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Mehmood Z, Assadi H, Li R, Kasmai B, Matthews G, Grafton-Clarke C, Sanz-Cepero A, Zhao X, Zhong L, Aung N, Skinner K, Hadinnapola C, Swoboda P, Swift AJ, Vassiliou VS, Miller C, van der Geest RJ, Peterson S, Garg P. Aortic flow is abnormal in HFpEF. Wellcome Open Res 2024; 8:577. [PMID: 38495400 PMCID: PMC10940846 DOI: 10.12688/wellcomeopenres.20192.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Aims Turbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF. Methods This case-controlled observational study used four-dimensional flow cardiovascular magnetic resonance derived, two-dimensional phase-contrast reformatted plane data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10). Results Differences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001). Conclusion Aortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.
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Affiliation(s)
- Zia Mehmood
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Hosamadin Assadi
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Rui Li
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Bahman Kasmai
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Ciaran Grafton-Clarke
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Aureo Sanz-Cepero
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Xiaodan Zhao
- National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Liang Zhong
- National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
- Cardiovascular Sciences Academic Clinical Program & Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore, 169857, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
| | - Kristian Skinner
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Charaka Hadinnapola
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Peter Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Christopher Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rob J. van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Steffen Peterson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
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2
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Nico E, Hossa J, McGuire LS, Alaraj A. Rupture-Risk Stratifying Patients with Cerebral Arteriovenous Malformations Using Quantitative Hemodynamic Flow Measurements. World Neurosurg 2023; 179:68-76. [PMID: 37597662 DOI: 10.1016/j.wneu.2023.08.047] [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: 05/17/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Arteriovenous malformations (AVMs) are high-pressure, low-resistance arterial-venous shunts without intervening capillaries. Up to 60% of AVMs present with an intracranial hemorrhage; however, noninvasive neuroimaging has increasingly diagnosed incidental AVMs. AVM management depends on weighing the lifetime rupture risk against the risks of intervention. Although AVM rupture risk relies primarily on angioarchitectural features, measuring hemodynamic flow is gaining traction. Accurate understanding of AVM hemodynamic flow parameters will help endovascular neurosurgeons and interventional neuroradiologists stratify patients by rupture risk and select treatment plans. This review examines various neuroimaging modalities and their capabilities to quantify AVM flow, as well as the relationship between AVM flow and rupture risk. Quantitative hemodynamic studies on the relationship between AVM flow and rupture risk have not reached a clear consensus; however, the preponderance of data suggests that higher arterial inflow and lower venous outflow in the AVM nidus contribute to increased hemorrhagic risk. Future studies should consider using larger sample sizes and standardized definitions of hemodynamic parameters to reach a consensus. In the meantime, classic angioarchitectural features may be more strongly correlated with AVM rupture than the amount of blood flow.
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Affiliation(s)
- Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jessica Hossa
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois Hospital, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Hospital, Chicago, Illinois, USA.
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3
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Azarnoosh J, Ghorbannia A, Ibrahim ESH, Jurkiewicz H, Kalvin L, LaDisa JF. Temporal evolution of mechanical stimuli from vascular remodeling in response to the severity and duration of aortic coarctation in a preclinical model. Sci Rep 2023; 13:8352. [PMID: 37221191 PMCID: PMC10205817 DOI: 10.1038/s41598-023-34400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Coarctation of the aorta (CoA) is one of the most common congenital cardiovascular diseases. CoA patients frequently undergo surgical repair, but hypertension (HTN) is still common. The current treatment guideline has revealed irreversible changes in structure and function, yet revised severity guidelines have not been proposed. Our objective was to quantify temporal alterations in mechanical stimuli and changes in arterial geometry in response to the range of CoA severities and durations (i.e. age of treatment) seen clinically. Rabbits were exposed to CoA resulting in peak-to-peak blood pressure gradient (BPGpp) severities of ≤ 10, 10-20, and ≥ 20 mmHg for a duration of ~ 1, 3, or 20 weeks using permanent, dissolvable, and rapidly dissolvable sutures. Elastic moduli and thickness were estimated from imaging and longitudinal fluid-structure interaction (FSI) simulations were conducted at different ages using geometries and boundary conditions from experimentally measured data. Mechanical stimuli were characterized including blood flow velocity patterns, wall tension, and radial strain. Experimental results show vascular alternations including thickening and stiffening proximal to the coarctation with increasing severity and/or duration of CoA. FSI simulations indicate wall tension in the proximal region increases markedly with coarctation severity. Importantly, even mild CoA induced stimuli for remodeling that exceeds values seen in adulthood if not treated early and using a BPGpp lower than the current clinical threshold. The findings are aligned with observations from other species and provide some guidance for the values of mechanical stimuli that could be used to predict the likelihood of HTN in human patients with CoA.
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Affiliation(s)
- Jamasp Azarnoosh
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Arash Ghorbannia
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - El-Sayed H Ibrahim
- Departments of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hilda Jurkiewicz
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lindsey Kalvin
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John F LaDisa
- Department of Pediatrics - Section of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Medicine - Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Departments of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
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4
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Calò K, Capellini K, De Nisco G, Mazzi V, Gasparotti E, Gallo D, Celi S, Morbiducci U. Impact of wall displacements on the large-scale flow coherence in ascending aorta. J Biomech 2023; 154:111620. [PMID: 37178494 DOI: 10.1016/j.jbiomech.2023.111620] [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: 01/09/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
In the context of aortic hemodynamics, uncertainties affecting blood flow simulations hamper their translational potential as supportive technology in clinics. Computational fluid dynamics (CFD) simulations under rigid-walls assumption are largely adopted, even though the aorta contributes markedly to the systemic compliance and is characterized by a complex motion. To account for personalized wall displacements in aortic hemodynamics simulations, the moving-boundary method (MBM) has been recently proposed as a computationally convenient strategy, although its implementation requires dynamic imaging acquisitions not always available in clinics. In this study we aim to clarify the real need for introducing aortic wall displacements in CFD simulations to accurately capture the large-scale flow structures in the healthy human ascending aorta (AAo). To do that, the impact of wall displacements is analyzed using subject-specific models where two CFD simulations are performed imposing (1) rigid walls, and (2) personalized wall displacements adopting a MBM, integrating dynamic CT imaging and a mesh morphing technique based on radial basis functions. The impact of wall displacements on AAo hemodynamics is analyzed in terms of large-scale flow patterns of physiological significance, namely axial blood flow coherence (quantified applying the Complex Networks theory), secondary flows, helical flow and wall shear stress (WSS). From the comparison with rigid-wall simulations, it emerges that wall displacements have a minor impact on the AAo large-scale axial flow, but they can affect secondary flows and WSS directional changes. Overall, helical flow topology is moderately affected by aortic wall displacements, whereas helicity intensity remains almost unchanged. We conclude that CFD simulations with rigid-wall assumption can be a valid approach to study large-scale aortic flows of physiological significance.
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Affiliation(s)
- Karol Calò
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Katia Capellini
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Giuseppe De Nisco
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Valentina Mazzi
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Emanuele Gasparotti
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy
| | - Simona Celi
- BioCardioLab, Bioengineering Unit - Heart Hospital, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy; PoliTo(BIO)Med Lab, Politecnico di Torino, Turin, Italy.
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5
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Moretti S, Tauro F, Orrico M, Mangialardi N, Facci AL. Comparative Analysis of Patient-Specific Aortic Dissections through Computational Fluid Dynamics Suggests Increased Likelihood of Degeneration in Partially Thrombosed False Lumen. Bioengineering (Basel) 2023; 10:bioengineering10030316. [PMID: 36978707 PMCID: PMC10045026 DOI: 10.3390/bioengineering10030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Aortic dissection is a life-threatening vascular disease associated with high rates of morbidity and mortality, especially in medically underserved communities. Understanding patients’ blood flow patterns is pivotal for informing evidence-based treatment as they greatly influence the disease outcome. The present study investigates the flow patterns in the false lumen of three aorta dissections (fully perfused, partially thrombosed, and fully thrombosed) in the chronic phase, and compares them to a healthy aorta. Three-dimensional geometries of aortic true and false lumens (TLs and FLs) are reconstructed through an ad hoc developed and minimally supervised image analysis procedure. Computational fluid dynamics (CFD) is performed through a finite volume unsteady Reynolds-averaged Navier–Stokes approach assuming rigid wall aortas, Newtonian and homogeneous fluid, and incompressible flow. In addition to flow kinematics, we focus on time-averaged wall shear stress and oscillatory shear index that are recognized risk factors for aneurysmal degeneration. Our analysis shows that partially thrombosed dissection is the most prone to false lumen degeneration. In all dissections, the arteries connected to the false lumen are generally poorly perfused. Further, both true and false lumens present higher turbulence levels than the healthy aorta, and critical stagnation points. Mesh sensitivity and a thorough comparison against literature data together support the reliability of the CFD methodology. Image-based CFD simulations are efficient tools to assess the possibility of aortic dissection to lead to aneurysmal degeneration, and provide new knowledge on the hemodynamic characteristics of dissected versus healthy aortas. Similar analyses should be routinely included in patient-specific hemodynamics investigations, to plan and design tailored therapeutic strategies, and to timely assess their effectiveness.
