-0.50, P < 0.002) and LA volume (|β| = 0.26-0.50, P < 0.003). CONCLUSIONS Atrial 4-dimensional flow MRI detected changes in global and regional LA flow dynamics associated with AF, age, and LA volume. Longitudinal studies are needed to test the diagnostic value of LA flow metrics as potential risk factors for thromboembolic events.
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Svalbring E, Fredriksson A, Eriksson J, Dyverfeldt P, Ebbers T, Bolger AF, Engvall J, Carlhäll CJ. Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI. PLoS One 2016; 11:e0161391. [PMID: 27532640 PMCID: PMC4988651 DOI: 10.1371/journal.pone.0161391] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/04/2016] [Indexed: 01/24/2023] Open
Abstract
AIMS 4D flow magnetic resonance imaging (MRI) allows quantitative assessment of left ventricular (LV) function according to characteristics of the dynamic flow in the chamber. Marked abnormalities in flow components' volume and kinetic energy (KE) have previously been demonstrated in moderately dilated and depressed LV's compared to healthy subjects. We hypothesized that these 4D flow-based measures would detect even subtle LV dysfunction and remodeling. METHODS AND RESULTS We acquired 4D flow and morphological MRI data from 26 patients with chronic ischemic heart disease with New York Heart Association (NYHA) class I and II and with no to mild LV systolic dysfunction and remodeling, and from 10 healthy controls. A previously validated method was used to separate the LV end-diastolic volume (LVEDV) into functional components: direct flow, which passes directly to ejection, and non-ejecting flow, which remains in the LV for at least 1 cycle. The direct flow and non-ejecting flow proportions of end-diastolic volume and KE were assessed. The proportions of direct flow volume and KE fell with increasing LVEDV-index (LVEDVI) and LVESV-index (LVESVI) (direct flow volume r = -0.64 and r = -0.74, both P<0.001; direct flow KE r = -0.48, P = 0.013, and r = -0.56, P = 0.003). The proportions of non-ejecting flow volume and KE rose with increasing LVEDVI and LVESVI (non-ejecting flow volume: r = 0.67 and r = 0.76, both P<0.001; non-ejecting flow KE: r = 0.53, P = 0.005 and r = 0.52, P = 0.006). The proportion of direct flow volume correlated moderately to LVEF (r = 0.68, P < 0.001) and was higher in a sub-group of patients with LVEDVI >74 ml/m2 compared to patients with LVEDVI <74 ml/m2 and controls (both P<0.05). CONCLUSION Direct flow volume and KE proportions diminish with increased LV volumes, while non-ejecting flow proportions increase. A decrease in direct flow volume and KE at end-diastole proposes that alterations in these novel 4D flow-specific markers may detect LV dysfunction even in subtle or subclinical LV remodeling.
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Affiliation(s)
- Emil Svalbring
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Alexandru Fredriksson
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Jonatan Eriksson
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jan Engvall
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, 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
| | - Carl-Johan Carlhäll
- Department of Medical and Health Sciences, Division of Cardiovascular Medicine, 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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43
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Suwa K, Saitoh T, Takehara Y, Sano M, Saotome M, Urushida T, Katoh H, Satoh H, Sugiyama M, Wakayama T, Alley M, Sakahara H, Hayashi H. Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: Analysis with 3D cine phase contrast MRI (4D-Flow). J Magn Reson Imaging 2016; 44:1493-1503. [PMID: 27185516 DOI: 10.1002/jmri.25315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/01/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To examine how left ventricular (LV) volume and function affect flow dynamics by analyzing 3D intra-LV vortex features using 4D-Flow. MATERIALS AND METHODS Twenty-one patients with preserved (LVEF > 60%) and 14 with impaired LV function (LVEF < 40%) underwent 4D-Flow (at 3T). RESULTS In patients with preserved LV function, the intra-LV vortices developed in both the early and late diastolic phases. The shift of inflow vectors at the basal LV toward the posterior-lateral side of the LV and the mid-ventricular turn of inflow vectors toward the LV outflow could explain clearer vortex formation in the late diastolic phase. In patients with impaired LV function, the intra-LV vortices during the diastolic phase located at the more apical LV were larger and more spherically shaped. Both the distance to the vortex core and the vortex area correlated significantly with LV end-diastolic volume (r = 0.66 and 0.73), LVEF (r = -0.74 and -0.68), LV sphericity index (r = -0.60 and -0.65), and peak filling rate (r = -0.61 and -0.64), respectively (P < 0.01). The intra-LV vortices developed during the systolic phase in 10 cases. In those, some of the particles at the apical LV rotated within the LV, whereas in patients with preserved LV function, all of the particles were directed straight to the ascending aorta with accelerated flow velocity (256.8 ± 120.2 cm/s vs. 414.3 ± 88.2 cm/s, P < 0.01). CONCLUSION Vortex formation during the diastolic phase may be critical for both LV filling and ejection. 4D-Flow showed the 3D alterations of intra-LV flow dynamics by LV dilatation and dysfunction in a noninvasive and comprehensive manner. J. Magn. Reson. Imaging 2016;44:1493-1503.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeji Saitoh
- Department of Emergency Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuo Takehara
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Sano
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masao Saotome
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tsuyoshi Urushida
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideki Katoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masataka Sugiyama
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Wakayama