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Affiliation(s)
- Simona Moretti
- DEIM Department of Economics, Engineering, Society and Business Administration, University of Tuscia, Largo dell’Università, 01100 Viterbo, Italy
| | - Flavia Tauro
- DIBAF Department for Innovation in Biological, Agro-Food and Forest Systems, University of Tuscia, Via San Camillo de Lellis, 01100 Viterbo, Italy
- Correspondence: ; Tel.: +39-0761-357355
| | - Matteo Orrico
- Vascular and Endovascular Surgery Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00149 Roma, Italy
| | - Nicola Mangialardi
- Vascular and Endovascular Surgery Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00149 Roma, Italy
| | - Andrea Luigi Facci
- DEIM Department of Economics, Engineering, Society and Business Administration, University of Tuscia, Largo dell’Università, 01100 Viterbo, Italy
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6
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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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7
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Njoku P, Wardley J, Garg P. Streamline-based three-dimensional peak-velocity tracing of transvalvular flow using four-dimensional flow cardiac magnetic resonance imaging for left ventricular diastolic assessment in aortic regurgitation: a case report. J Med Case Rep 2022; 16:205. [PMID: 35570306 PMCID: PMC9109406 DOI: 10.1186/s13256-022-03422-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Doppler transthoracic echocardiography is routinely performed to measure peak mitral inflow velocities in the assessment of left ventricular diastolic function. The limitations of echocardiography are well documented, but its accuracy in the measurement of transmitral peak velocity in the presence of aortic valve regurgitation has not yet been compared with four-dimensional flow cardiac magnetic resonance imaging. Four-dimensional flow cardiac magnetic resonance imaging offers time-resolved cross-sectional velocity information that can be used to investigate mitral inflow peak velocity. We present a case report demonstrating the potential superior capabilities of four-dimensional flow cardiac magnetic resonance imaging in accurately detecting mitral inflow velocities over Doppler echocardiography in patients with aortic regurgitation. CASE PRESENTATION A 67-year-old Caucasian female presented to our outpatient cardiology clinic with exertional dyspnea. Doppler transthoracic echocardiography identified moderate to severe aortic regurgitation. Mapping of mitral inflow peak velocities proved challenging with Doppler echocardiography. Additionally, four-dimensional flow cardiac magnetic resonance imaging with automated three-dimensional flow streamlines was performed, which allowed for more accurate detection of mitral inflow peak velocities. CONCLUSIONS Doppler echocardiography has a limited role in mitral inflow assessment where aortic regurgitation is present. In such cases, four-dimensional flow cardiac magnetic resonance imaging is an alternative imaging technique that may circumvent this issue and allow mitral inflow assessment.
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Affiliation(s)
- Paul Njoku
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - James Wardley
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Pankaj Garg
- Cardiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
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8
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Abstract
This special issue of Magnetic Resonance in Medical Sciences features the most recent reviews on 4D Flow MRI. These reviews deal with the current status of the emerging technique of 4D Flow MRI facilitated in various areas that are difficult to obtain with conventional flowmetry. MR signals inherently contain flow velocity information. In previous decades, in vivo blood flow measurement was traditionally performed by 2D methods, such as Doppler ultrasonography and 2D phase-contrast MRI, which have long been regarded as mature techniques in hemodynamic flowmetry. Although 2D velocimetries have many advantages over 4D Flow MRI in terms of cost and accessibility, and provide excellent temporal and in-plane spatial resolutions, they also have some disadvantages. The emerging technology of 4D Flow MRI can overcome the shortcomings of conventional 2D imaging. In recent years, hemodynamic analysis has witnessed significant progress that is primarily attributable to advances in 4D Flow MRI.
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Affiliation(s)
- Yasuo Takehara
- Department of Fundamental Development for Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Takayuki Obata
- Applied MRI Research, Department of Molecular Imaging and Theranostics, National Institutes for Quantum Science and Technology
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9
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Kari FA, Russe MF, Schlett CL. Magnetic resonance angiography-derived flow parameters to assess thoracic aortic disease risk. Eur J Cardiothorac Surg 2021; 61:403-404. [PMID: 34893800 DOI: 10.1093/ejcts/ezab533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Medical Center-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian F Russe
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
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10
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Truedsson F, Polte CL, Gao SA, Johnsson ÅA, Bech-Hanssen O, Lagerstrand KM. Importance of complex blood flow in the assessment of aortic regurgitation severity using phase contrast magnetic resonance imaging. Int J Cardiovasc Imaging 2021; 37:3561-3572. [PMID: 34273066 PMCID: PMC8604828 DOI: 10.1007/s10554-021-02341-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate if and how complex flow influences the assessment of aortic regurgitation (AR) using phase contrast MRI in patients with chronic AR. Patients with moderate (n = 15) and severe (n = 28) chronic AR were categorized into non-complex flow (NCF) or complex flow (CF) based on the presence of systolic backward flow volume. Phase contrast MRI was performed repeatedly at the level of the sinotubular junction (Ao1) and 1 cm distal to the sinotubular junction (Ao2). All AR patients were assessed to have non-severe AR or severe AR (cut-off values: regurgitation volume (RVol) ≥ 60 ml and regurgitation fraction (RF) ≥ 50%) in both measurement positions. The repeatability was significantly lower, i.e. variation was larger, for patients with CF than for NCF (≥ 12 ± 12% versus ≥ 6 ± 4%, P ≤ 0.03). For patients with CF, the repeatability was significantly lower at Ao2 compared to Ao1 (≥ 21 ± 20% versus ≥ 12 ± 12%, P ≤ 0.02), as well as the assessment of regurgitation (RVol: 42 ± 34 ml versus 54 ± 42 ml, P < 0.001; RF: 30 ± 18% versus 34 ± 16%, P = 0.01). This was not the case for patients with NCF. The frequency of patients that changed in AR grade from severe to non-severe when the position of the measurement changed from Ao1 to Ao2 was higher for patients with CF compared to NCF (RVol: 5/26 (19%) versus 1/17 (6%), P = 0.2; RF: 4/26 (15%) versus 0/17 (0%), P = 0.09). Our study shows that complex flow influences the quantification of chronic AR, which can lead to underestimation of AR severity when using PC-MRI.
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Affiliation(s)
- Frida Truedsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden. .,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden. .,Sahlgrenska University Hospital, MR-Centre, Bruna stråket 13, 413 45, Gothenburg, Sweden.
| | - Christian L Polte
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Sinsia A Gao
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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11
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Komoriyama H, Kamiya K, Nagai T, Oyama-Manabe N, Tsuneta S, Kobayashi Y, Kato Y, Sarashina M, Omote K, Konishi T, Sato T, Tsujinaga S, Iwano H, Shingu Y, Wakasa S, Anzai T. Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement. J Cardiovasc Magn Reson 2021; 23:81. [PMID: 34176516 PMCID: PMC8237445 DOI: 10.1186/s12968-021-00771-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre- and post-procedural hemodynamic changes which could affect adverse outcomes in aortic stenosis (AS) patients who undergo transcatheter aortic valve replacement (TAVR) have not been well investigated. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) enables accurate analysis of blood flow dynamics such as flow velocity, flow pattern, wall shear stress (WSS), and energy loss (EL). We sought to examine the changes in blood flow dynamics of patients with severe AS who underwent TAVR. METHODS We examined 32 consecutive severe AS patients who underwent TAVR between May 2018 and June 2019 (17 men, 82 ± 5 years, median left ventricular ejection fraction 61%, 6 self-expanding valve), after excluding those without CMR because of a contraindication or inadequate imaging from the analyses. We analyzed blood flow patterns, WSS and EL in the ascending aorta (AAo), and those changes before and after TAVR using 4D flow CMR. RESULTS After TAVR, semi-quantified helical flow in the AAo was significantly decreased (1.4 ± 0.6 vs. 1.9 ± 0.8, P = 0.002), whereas vortical flow and eccentricity showed no significant changes. WSS along the ascending aortic circumference was significantly decreased in the left (P = 0.038) and left anterior (P = 0.033) wall at the basal level, right posterior (P = 0.011) and left (P = 0.010) wall at the middle level, and right (P = 0.012), left posterior (P = 0.019) and left anterior (P = 0.028) wall at the upper level. EL in the AAo was significantly decreased (15.6 [10.8-25.1 vs. 25.8 [18.6-36.2]] mW, P = 0.012). Furthermore, a significant negative correlation was observed between EL and effective orifice area index after TAVR (r = - 0.38, P = 0.034). CONCLUSIONS In severe AS patients undergoing TAVR, 4D flow CMR demonstrates that TAVR improves blood flow dynamics, especially when a larger effective orifice area index is obtained.
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Affiliation(s)
- Hirokazu Komoriyama
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshiya Kato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Miwa Sarashina
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kazunori Omote
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takao Konishi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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12
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Combining 4D Flow MRI and Complex Networks Theory to Characterize the Hemodynamic Heterogeneity in Dilated and Non-dilated Human Ascending Aortas. Ann Biomed Eng 2021; 49:2441-2453. [PMID: 34080100 PMCID: PMC8455395 DOI: 10.1007/s10439-021-02798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
Motivated by the evidence that the onset and progression of the aneurysm of the ascending aorta (AAo) is intertwined with an adverse hemodynamic environment, the present study characterized in vivo the hemodynamic spatiotemporal complexity and organization in human aortas, with and without dilated AAo, exploring the relations with clinically relevant hemodynamic and geometric parameters. The Complex Networks (CNs) theory was applied for the first time to 4D flow magnetic resonance imaging (MRI) velocity data of ten patients, five of them presenting with AAo dilation. The time-histories along the cardiac cycle of velocity-based quantities were used to build correlation-based CNs. The CNs approach succeeded in capturing large-scale coherent flow features, delimiting flow separation and recirculation regions. CNs metrics highlighted that an increasing AAo dilation (expressed in terms of the ratio between the maximum AAo and aortic root diameter) disrupts the correlation in forward flow reducing the correlation persistence length, while preserving the spatiotemporal homogeneity of secondary flows. The application of CNs to in vivo 4D MRI data holds promise for a mechanistic understanding of the spatiotemporal complexity and organization of aortic flows, opening possibilities for the integration of in vivo quantitative hemodynamic information into risk stratification and classification criteria.
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13
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Effects of Ageing on Aortic Circulation During Atrial Fibrillation; a Numerical Study on Different Aortic Morphologies. Ann Biomed Eng 2021; 49:2196-2213. [PMID: 33655419 PMCID: PMC8455405 DOI: 10.1007/s10439-021-02744-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/01/2021] [Indexed: 01/21/2023]
Abstract
Atrial fibrillation (AF) can alter intra-cardiac flow and cardiac output that subsequently affects aortic flow circulation. These changes may become more significant where they occur concomitantly with ageing. Aortic ageing is accompanied with morphological changes such as dilation, lengthening, and arch unfolding. While the recognition of AF mechanism has been the subject of numerous studies, less focus has been devoted to the aortic circulation during the AF and there is a lack of such investigation at different ages. The current work aims to address the present gap. First, we analyse aortic flow distribution in three configurations, which attribute to young, middle and old people, using geometries constructed via clinical data. We then introduce two transient inlet flow conditions representative of key AF-associated defects. Results demonstrate that both AF and ageing negatively affect flow circulation. The main consequence of concomitant occurrence is enhancement of endothelial cell activation potential (ECAP) throughout the vascular domain, mainly at aortic arch and descending thoracic aorta, which is consistent with some clinical observations. The outcome of the current study suggests that AF exacerbates the vascular defects occurred due to the ageing, which increases the possibility of cardiovascular diseases per se.
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14
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Qiu D, Peng L, Ghista DN, Wong KKL. Left Atrial Remodeling Mechanisms Associated with Atrial Fibrillation. Cardiovasc Eng Technol 2021; 12:361-372. [PMID: 33650086 DOI: 10.1007/s13239-021-00527-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Heart disease has always been one of the important diseases that endanger health and cause death. Therefore, it is particularly important to understand left atrium reconstruction and atrial fibrillation before heart image processing. The purpose of this paper is to provide an important review of the mechanisms of left atrial remodeling (LAR) associated with atrial fibrillation (AF). LAR refers to the spectrum of pathophysiological changes in (i) atrial structure and physiological function, and (ii) electric, ionic, and molecular milieu of the LA, in response to stresses imposed by conditions such as hypertension, myocardial ischemia, autonomic denervation and congestive heart failure. The main mechanisms of LAR include electrical remodeling, structural remodeling, metabolic remodeling, autonomic remodeling, neurohormones and inflammation, and other influencing factors. LAR is not only the basic mechanism of AF and heart failure, but also the pathophysiological basis of its progression. In clinical practice, AF is the most common persistent arrhythmia, and is believed to be the result of a combination of mechanisms that have triggers and maintenance mechanisms, including spontaneous ectopic pacing and multiple wavelet reentry. While LA electrophysiological, structural, and ultra-structural changes trigger AF, in turn, AF alters the LA electrical and structural properties that promote its maintenance and recurrence. Chronic AF leads to extensive changes in atrial cellular substructures, including loss of myofibrils, accumulation of glycogen, changes in mitochondrial shape and size, fragmentation of sarcoplasmic reticulum, and dispersion of nuclear chromatin. Electrical remodeling and structural remodeling of the atria during AF, involving structural changes and functional impairment of the left atrium, can lead to serious decline in left ventricular function and severe heart failure. Therefore, LAR and AF are inter-activating phenomena, and the resulting complications can cause serious disabling and fatal events. In this paper, we present (i) the mechanisms of LAR, in the form of structural, electrical, metabolic, and neurohormonal changes, and (ii) their interactive roles in initiating and maintaining AF. These in-depth understanding of the atrial remodeling mechanisms can in turn provide useful insights into the treatment of AF and heart failure.
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Affiliation(s)
- Defu Qiu
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Dhanjoo N Ghista
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University 2020 Foundation, San Jose, CA, 95126, USA
| | - Kelvin K L Wong
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, 5005, Australia.
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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15
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Zhang Z, Zhou X, Suarez-Pierre A, Lui C, Kearney S, Yeung E, Halperin H, Choi CW, Katz J. Time-Resolved Echo-Particle Image/Tracking Velocimetry Measurement of Interactions Between Native Cardiac Output and Veno-Arterial ECMO Flows. J Biomech Eng 2021; 143:021008. [PMID: 32914854 DOI: 10.1115/1.4048424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 11/08/2022]
Abstract
Determination of optimal hemodynamic and pressure-volume loading conditions for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) would benefit from understanding the impact of ECMO flow rates (QE) on the native cardiac output in the admixing zone, i.e., aortic root. This study characterizes the flow in the aortic root of a pig with severe myocardial ischemia using contrast-enhanced ultrasound particle image/tracking velocimetry (echo-PIV/PTV). New methods for data preprocessing are introduced, including autocontouring to remove surrounding tissues, followed by blind deconvolution to identify the centers of elongated bubble traces in images with low signal to noise ratio. Calibrations based on synthetic images show that this procedure increases the number of detected bubbles and reduces the error in their locations by 50%. Then, an optimized echo-PIV/PTV procedure, which integrates image enhancement with velocity measurements, is used for characterizing the time-resolved two-dimensional (2D) velocity distributions. Phase-averaged and instantaneous flow fields show that the ECMO flow rate influences the velocity and acceleration of the cardiac output during systole, and secondary flows during diastole. When QE is 3.0 L/min or higher, the cardiac ejection velocity, phase interval with open aortic valve, velocity-time integral (VTI), and mean arterial pressure (MAP) increase with decreasing QE, all indicating sufficient support. For lower QE, the MAP and VTI decrease as QE is reduced, and the deceleration during transition to diastole becomes milder. Hence, for this specific case, the optimal ECMO flow rate is 3.0 L/min.
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Affiliation(s)
- Zeng Zhang
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe b31, Baltimore, MD 21218
| | - Xun Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Cecillia Lui
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Sean Kearney
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Enoch Yeung
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287; Department of Surgery, Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840
| | - Henry Halperin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Chun Woo Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287
| | - Joseph Katz
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe 122, Baltimore, MD 21218
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16
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Edlin J, Youssefi P, Bilkhu R, Figueroa CA, Morgan R, Nowell J, Jahangiri M. Haemodynamic assessment of bicuspid aortic valve aortopathy: a systematic review of the current literature. Eur J Cardiothorac Surg 2020; 55:610-617. [PMID: 30239633 DOI: 10.1093/ejcts/ezy312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 11/12/2022] Open
Abstract
Both genetic and haemodynamic theories explain the aetiology, progression and optimal management of bicuspid aortic valve aortopathy. In recent years, the haemodynamic theory has been explored with the help of magnetic resonance imaging and computational fluid dynamics. The objective of this review was to summarize the findings of these investigations with focus on the blood flow pattern and associated variables, including flow eccentricity, helicity, flow displacement, cusp opening angle, systolic flow angle, wall shear stress (WSS) and oscillatory shear index. A structured literature review was performed from January 1990 to January 2018 and revealed the following 3 main findings: (i) the bicuspid aortic valve is associated with flow eccentricity and helicity in the ascending aorta compared to healthy and diseased tricuspid aortic valve, (ii) flow displacement is easier to obtain than WSS and has been shown to correlate with valve morphology and type of aortopathy and (iii) the stenotic bicuspid aortic valve is associated with elevated WSS along the greater curvature of the ascending aorta, where aortic dilatation and aortic wall thinning are commonly found. We conclude that new haemodynamic variables should complement ascending aorta diameter as an indicator for disease progression and the type and timing of intervention. WSS describes the force that blood flow exerts on the vessel wall as a function of viscosity and geometry of the vessel, making it a potentially more reliable marker of disease progression.