- Applied Science Laboratory Asia Pacific, GE Healthcare Japan, Hino, Tokyo, Japan
| | - Marcus Alley
- Division of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Harumi Sakahara
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideharu Hayashi
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
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44
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McCormick ME, Manduchi E, Witschey WRT, Gorman RC, Gorman JH, Jiang YZ, Stoeckert CJ, Barker AJ, Markl M, Davies PF. Integrated Regional Cardiac Hemodynamic Imaging and RNA Sequencing Reveal Corresponding Heterogeneity of Ventricular Wall Shear Stress and Endocardial Transcriptome. J Am Heart Assoc 2016; 5:e003170. [PMID: 27091183 PMCID: PMC4859290 DOI: 10.1161/jaha.115.003170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Unlike arteries, in which regionally distinct hemodynamics are associated with phenotypic heterogeneity, the relationships between endocardial endothelial cell phenotype and intraventricular flow remain largely unexplored. We investigated regional differences in left ventricular wall shear stress and their association with endocardial endothelial cell gene expression. Methods and Results Local wall shear stress was calculated from 4‐dimensional flow magnetic resonance imaging in 3 distinct regions of human (n=8) and pig (n=5) left ventricle: base, adjacent to the outflow tract; midventricle; and apex. In both species, wall shear stress values were significantly lower in the apex and midventricle relative to the base; oscillatory shear index was elevated in the apex. RNA sequencing of the endocardial endothelial cell transcriptome in pig left ventricle (n=8) at a false discovery rate ≤10% identified 1051 genes differentially expressed between the base and the apex and 327 between the base and the midventricle; no differentially expressed genes were detected at this false discovery rate between the apex and the midventricle. Enrichment analyses identified apical upregulation of genes associated with translation initiation including mammalian target of rapamycin, and eukaryotic initiation factor 2 signaling. Genes of mitochondrial dysfunction and oxidative phosphorylation were also consistently upregulated in the left ventricular apex, as were tissue factor pathway inhibitor (mean 50‐fold) and prostacyclin synthase (5‐fold)—genes prominently associated with antithrombotic protection. Conclusions We report the first spatiotemporal measurements of wall shear stress within the left ventricle and linked regional hemodynamics to heterogeneity in ventricular endothelial gene expression, most notably to translation initiation and anticoagulation properties in the left ventricular apex, in which oscillatory shear index is increased and wall shear stress is decreased.
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Affiliation(s)
- Margaret E McCormick
- Institute for Medicine and Engineering, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elisabetta Manduchi
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Walter R T Witschey
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert C Gorman
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph H Gorman
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yi-Zhou Jiang
- Institute for Medicine and Engineering, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christian J Stoeckert
- Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, IL
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL Department of Biomedical Engineering, Northwestern University, Chicago, IL
| | - Peter F Davies
- Institute for Medicine and Engineering, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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45
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Wong J, Chabiniok R, deVecchi A, Dedieu N, Sammut E, Schaeffter T, Razavi R. Age-related changes in intraventricular kinetic energy: a physiological or pathological adaptation? Am J Physiol Heart Circ Physiol 2016; 310:H747-55. [PMID: 26747496 PMCID: PMC4867343 DOI: 10.1152/ajpheart.00075.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 01/08/2016] [Indexed: 11/22/2022]
Abstract
Measuring intracardiac kinetic energy using four-dimensionl flow cardiac magnetic resonance provides important information on the decline in the early diastolic kinetic energy of blood with aging. The decline is comparable with that seen in those with heart failure and may be a marker of cardiac function. Aging has important deleterious effects on the cardiovascular system. We sought to compare intraventricular kinetic energy (KE) in healthy subjects of varying ages with subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. Four-dimensional flow MRI was acquired in 35 healthy subjects (age: 1–67 yr) and 10 patients with left ventricular (LV) dysfunction (age: 28–79 yr). Healthy subjects were divided into age quartiles (1st quartile: <16 yr, 2nd quartile: 17–32 yr, 3rd quartile: 33–48 yr, and 4th quartile: 49–64 yr). KE was measured in the LV throughout the cardiac cycle and indexed to ventricular volume. In healthy subjects, two large peaks corresponding to systole and early diastole occurred during the cardiac cycle. A third smaller peak was seen during late diastole in eight adults. Systolic KE (P = 0.182) and ejection fraction (P = 0.921) were preserved through all age groups. Older adults showed a lower early peak diastolic KE compared with children (P < 0.0001) and young adults (P = 0.025). Subjects with LV dysfunction had reduced ejection fraction (P < 0.001) and compared with older healthy adults exhibited a similar early peak diastolic KE (P = 0.142) but with the addition of an elevated KE in diastasis (P = 0.029). In healthy individuals, peak diastolic KE progressively decreases with age, whereas systolic peaks remain constant. Peak diastolic KE in the oldest subjects is comparable to those with LV dysfunction. Unique age-related changes in ventricular diastolic energetics might be physiological or herald subclinical pathology.
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Affiliation(s)
- James Wong
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Radomir Chabiniok
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom; Inria and Paris-Saclay University, Palaiseau, France
| | - Adelaide deVecchi
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Nathalie Dedieu
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Eva Sammut
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Tobias Schaeffter
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom
| | - Reza Razavi
- Department of Imaging Sciences, Kings College London, St Thomas' Hospital, London, United Kingdom;
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46
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Hirtler D, Garcia J, Barker AJ, Geiger J. Assessment of intracardiac flow and vorticity in the right heart of patients after repair of tetralogy of Fallot by flow-sensitive 4D MRI. Eur Radiol 2016; 26:3598-607. [PMID: 26747260 DOI: 10.1007/s00330-015-4186-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/22/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To comprehensively and quantitatively analyse flow and vorticity in the right heart of patients after repair of tetralogy of Fallot (rTOF) compared with healthy volunteers. METHODS Time-resolved flow-sensitive 4D MRI was acquired in 24 rTOF patients and 12 volunteers. Qualitative flow evaluation was based on consensus reading of two observers. Quantitative analysis included segmentation of the right atrium (RA) and ventricle (RV) in a four-chamber view to extract volumes and regional haemodynamic information for computation of regional mean and peak vorticity. RESULTS Right heart intra-atrial, intraventricular and outflow tract flow patterns differed considerably between rTOF patients and volunteers. Peak RA and mean RV vorticity was significantly higher in patients (p = 0.02/0.05). Significant negative correlations were found between patients' maximum and mean RV and RA vorticity and ventricular volumes (p < 0.05). The main pulmonary artery (MPA) regurgitant flow was associated with higher RA and RV vorticity, which was significant for RA maximum and RV mean vorticity (p = 0.01/0.03). CONCLUSION The calculation of vorticity based on 4D flow data is an alternative approach to assess intracardiac flow changes in rTOF patients compared with qualitative flow visualization. Alterations in intracardiac vorticity could be relevant with regard to the development of RV dilation and impaired function. KEY POINTS • 4D flow MRI with vorticity calculation enables a novel approach to assess intracardiac flow. • Significantly higher intracardiac vorticity occurred in patients after repair of tetralogy of Fallot. • Regurgitant flow in the main pulmonary artery is associated with higher right heart vorticity.
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Affiliation(s)
- Daniel Hirtler
- Department of Congenital Heart Defects and Pediatric Cardiology (Heart Center, University of Freiburg), University Hospital Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany.