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Affiliation(s)
- Joy Edlin
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Pouya Youssefi
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Rajdeep Bilkhu
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Carlos Alberto Figueroa
- Department of Biomedical Engineering, King's College London, London, UK.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert Morgan
- Department of Radiology, St George's Hospital, London, UK
| | - Justin Nowell
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St George's Hospital, London, UK
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17
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Abstract
4D Flow is an emerging MR technique enabling three-dimensional and cardiac phase-resolved flowmetry with ECG-gated phase-contrast MRI that increased the speed of data acquisitions, accuracy and robustness. The method is promoting researches in areas that have not been fully addressed before in the cardiovascular system, such as flowmetry of the bloodstream across the valves, within the heart chambers, complexed flow dynamics such as vortex, helical or retrograde. Wall shear stress and other potential biomarkers derived from 4D Flow are known to be related to vascular wall diseases such as atherosclerosis. In this review, fundamental concepts of 4D Flow technique and post-processing, benefits and limitations as well as its clinical applications are discussed, and the importance of quality control and validation of the method is emphasized. New ideas inspired by 4D Flow can help clinicians and MR scientists further understand the role of flow dynamics in health sciences, diseases and various aspects of cardiovascular physiology.
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Affiliation(s)
- Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
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18
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Oechtering TH, Sieren MM, Hunold P, Hennemuth A, Huellebrand M, Scharfschwerdt M, Richardt D, Sievers HH, Barkhausen J, Frydrychowicz A. Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) reveals altered blood flow patterns in the ascending aorta of patients with valve-sparing aortic root replacement. J Thorac Cardiovasc Surg 2020; 159:798-810.e1. [DOI: 10.1016/j.jtcvs.2019.02.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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19
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Ebel S, Dufke J, Köhler B, Preim B, Behrendt B, Riekena B, Jung B, Stehning C, Kropf S, Grothoff M, Gutberlet M. Automated Quantitative Extraction and Analysis of 4D flow Patterns in the Ascending Aorta: An intraindividual comparison at 1.5 T and 3 T. Sci Rep 2020; 10:2949. [PMID: 32076060 PMCID: PMC7031260 DOI: 10.1038/s41598-020-59826-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/29/2020] [Indexed: 12/28/2022] Open
Abstract
4D flow MRI enables quantitative assessment of helical flow. Current methods are susceptible to noise. To evaluate helical flow patterns in healthy volunteers and patients with bicuspid aortic valves (BAV) at 1.5 T and 3 T using pressure-based helix-extraction in 4D flow MRI. Two intraindividual 4D flow MRI examinations were performed at 1.5 T and 3 T in ten healthy volunteers (5 females, 32 ± 3 years) and 2 patients with BAV using different acceleration techniques (kt-GRAPPA and centra). Several new quantitative parameters for the evaluation of volumes [ml], lengths [mm] as well as temporal parameters [ms] of helical flow were introduced and analyzed using the software tool Bloodline. We found good correlations between measurements in volunteers at 1.5 T and 3 T regarding helical flow volumes (R = 0.98) and temporal existence (R = 0.99) of helices in the ascending aorta. Furthermore, we found significantly larger (11.7 vs. 77.6 ml) and longer lasting (317 vs. 769 ms) helices in patients with BAV than in volunteers. The assessed parameters do not depend on the magnetic field strength used for the acquisition. The technique of pressure-based extraction of 4D flow MRI pattern is suitable for differentiation of normal and pathological flow.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany. .,Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Josefin Dufke
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Benjamin Köhler
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Boris Riekena
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and paediatric Radiology, University of Bern, Bern, Switzerland
| | | | - Siegfried Kropf
- Institute for Biometrics and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
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20
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OLIVEIRA DIANAC, LARANJO SÉRGIO, TIAGO JORGE, PINTO FÁTIMAF, SEQUEIRA ADÉLIA. NUMERICAL SIMULATION OF DILATION PATTERNS OF THE ASCENDING AORTA IN AORTOPATHIES. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aortic dilation is associated with congenital bicuspid aortic valve (BAV) disease, and its etiology is still not completely understood. The aim of this study is to provide further insight into aortic hemodynamics in a BAV population with different degrees of aortic dilation and regurgitation in comparison with a patient without pathology. A fluid–structure interaction (FSI) numerical approach is implemented regarding patient-specific geometries, where the aortic valves are defined by analytical orifices. Results show that, while the patient without pathology displays a typical hemodynamic behavior of flows in bends, BAV-related aortas present an accelerated flow along the outer aortic wall. Wall shear stress (WSS) overload in the outer curvature is observed, more marked in more dilated aortas. Moreover, helices in the ascending aorta are present in these patients, enhanced with greater dilation. These findings support the fact that hemodynamic factors play an important role in aortic dilation onset and development in BAV patients, caused by a prolonged exposure of the outer ascending aortic curvature to altered WSS. Besides, our results suggest that greater aortic regurgitation may be associated with abnormal WSS distributions in the ascending aorta during diastole, which can facilitate aortic root dilation.
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Affiliation(s)
- DIANA C. OLIVEIRA
- Department of Bioengineering and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
| | - SÉRGIO LARANJO
- Pediatric Cardiology Department, Congenital Heart Diseases Reference Centre, Hospital de Santa Marta (CHLC), Rua de Santa Marta 50 1169-024 Lisboa, Portugal
| | - JORGE TIAGO
- Department of Mathematics and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
| | - FÁTIMA F. PINTO
- Pediatric Cardiology Department, Congenital Heart Diseases Reference Centre, Hospital de Santa Marta (CHLC), Rua de Santa Marta 50 1169-024 Lisboa, Portugal
| | - ADÉLIA SEQUEIRA
- Department of Mathematics and CEMAT, Instituto Superior Técnico, Ulisboa Av. Rovisco Pais, 1 1049-001 Lisboa, Portugal
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21
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Zhu Y, Zhan W, Hamady M, Xu XY. A pilot study of aortic hemodynamics before and after thoracic endovascular repair with a double-branched endograft. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2019. [DOI: 10.1016/j.medntd.2020.100027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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22
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Kamada H, Ota H, Nakamura M, Imai Y, Ishida S, Sun W, Sakatsume K, Yoshioka I, Saiki Y, Takase K. Perioperative Hemodynamic Changes in the Thoracic Aorta in Patients With Aortic Valve Stenosis: A Prospective Serial 4D-Flow MRI Study. Semin Thorac Cardiovasc Surg 2019; 32:25-34. [PMID: 31323320 DOI: 10.1053/j.semtcvs.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 01/25/2023]
Abstract
This study investigated hemodynamic changes in the thoracic aorta and aortic arch branches before and after aortic valve replacement (AVR) by 4D-flow MRI in patients with aortic valve stenosis (AS). Thoracic 4D-flow MRI was performed in 10 AS patients before and after AVR (mean 27 ± 1.9 days). Fifteen aortic planes and 3 aortic arch branches planes were set to evaluate the mean volume flow rate in each plane during a cardiac cycle and the angle between the main flow direction in a specified plane and the axial direction of the aorta. We also focused on the distribution and magnitude of helicity density to evaluate the flow complexity. A significant increase in the volume flow rate after AVR was found in the ascending aorta (before 59.2 ± 8.7 mL/s vs after 77.3 ± 6.2 mL/s, P < 0.05) and the aortic arch branches (before 26.5 ± 2.8 mL/s vs after 35.8 ± 3.3 mL/s, P < 0.001). The flow angle significantly decreased in the ascending aorta (before 39.2 ± 2.7 degree vs after 25.2 ± 1.7°, P < 0.0001) and the arch aorta (before 19.3 ± 2.0 degree vs after 13.4 ± 0.9°, P < 0.001). The volume flow rate in the ascending aorta and the arch branches increased within 1 month after AVR, showing an increased blood supply to the upper body, including to the brain. The postoperative change was accompanied with an increased blood flow in the ascending aorta and a decreased flow complexity proximal to the arch branches.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masanori Nakamura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Yohsuke Imai
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Shunichi Ishida
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Wenyu Sun
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Ko Sakatsume
- Division of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan
| | - Ichiro Yoshioka
- Division of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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Pasipoularides A. Clinical-pathological correlations of BAV and the attendant thoracic aortopathies. Part 1: Pluridisciplinary perspective on their hemodynamics and morphomechanics. J Mol Cell Cardiol 2019; 133:223-232. [PMID: 31150733 DOI: 10.1016/j.yjmcc.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
Clinical BAV manifestations pertain to faulty aortic valve (AOV) function, the associated aortopathy, and other complications such as endocarditis, thrombosis and thromboembolism. BAV arises during valvulogenesis when 2 of the 3 leaflets/cusps of the AOV are fused together. Ensuing asymmetric BAV morphologies alter downstream ejection jet flow-trajectories. Based on BAV morphologies, ejection-flows exhibit different wall-impingement and scouring patterns in the proximal aorta, with excessive hydrodynamic wall-shear that correlates closely with mural vascular smooth muscle cell and extracellular matrix disruptions, revealing hemodynamic participation in the pathogenesis of BAV-associated aortopathies. Since the embryologic regions implicated in both BAV and aortopathies derive from neural crest cells and second heart field cells, there may exist a common multifactorial/polygenic embryological basis linking the abnormalities. The use of Electronic Health Records - encompassing integrated NGS variant panels and phenotypic data - in clinical studies could speed-up comprehensive understanding of multifactorial genetic-phenotypic and environmental factor interactions. This Survey represents the first in a 2-article pluridisciplinary work. Taken in toto, the series covers hemodynamic/morphomechanical and environmental (milieu intérieur) aspects in Part 1, and molecular, genetic and associated epigenetic aspects in Part 2. Together, Parts 1-2 should serve as a reference-milestone and driver for further pluridisciplinary research and its urgent translations in the clinical setting.
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Affiliation(s)
- Ares Pasipoularides
- Duke/NSF Center for Emerging Cardiovascular Technologies, Emeritus Faculty of Surgery and of Biomedical Engineering, Duke University School of Medicine and Graduate School, Durham, NC, USA.
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Aristova M, Vali A, Ansari SA, Shaibani A, Alden TD, Hurley MC, Jahromi BS, Potts MB, Markl M, Schnell S. Standardized Evaluation of Cerebral Arteriovenous Malformations Using Flow Distribution Network Graphs and Dual-venc 4D Flow MRI. J Magn Reson Imaging 2019; 50:1718-1730. [PMID: 31070849 DOI: 10.1002/jmri.26784] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral arteriovenous malformations (AVMs) are pathological connections between arteries and veins. Dual-venc 4D flow MRI, an extended 4D flow MRI method with improved velocity dynamic range, provides time-resolved 3D cerebral hemodynamics. PURPOSE To optimize dual-venc 4D flow imaging parameters for AVM; to assess the relationship between spatial resolution, acceleration, and flow quantification accuracy; and to introduce and apply the flow distribution network graph (FDNG) paradigm for storing and analyzing complex neurovascular 4D flow data. STUDY TYPE Retrospective cohort study. SUBJECTS/PHANTOM Scans were performed in a specialized flow phantom: 26 healthy subjects (age 41 ± 17 years) and five AVM patients (age 27-68 years). FIELD STRENGTH/SEQUENCE Dual-venc 4D flow with varying spatial resolution and acceleration factors were performed at 3T field strength. ASSESSMENT Quantification accuracy was assessed in vitro by direct comparison to measured flow. FDNGs were used to quantify and compare flow, peak velocity (PV), and pulsatility index (PI) between healthy controls with various Circle of Willis (CoW) anatomy and AVM patients. STATISTICAL TESTS In vitro measurements were compared to ground truth with Student's t-test. In vivo groups were compared with Wilcoxon rank-sum test and Kruskal-Wallis test. RESULTS Flow was overestimated in all in vitro experiments, by an average 7.1 ± 1.4% for all measurement conditions. Error in flow measurement was significantly correlated with number of voxels across the channel (P = 3.11 × 10-28 ) but not with acceleration factor (P = 0.74). For the venous-arterial PV and PI ratios, a significant difference was found between AVM nidal and extranidal circulation (P = 0.008 and 0.05, respectively), and between AVM nidal and healthy control circulation (P = 0.005 and 0.003, respectively). DATA CONCLUSION Dual-venc 4D flow MRI and standardized FDNG analysis might be feasible in clinical applications. Venous-arterial ratios of PV and PI are proposed as network-based biomarkers characterizing AVM nidal hemodynamics. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1718-1730.
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Affiliation(s)
- Maria Aristova
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,McCormick School of Engineering, Biomedical Engineering, Northwestern University, Evanston, USA
| | - Alireza Vali
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sameer A Ansari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ali Shaibani
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Tord D Alden
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Michael C Hurley
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,McCormick School of Engineering, Biomedical Engineering, Northwestern University, Evanston, USA
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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25
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Gomez A, Marčan M, Arthurs CJ, Wright R, Youssefi P, Jahangiri M, Figueroa CA. Optimal B-spline Mapping of Flow Imaging Data for Imposing Patient-specific Velocity Profiles in Computational Hemodynamics. IEEE Trans Biomed Eng 2018; 66:10.1109/TBME.2018.2880606. [PMID: 30561336 PMCID: PMC6594901 DOI: 10.1109/tbme.2018.2880606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We propose a novel method to map patient-specific blood velocity profiles obtained from imaging data such as 2D flow MRI or 3D colour Doppler ultrasound) to geometric vascular models suitable to perform CFD simulations of haemodynamics. We describe the implementation and utilisation of the method within an open-source computational hemodynamics simulation software (CRIMSON). METHODS The proposed method establishes point-wise correspondences between the contour of a fixed geometric model and time-varying contours containing the velocity image data, from which a continuous, smooth and cyclic deformation field is calculated. Our methodology is validated using synthetic data, and demonstrated using two different in-vivo aortic velocity datasets: a healthy subject with normal tricuspid valve and a patient with bicuspid aortic valve. RESULTS We compare our method with the state-of-the-art Schwarz-Christoffel method, in terms of preservation of velocities and execution time. Our method is as accurate as the Schwarz-Christoffel method, while being over 8 times faster. CONCLUSIONS Our mapping method can accurately preserve either the flow rate or the velocity field through the surface, and can cope with inconsistencies in motion and contour shape. SIGNIFICANCE The proposed method and its integration into the CRIMSON software enable a streamlined approach towards incorporating more patient-specific data in blood flow simulations.
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Affiliation(s)
- Alberto Gomez
- Department of Biomedical Engineering, King’s College London, UK
| | - Marija Marčan
- Department of Biomedical Engineering, King’s College London, UK
| | | | - Robert Wright
- Department of Biomedical Engineering, King’s College London, UK
| | - Pouya Youssefi
- Department of Cardiothoracic Surgery & Cardiology, St. George’s Hospital, London, UK
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery & Cardiology, St. George’s Hospital, London, UK
| | - C. Alberto Figueroa
- Department of Biomedical Engineering, King’s College London, UK, Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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The Atheroprotective Nature of Helical Flow in Coronary Arteries. Ann Biomed Eng 2018; 47:425-438. [DOI: 10.1007/s10439-018-02169-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022]
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Youssefi P, Gomez A, Arthurs C, Sharma R, Jahangiri M, Alberto Figueroa C. Impact of Patient-Specific Inflow Velocity Profile on Hemodynamics of the Thoracic Aorta. J Biomech Eng 2018; 140:2654063. [PMID: 28890987 DOI: 10.1115/1.4037857] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 11/08/2022]
Abstract
Computational fluid dynamics (CFD) provides a noninvasive method to functionally assess aortic hemodynamics. The thoracic aorta has an anatomically complex inlet comprising of the aortic valve and root, which is highly prone to different morphologies and pathologies. We investigated the effect of using patient-specific (PS) inflow velocity profiles compared to idealized profiles based on the patient's flow waveform. A healthy 31 yo with a normally functioning tricuspid aortic valve (subject A), and a 52 yo with a bicuspid aortic valve (BAV), aortic valvular stenosis, and dilated ascending aorta (subject B) were studied. Subjects underwent MR angiography to image and reconstruct three-dimensional (3D) geometric models of the thoracic aorta. Flow-magnetic resonance imaging (MRI) was acquired above the aortic valve and used to extract the patient-specific velocity profiles. Subject B's eccentric asymmetrical inflow profile led to highly complex velocity patterns, which were not replicated by the idealized velocity profiles. Despite having identical flow rates, the idealized inflow profiles displayed significantly different peak and radial velocities. Subject A's results showed some similarity between PS and parabolic inflow profiles; however, other parameters such as Flowasymmetry were significantly different. Idealized inflow velocity profiles significantly alter velocity patterns and produce inaccurate hemodynamic assessments in the thoracic aorta. The complex structure of the aortic valve and its predisposition to pathological change means the inflow into the thoracic aorta can be highly variable. CFD analysis of the thoracic aorta needs to utilize fully PS inflow boundary conditions in order to produce truly meaningful results.