| | - Julio Garcia
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia Geiger
- Department of Radiology, University Childrens' Hospital Zurich, Zurich, Switzerland
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47
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Steding-Ehrenborg K, Arvidsson PM, Töger J, Rydberg M, Heiberg E, Carlsson M, Arheden H. Determinants of kinetic energy of blood flow in the four-chambered heart in athletes and sedentary controls. Am J Physiol Heart Circ Physiol 2016; 310:H113-22. [DOI: 10.1152/ajpheart.00544.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 11/22/2022]
Abstract
The kinetic energy (KE) of intracardiac blood may play an important role in cardiac function. The aims of the present study were to 1) quantify and investigate the determinants of KE, 2) compare the KE expenditure of intracardiac blood between athletes and control subjects, and 3) quantify the amount of KE inside and outside the diastolic vortex. Fourteen athletes and fourteen volunteers underwent cardiac MRI, including four-dimensional phase-contrast sequences. KE was quantified in four chambers, and energy expenditure was calculated by determining the mean KE/cardiac index. Left ventricular (LV) mass was an independent predictor of diastolic LVKE ( R2= 0.66, P < 0.001), whereas right ventricular (RV) end-diastolic volume was important for diastolic RVKE ( R2= 0.76, P < 0.001). The mean KE/cardiac index did not differ between groups (control subjects: 0.53 ± 0.14 mJ·l−1·min·m2and athletes: 0.56 ± 0.21 mJ·l−1·min·m2, P = 0.98). Mean LV diastolic vortex KE made up 70 ± 1% and 73 ± 2% of total LV diastolic KE in athletes and control subjects ( P = 0.18). In conclusion, the characteristics of the LV as a pressure pump and the RV as a volume pump are demonstrated as an association between LVKE and LV mass and between RVKE and end-diastolic volume. This also suggests different filling mechanisms where the LV is dependent on diastolic suction, whereas the RV fills with a basal movement of the atrioventricular plane over “stationary” blood. Both groups had similar energy expenditure for intracardiac blood flow, indicating similar pumping efficiency, likely explained by the lower heart rate that cancels the higher KE per heart beat in athletes. The majority of LVKE is found within the LV diastolic vortex, in contrast to earlier findings.
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Affiliation(s)
- K. Steding-Ehrenborg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - P. M. Arvidsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - J. Töger
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - M. Rydberg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - E. Heiberg
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - M. Carlsson
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
| | - H. Arheden
- Department of Clinical Physiology, Lund University, Lund University Hospital Lund, Lund, Sweden
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48
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Töger J, Kanski M, Arvidsson PM, Carlsson M, Kovács SJ, Borgquist R, Revstedt J, Söderlind G, Arheden H, Heiberg E. Vortex-ring mixing as a measure of diastolic function of the human heart: Phantom validation and initial observations in healthy volunteers and patients with heart failure. J Magn Reson Imaging 2015; 43:1386-97. [PMID: 26663607 DOI: 10.1002/jmri.25111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/17/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present and validate a new method for 4D flow quantification of vortex-ring mixing during early, rapid filling of the left ventricle (LV) as a potential index of diastolic dysfunction and heart failure. MATERIALS AND METHODS 4D flow mixing measurements were validated using planar laser-induced fluorescence (PLIF) in a phantom setup. Controls (n = 23) and heart failure patients (n = 23) were studied using 4D flow at 1.5T (26 subjects) or 3T (20 subjects) to determine vortex volume (VV) and inflowing volume (VVinflow ). The volume mixed into the vortex-ring was quantified as VVmix-in = VV-VVinflow . The mixing ratio was defined as MXR = VVmix-in /VV. Furthermore, we quantified the fraction of the end-systolic volume (ESV) mixed into the vortex-ring (VVmix-in /ESV) and the fraction of the LV volume at diastasis (DV) occupied by the vortex-ring (VV/DV). RESULTS PLIF validation of MXR showed fair agreement (R(2) = 0.45, mean ± SD 1 ± 6%). MXR was higher in patients compared to controls (28 ± 11% vs. 16 ± 10%, P < 0.001), while VVmix-in /ESV and VV/DV were lower in patients (10 ± 6% vs. 18 ± 12%, P < 0.01 and 25 ± 8% vs. 50 ± 6%, P < 0.0001). CONCLUSION Vortex-ring mixing can be quantified using 4D flow. The differences in mixing parameters observed between controls and patients motivate further investigation as indices of diastolic dysfunction. J. Magn. Reson. Imaging 2016;43:1386-1397.