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Affiliation(s)
- Pouya Youssefi
- Department of Cardiothoracic Surgery, St. George's Hospital, London SW17 0QT, UK.,Department of Biomedical Engineering, King's College London, London SE1 7EH, UK e-mail:
| | - Alberto Gomez
- Department of Biomedical Engineering, King's College London, London SE1 7EH, UK e-mail:
| | - Christopher Arthurs
- Department of Biomedical Engineering, King's College London, London SE1 7EH, UK e-mail:
| | - Rajan Sharma
- Department of Cardiology, St. George's Hospital, London SW17 0QT, UK e-mail:
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, London SW17 0QT, UK e-mail:
| | - C Alberto Figueroa
- Department of Biomedical Engineering, King's College London, London SE1 7EH, UK.,Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
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Morbiducci U, Lemma M, Ponzini R, Boi A, Bondavalli L, Antona C, Montevecchi FM, Redaelli A. Does the Ventrica Magnetic Vascular Positioner (MVP®) for Coronary Artery Bypass Grafting Significantly alter Local Fluid Dynamics? a Numeric Study. Int J Artif Organs 2018; 30:628-39. [PMID: 17674340 DOI: 10.1177/039139880703000711] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Automatic devices have been recently introduced to make the anastomosis procedure quick and efficient when creating a coronary bypass on the beating heart. However, the implantation of these devices could modify the graft configuration, consistently affecting the hemodynamics usually found in the traditional anastomosis. As local fluid dynamics could play a significant role in the onset of vessel wall pathologies, in this article a computational approach was designed to investigate flow patterns in the presence of the Ventrica magnetic vascular positioner (Ventrica MVP®) device. Methods A model of standard hand-sewn anastomosis and of automated magnetic anastomosis were constructed, and the finite volume method was used to simulate in silico realistic graft hemodynamics. Synthetic analytical descriptors - i.e., time-averaged wall shear stress (TAWSS), oscillating shear index (OSI) and helical flow index (HFI) - were calculated and compared for quantitative assessment of the anastomosis geometry hemodynamic performance. Results In this case study, the same most critical region was identified for the 2 models as the one with the lowest TAWSS and the highest OSI (TAWSS=0.229, OSI=0.255 for the hand-sewn anastomosis; TAWSS=0.297, OSI=0.171 for the Ventrica MVP®). However, the shape of the Ventrica MVP® does not induce more critical wall shear stresses, oscillating flow and damped helicity in the graft fluid dynamics, as compared with conventional anastomosis. Conclusions We found that the use of the Ventrica MVP® for the case study under investigation was not associated with more critical fluid dynamics than with conventional hand-sewn anastomosis. Thereby, the device could facilitate beating heart and minimally invasive coronary artery bypass grafting without increasing local hemodynamic-related risks of failure. (Int J Artif Organs 2007; 30: 628–39)
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Affiliation(s)
- U Morbiducci
- Department of Mechanics, Università Politecnica delle Marche, Ancona, Italy.
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29
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Kemmerling EMC, Peattie RA. Abdominal Aortic Aneurysm Pathomechanics: Current Understanding and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1097:157-179. [DOI: 10.1007/978-3-319-96445-4_8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Ardellier FD, D'Ostrevy N, Cassagnes L, Ouchchane L, Dubots E, Chabrot P, Boyer L, Camilleri L. CT patterns of acute type A aortic arch dissection: longer, higher, more anterior. Br J Radiol 2017; 90:20170417. [PMID: 28830228 DOI: 10.1259/bjr.20170417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study analysed CT patterns of the acute dissected aortic arch using original biometric features along with comparison with normal aortas. METHODS The diagnostic CT scans of 57 patients (42 males, age (mean ± SD: 64.5 ± 13.8 years) admitted with acute Stanford type A dissection involving the aortic arch were analysed by semi-automatic detection protocol of the true lumen of the dissection. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch and of its segments (especially between the brachiocephalic artery trunk and the left subclavian artery), as well as the surface area, angle, height and shift of the arch. These measurements were compared with results previously obtained in a healthy cohort in an analysis adjusted for age, sex and weight. The surface area and rotation of the false lumen were also analysed. RESULTS Compared to normal aortic arches (N), dissected aortic arches (D) were longer (D: 155 ± 26 mm, N: 135 ± 25 mm, p = 0.002), higher (D: 51 ± 10 mm, N: 45 ± 9 mm, p = 0.04), and with a more anterior apex (shift: D: 1.19 ± 0.56, N: 1.40 ± 0.62, p = 0.007). False lumen occupied between 47-65% of the aorta, turned preferentially clockwise and its rotation decreased progressively along the arch. CONCLUSIONS The morphology of the dissected aortic arch differs from that of the normal arch. Thus, our compilation of aortic arch measurements may help improve existing endovascular devices and/or design of new endoprostheses. Advances in knowledge: In this article, we provide a comprehensive set of measurements of the dissected aortic arch, and show that dissected aortic arches are longer, higher, and with a more anterior apex than normal arches.
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Affiliation(s)
| | - Nicolas D'Ostrevy
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lucie Cassagnes
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- 3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France.,4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Dubots
- 4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Chabrot
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lionel Camilleri
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
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Hansen KL, Møller-Sørensen H, Kjaergaard J, Jensen MB, Jensen JA, Nielsen MB. Aortic Valve Stenosis Increases Helical Flow and Flow Complexity: A Study of Intra-Operative Cardiac Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1607-1617. [PMID: 28495300 DOI: 10.1016/j.ultrasmedbio.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
Aortic valve stenosis alters blood flow in the ascending aorta. Using intra-operative vector flow imaging on the ascending aorta, secondary helical flow during peak systole and diastole, as well as flow complexity of primary flow during systole, were investigated in patients with normal, stenotic and replaced aortic valves. Peak systolic helical flow, diastolic helical flow and flow complexity during systole differed between the groups (p < 0.0001), and correlated to peak systolic velocity (R = 0.94, 0.87 and 0.88, respectively). The study indicates that aortic valve stenosis increases helical flow and flow complexity, which are measurable with vector flow imaging. For assessment of aortic stenosis and optimization of valve surgery, vector flow imaging may be useful.
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Affiliation(s)
| | | | | | | | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Denmark
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Montalba C, Urbina J, Sotelo J, Andia ME, Tejos C, Irarrazaval P, Hurtado DE, Valverde I, Uribe S. Variability of 4D flow parameters when subjected to changes in MRI acquisition parameters using a realistic thoracic aortic phantom. Magn Reson Med 2017; 79:1882-1892. [DOI: 10.1002/mrm.26834] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Cristian Montalba
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
| | - Jesus Urbina
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
| | - Julio Sotelo
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Marcelo E. Andia
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
| | - Cristian Tejos
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Pablo Irarrazaval
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of Electrical EngineeringPontificia Universidad Católica de ChileSantiago Chile
| | - Daniel E. Hurtado
- Department of Structural and Geotechnical EngineeringPontificia Universidad Católica de ChileSantiago Chile
- Institute for Biological and Medical EngineeringSchools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de ChileSantiago Chile
| | - Israel Valverde
- Hospital Virgen del RocioUniversidad de SevillaSeville Spain
- Institute of Biomedicine of SevilleUniversidad de SevillaSeville Spain
| | - Sergio Uribe
- Biomedical Imaging CenterPontificia Universidad Católica de ChileSantiago Chile
- Department of RadiologySchool of Medicine, Pontificia Universidad Católica de ChileSantiago Chile
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Youssefi P, Sharma R, Figueroa CA, Jahangiri M. Functional assessment of thoracic aortic aneurysms - the future of risk prediction? Br Med Bull 2017; 121:61-71. [PMID: 27989994 PMCID: PMC5862296 DOI: 10.1093/bmb/ldw049] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/13/2016] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Treatment guidelines for the thoracic aorta concentrate on size, yet acute aortic dissection or rupture can occur when aortic size is below intervention criteria. Functional imaging and computational techniques are a means of assessing haemodynamic parameters involved in aortic pathology. SOURCES OF DATA Original articles, reviews, international guidelines. AREAS OF AGREEMENT Computational fluid dynamics and 4D flow MRI allow non-invasive assessment of blood flow parameters and aortic wall biomechanics. AREAS OF CONTROVERSY Aortic valve morphology (particularly bicuspid aortic valve) is associated with aneurysm of the ascending aorta, although the exact mechanism of aneurysm formation is not yet established. GROWING POINTS Haemodynamic assessment of the thoracic aorta has highlighted parameters which are linked with both clinical outcome and protein changes in the aortic wall. Wall shear stress, flow displacement and helicity are elevated in patients with bicuspid aortic valve, particularly at locations of aneurysm formation. AREAS TIMELY FOR DEVELOPING RESEARCH With further validation, functional assessment of the aorta may help identify patients at risk of aortic complications, and introduce new haemodynamic indices into management guidelines.