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Affiliation(s)
- Johannes Töger
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.,Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Mikael Kanski
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Per M Arvidsson
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Sándor J Kovács
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rasmus Borgquist
- Department of Arrhythmias, Lund University Hospital, Lund, Lund University, Lund, Sweden
| | - Johan Revstedt
- Department of Energy Sciences, Faculty of Engineering, Lund University, Sweden
| | - Gustaf Söderlind
- Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University Hospital, Lund University, Lund, Sweden.,Department of Numerical Analysis, Centre for Mathematical Sciences, Lund University, Lund, Sweden.,Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
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49
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Lee DC, Markl M, Ng J, Carr M, Benefield B, Carr JC, Goldberger JJ. Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR. Eur Heart J Cardiovasc Imaging 2015; 17:1259-1268. [PMID: 26590397 DOI: 10.1093/ehjci/jev304] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/21/2015] [Indexed: 12/15/2022] Open
Abstract
AIMS To apply 4D flow cardiac magnetic resonance (CMR) for the volumetric measurement of 3D left atrial (LA) blood flow to evaluate its potential to detect altered LA flow in patients with atrial fibrillation (AF) and to investigate associations of changes in systolic and diastolic LA flow with the current clinical risk score (CHA2DS2-VASc) used for the assessment of thromboembolic risk in AF. METHODS AND RESULTS 4D flow CMR was performed in 40 patients with a history of AF (in sinus rhythm during CMR scan, age = 61 ± 11 years), 20 age-appropriate controls (59 ± 7 years), and 10 young healthy volunteers (24 ± 2 years) to measure in vivo time-resolved 3D LA blood flow. LA velocities were characterized with respect to atrial function and timing by calculating normalized LA flow velocity histograms during ventricular systole, early diastole, mid-late diastole, and the entire cardiac cycle. Mean, median, and peak LA velocity steadily decreased when comparing young volunteers, age-appropriate controls, and AF patients by 10-44% and 8-26% for early diastole and the entire cardiac cycle, respectively (P < 0.01 for all comparisons except median velocity for young vs. older volunteers and peak velocity for older volunteers and AF patients). There were moderate but significant inverse relationships between increased CHA2DS2-VASc score and reduced mean LA velocity (early diastole: r = -0.37, P < 0.001; entire RR-interval: r = -0.33, P = 0.005), median LA velocity (r = -0.33, P = 0.003; r = -0.25, P = 0.017), and peak velocity (r = -0.36, P = 0.001; r = -0.45, P < 0.001). LA flow indices also correlated significantly with age and LA volume (R2 = 0.44-0.62, P < 0.001), but not with left ventricular ejection fraction. CONCLUSION Left atrial 4D flow CMR demonstrated significantly reduced LA blood flow velocities in patients with AF. Further study is needed to determine whether these measures can improve upon the CHA2DS2-VASc score for stroke risk prediction and enhance individual decisions on anticoagulation in patients with AF.
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Affiliation(s)
- Daniel C Lee
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Avenue Suite 1600, Chicago, IL 60611, USA.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Avenue Suite 1600, Chicago, IL 60611, USA .,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Jason Ng
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Brandon Benefield
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Jeffrey J Goldberger
- Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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50
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Goldberger JJ, Arora R, Green D, Greenland P, Lee DC, Lloyd-Jones DM, Markl M, Ng J, Shah SJ. Evaluating the Atrial Myopathy Underlying Atrial Fibrillation: Identifying the Arrhythmogenic and Thrombogenic Substrate. Circulation 2015. [PMID: 26216085 DOI: 10.1161/circulationaha.115.016795] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial disease or myopathy forms the substrate for atrial fibrillation (AF) and underlies the potential for atrial thrombus formation and subsequent stroke. Current diagnostic approaches in patients with AF focus on identifying clinical predictors with the evaluation of left atrial size by echocardiography serving as the sole measure specifically evaluating the atrium. Although the atrial substrate underlying AF is likely developing for years before the onset of AF, there is no current evaluation to identify the preclinical atrial myopathy. Atrial fibrosis is 1 component of the atrial substrate that has garnered recent attention based on newer MRI techniques that have been applied to visualize atrial fibrosis in humans with prognostic implications regarding the success of treatment. Advanced ECG signal processing, echocardiographic techniques, and MRI imaging of fibrosis and flow provide up-to-date approaches to evaluate the atrial myopathy underlying AF. Although thromboembolic risk is currently defined by clinical scores, their predictive value is mediocre. Evaluation of stasis via imaging and biomarkers associated with thrombogenesis may provide enhanced approaches to assess risk for stroke in patients with AF. Better delineation of the atrial myopathy that serves as the substrate for AF and thromboembolic complications might improve treatment outcomes. Furthermore, better delineation of the pathophysiologic mechanisms underlying the development of the atrial substrate for AF, particularly in its earlier stages, could help identify blood and imaging biomarkers that could be useful to assess risk for developing new-onset AF and suggest specific pathways that could be targeted for prevention.
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Affiliation(s)
- Jeffrey J Goldberger
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Rishi Arora
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Green
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Philip Greenland
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel C Lee
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Donald M Lloyd-Jones
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Markl
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jason Ng
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sanjiv J Shah
- From Division of Cardiology (J.J.G., R.A., D.C.L., J.N., S.J.S.) and Division of Hematology (D.G.), Department of Medicine, Department of Preventive Medicine (P.G., D.M.L.-J.), and Department of Radiology (M.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
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