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Affiliation(s)
- Pouya Youssefi
- Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, Blackshaw Road, London, SW17 0QT, United Kingdom.,Department of Biomedical Engineering, Rayne Institute, St. Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Rajan Sharma
- Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, Blackshaw Road, London, SW17 0QT, United Kingdom
| | - C Alberto Figueroa
- Department of Biomedical Engineering, Rayne Institute, St. Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom.,Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109 USA
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery & Cardiology, St. George's Hospital, St. George's University of London, Blackshaw Road, London, SW17 0QT, United Kingdom
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Owen JW, Raptis CA. Emerging Clinical Applications of 4D Flow MR in the Heart and Aorta. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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35
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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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Spiral Laminar Flow: a Survey of a Three-Dimensional Arterial Flow Pattern in a Group of Volunteers. Eur J Vasc Endovasc Surg 2016; 52:674-680. [DOI: 10.1016/j.ejvs.2016.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/16/2016] [Indexed: 11/18/2022]
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SOUDAH E, CASACUBERTA J, GAMEZ-MONTERO PJ, PÉREZ JS, RODRÍGUEZ-CANCIO M, RAUSH G, LI CH, CARRERAS F, CASTILLA R. ESTIMATION OF WALL SHEAR STRESS USING 4D FLOW CARDIOVASCULAR MRI AND COMPUTATIONAL FLUID DYNAMICS. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519417500464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the last few years, wall shear stress (WSS) has arisen as a new diagnostic indicator in patients with arterial disease. There is a substantial evidence that the WSS plays a significant role, together with hemodynamic indicators, in initiation and progression of the vascular diseases. Estimation of WSS values, therefore, may be of clinical significance and the methods employed for its measurement are crucial for clinical community. Recently, four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has been widely used in a number of applications for visualization and quantification of blood flow, and although the sensitivity to blood flow measurement has increased, it is not yet able to provide an accurate three-dimensional (3D) WSS distribution. The aim of this work is to evaluate the aortic blood flow features and the associated WSS by the combination of 4D flow cardiovascular magnetic resonance (4D CMR) and computational fluid dynamics technique. In particular, in this work, we used the 4D CMR to obtain the spatial domain and the boundary conditions needed to estimate the WSS within the entire thoracic aorta using computational fluid dynamics. Similar WSS distributions were found for cases simulated. A sensitivity analysis was done to check the accuracy of the method. 4D CMR begins to be a reliable tool to estimate the WSS within the entire thoracic aorta using computational fluid dynamics. The combination of both techniques may provide the ideal tool to help tackle these and other problems related to wall shear estimation.
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Affiliation(s)
- E. SOUDAH
- Centre Internacional de Métodes Numérics en Enginyeria (CIMNE), Universitat Politécnica de Catalunya, Edificio C1, Campus Norte, Jordi Girona 1-3, Barcelona 08034, Spain
| | - J. CASACUBERTA
- E.T.S. d’Enginyeries Industrial i Aeronáutica de Terrassa, Universitat Politécnica de Catalunya, C/Colom, 11, Terrassa 08222, Spain
| | - P. J. GAMEZ-MONTERO
- E.T.S. d’Enginyeries Industrial i Aeronáutica de Terrassa, Universitat Politécnica de Catalunya, C/Colom, 11, Terrassa 08222, Spain
| | - J. S. PÉREZ
- Centre Internacional de Métodes Numérics en Enginyeria (CIMNE), Universitat Politécnica de Catalunya, Edificio C1, Campus Norte, Jordi Girona 1-3, Barcelona 08034, Spain
| | - M. RODRÍGUEZ-CANCIO
- Centre Internacional de Métodes Numérics en Enginyeria (CIMNE), Universitat Politécnica de Catalunya, Edificio C1, Campus Norte, Jordi Girona 1-3, Barcelona 08034, Spain
| | - G. RAUSH
- E.T.S. d’Enginyeries Industrial i Aeronáutica de Terrassa, Universitat Politécnica de Catalunya, C/Colom, 11, Terrassa 08222, Spain
| | - C. H. LI
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - F. CARRERAS
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, Barcelona 08025, Spain
| | - R. CASTILLA
- E.T.S. d’Enginyeries Industrial i Aeronáutica de Terrassa, Universitat Politécnica de Catalunya, C/Colom, 11, Terrassa 08222, Spain
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Ha H, Kim GB, Kweon J, Lee SJ, Kim YH, Kim N, Yang DH. The influence of the aortic valve angle on the hemodynamic features of the thoracic aorta. Sci Rep 2016; 6:32316. [PMID: 27561388 PMCID: PMC4999809 DOI: 10.1038/srep32316] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022] Open
Abstract
Since the first observation of a helical flow pattern in aortic blood flow, the existence of helical blood flow has been found to be associated with various pathological conditions such as bicuspid aortic valve, aortic stenosis, and aortic dilatation. However, an understanding of the development of helical blood flow and its clinical implications are still lacking. In our present study, we hypothesized that the direction and angle of aortic inflow can influence helical flow patterns and related hemodynamic features in the thoracic aorta. Therefore, we investigated the hemodynamic features in the thoracic aorta and various aortic inflow angles using patient-specific vascular phantoms that were generated using a 3D printer and time-resolved, 3D, phase-contrast magnetic resonance imaging (PC-MRI). The results show that the rotational direction and strength of helical blood flow in the thoracic aorta largely vary according to the inflow direction of the aorta, and a higher helical velocity results in higher wall shear stress distributions. In addition, right-handed rotational flow conditions with higher rotational velocities imply a larger total kinetic energy than left-handed rotational flow conditions with lower rotational velocities.
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Affiliation(s)
- Hojin Ha
- POSTECH Biotech Center, Pohang University of Science and Technology, San 31, Hyoja-dong, Pohang 790-784, South Korea
| | - Guk Bae Kim
- Asan Institute of Life Science, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Jihoon Kweon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Sang Joon Lee
- POSTECH Biotech Center, Pohang University of Science and Technology, San 31, Hyoja-dong, Pohang 790-784, South Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), San 31, Hyoja-dong, Pohang 790-784, South Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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Visualization of CSF Flow with Time-resolved 3D MR Velocity Mapping in Aqueductal Stenosis Before and After Endoscopic Third Ventriculostomy. Clin Neuroradiol 2016; 28:69-74. [DOI: 10.1007/s00062-016-0530-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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van Ooij P, Garcia J, Potters WV, Malaisrie SC, Collins JD, Carr JC, Markl M, Barker AJ. Age-related changes in aortic 3D blood flow velocities and wall shear stress: Implications for the identification of altered hemodynamics in patients with aortic valve disease. J Magn Reson Imaging 2016; 43:1239-49. [PMID: 26477691 PMCID: PMC4836971 DOI: 10.1002/jmri.25081] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate age-related changes in peak systolic aortic 3D velocity and wall shear stress (WSS) in healthy controls and to investigate the importance of age-matching for 3D mapping of abnormal aortic hemodynamics in bicuspid aortic valve disease (BAV). MATERIALS AND METHODS 4D flow MRI (fields strengths = 1.5-3T; resolution = 2.2-3.9 × 1.7-2.6 × 2.2-4.0 mm(3) ; Venc = 150-250 cm/s; TE/TR/FA = 2.3-2.8/4.7-5.4msec/7-15°) was performed in 56 controls (age range: 19-78 years) and in two BAV patient groups each consisting of 10 subjects (group 1: 20-29 years, group 2: 52-57 years). Heat maps showing abnormal 3D velocity and WSS were created for the BAV patients by comparison with an age-matched and with an unmatched control group. The fraction of the aorta exposed to abnormal velocity/WSS was calculated relative to the total aortic volume/surface. RESULTS Significant inverse relationships between age and healthy velocity/WSS were found (R(2) = 0.32/0.39, P < 0.001). For BAV group 1, abnormally elevated velocity/WSS was overestimated when compared with older controls (51-60 years) than when correctly age-matched (∼25 ± 14% vs. ∼8 ± 5%). For BAV group 2, abnormally decreased velocity/WSS was overestimated when compared with younger controls (21-30 years) than when correctly age-matched (∼9 ± 7% vs. 1 ± 1%). CONCLUSION Significant correlations exist between age and peak systolic velocity and WSS. Therefore, robust age-matching is important when creating abnormal 3D aortic velocity and WSS maps for patients with BAV.
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Affiliation(s)
- Pim van Ooij
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Julio Garcia
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Wouter V. Potters
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - James C. Carr
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA
| | - Alex J. Barker
- Department of Radiology, Northwestern University, Chicago, IL, USA
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Parikh JD, Hollingsworth KG, Kunadian V, Blamire A, MacGowan GA. Measurement of pulse wave velocity in normal ageing: comparison of Vicorder and magnetic resonance phase contrast imaging. BMC Cardiovasc Disord 2016; 16:50. [PMID: 26892669 PMCID: PMC4759948 DOI: 10.1186/s12872-016-0224-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
Background Pulse wave velocity is an important measure of cardiovascular risk, and can be measured by several different techniques. We compared age-related changes in pulse wave velocity derived from carotid and femoral artery waveforms using the Vicorder device and descending thoracic aorta time velocity curves using phase contrast magnetic resonance imaging (MRI) in a group of normal healthy volunteers, without cardiovascular disease, aged between 20 and 79 years. Methods Eighty subjects underwent same-day measurements of Vicorder and MRI pulse wave velocity measurements. Results Both Vicorder and MRI-based pulse wave velocity measurements were significantly increased with age (R = 0.59 and 0.57 respectively, both P < 0.0001). Vicorder and MRI pulse wave velocities were also significantly related to each other (R = 0.27, P < 0.05), and Bland Altman plots showed that on average Vicorder measurements were 1.6 m/s greater than MRI. In 5 % of cases, agreement between the values of the two techniques were above and below 2 standard deviations, and these were at higher levels of pulse wave velocities. Multiple linear stepwise regression analysis confirmed highly significant relationships of both techniques to age (both P < 0.0001), and MRI was also significantly related to heart rate (P = 0.006) but Vicorder was not. Conclusions Both Vicorder and MRI perform similarly in detecting age-related changes in pulse wave velocity. Thus, the choice of using one or the other will depend on other aspects of the investigation, such as the need for portability favouring Vicorder, or need for additional cardiovascular imaging favouring MRI. Trial registration ClinicalTrials.Gov identifier NCT01504828
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Affiliation(s)
- Jehill D Parikh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. .,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
| | - Andrew Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Guy A MacGowan
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK. .,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK.
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BERNAD ELENAS, BERNAD SANDORI, SARGAN IZABELLA, CRAINA MARIUSL. SAPHENOUS VEIN GRAFT PATENCY AFTER GEOMETRY REMODELING. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tortuous saphenous vein graft (SVG) hemodynamics was investigated using computational fluid dynamics (CFD) techniques. Computed tomography (CT) technology is used for noninvasive bypass graft assessment seven days after surgery. CT investigation shows two regions with severe shape remodeling, one is an angle type contortion and the other one is a sharp curvature with tortuous area reduction. The numerical analysis carefully examines the effect of an SVG geometry remodeling through flow separation, particle deposition, and wall shear stress (WSS). During the cardiac cycle, overall pressure drop increases from 2.6[Formula: see text]mmHg to 4.4[Formula: see text]mmHg. In the accelerating part of the systolic phase, particles released in the inlet section move downstream toward the first narrowed part (elbow type contortion) with a helical motion. WSS range along the cardiac cycle varies from 2[Formula: see text]Pa to 42[Formula: see text]Pa, enough to damage the endothelial cells. Vessel torsion induced helical flow can reduce the flow disturbance and separation. Additionally, in the distal end of the graft, the high particle concentrations can promote the inflammatory processes in the vessels.
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Affiliation(s)
- ELENA S. BERNAD
- University of Medicine and Pharmacy “Victor Babes” Timisoara University Clinic “Bega” P-ta Eftimie Murgu 2, RO-300041, Timisoara, Romania
| | - SANDOR I. BERNAD
- Romanian Academy, Timisoara Branch Centre for Fundamental and Advanced Technical Research Bd. Mihai Viteazul 24, RO-300223, Timisoara, Romania
| | - IZABELLA SARGAN
- University of Medicine and Pharmacy “Victor Babes” Timisoara University Clinic “Bega” P-ta Eftimie Murgu 2, RO-300041, Timisoara, Romania
| | - MARIUS L. CRAINA
- University of Medicine and Pharmacy “Victor Babes” Timisoara University Clinic “Bega” P-ta Eftimie Murgu 2, RO-300041, Timisoara, Romania
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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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Sarrami-Foroushani A, Nasr Esfahany M, Nasiraei Moghaddam A, Saligheh Rad H, Firouznia K, Shakiba M, Ghanaati H, Wilkinson ID, Frangi AF. Velocity Measurement in Carotid Artery: Quantitative Comparison of Time-Resolved 3D Phase-Contrast MRI and Image-based Computational Fluid Dynamics. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e18286. [PMID: 26793288 PMCID: PMC4711029 DOI: 10.5812/iranjradiol.18286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/20/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
Background: Understanding hemodynamic environment in vessels is important for realizing the mechanisms leading to vascular pathologies. Objectives: Three-dimensional velocity vector field in carotid bifurcation is visualized using TR 3D phase-contrast magnetic resonance imaging (TR 3D PC MRI) and computational fluid dynamics (CFD). This study aimed to present a qualitative and quantitative comparison of the velocity vector field obtained by each technique. Subjects and Methods: MR imaging was performed on a 30-year old male normal subject. TR 3D PC MRI was performed on a 3 T scanner to measure velocity in carotid bifurcation. 3D anatomical model for CFD was created using images obtained from time-of-flight MR angiography. Velocity vector field in carotid bifurcation was predicted using CFD and PC MRI techniques. A statistical analysis was performed to assess the agreement between the two methods. Results: Although the main flow patterns were the same for the both techniques, CFD showed a greater resolution in mapping the secondary and circulating flows. Overall root mean square (RMS) errors for all the corresponding data points in PC MRI and CFD were 14.27% in peak systole and 12.91% in end diastole relative to maximum velocity measured at each cardiac phase. Bland-Altman plots showed a very good agreement between the two techniques. However, this study was not aimed to validate any of methods, instead, the consistency was assessed to accentuate the similarities and differences between Time-resolved PC MRI and CFD. Conclusion: Both techniques provided quantitatively consistent results of in vivo velocity vector fields in right internal carotid artery (RCA). PC MRI represented a good estimation of main flow patterns inside the vasculature, which seems to be acceptable for clinical use. However, limitations of each technique should be considered while interpreting results.
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Affiliation(s)
| | - Mohsen Nasr Esfahany
- Department of Chemical Engineering, Isfahan University of Technology, Isfahan, Iran
- Corresponding author: Mohsen Nasr Esfahany, Department of Chemical Engineering, Isfahan University of Technology, Isfahan, Iran. Tel: +98-3133915631, Fax: +98-3113912677, E-mail:
| | - Abbas Nasiraei Moghaddam
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Hamidreza Saligheh Rad
- Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Iain David Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, South Yorkshire, United Kingdom
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von Spiczak J, Crelier G, Giese D, Kozerke S, Maintz D, Bunck AC. Quantitative Analysis of Vortical Blood Flow in the Thoracic Aorta Using 4D Phase Contrast MRI. PLoS One 2015; 10:e0139025. [PMID: 26418327 PMCID: PMC4587936 DOI: 10.1371/journal.pone.0139025] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 09/07/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction Phase contrast MRI allows for the examination of complex hemodynamics in the heart and adjacent great vessels. Vortex flow patterns seem to play an important role in certain vascular pathologies. We propose two- and three-dimensional metrics for the objective quantification of aortic vortex blood flow in 4D phase contrast MRI. Materials and Methods For two-dimensional vorticity assessment, a standardized set of 6 regions-of-interest (ROIs) was defined throughout the course of the aorta. For each ROI, a heatmap of time-resolved vorticity values ω→=∇v→ was computed. Evolution of minimum, maximum, and average values as well as opposing rotational flow components were analyzed. For three-dimensional analysis, vortex core detection was implemented combining the predictor-corrector method with λ2 correction. Strength, elongation, and radial expansion of the detected vortex core were recorded over time. All methods were applied to 4D flow MRI datasets of 9 healthy subjects, 2 patients with mildly dilated aorta, and 1 patient with aortic aneurysm. Results Vorticity quantification in the 6 standardized ROIs enabled the description of physiological vortex flow in the healthy aorta. Helical flow developed early in the ascending aorta (absolute vorticity = 166.4±86.4 s-1 at 12% of cardiac cycle) followed by maximum values in mid-systole in the aortic arch (240.1±45.2 s-1 at 16%). Strength, elongation, and radial expansion of 3D vortex cores escalated in early systole, reaching a peak in mid systole (strength = 241.2±30.7 s-1 at 17%, elongation = 65.1±34.6 mm at 18%, expansion = 80.1±48.8 mm2 at 20%), before all three parameters similarly decreased to overall low values in diastole. Flow patterns were considerably altered in patient data: Vortex flow developed late in mid/end-systole close to the aortic bulb and no physiological helix was found in the aortic arch. Conclusions We have introduced objective measures for quantification of vortical flow in 4D phase contrast MRI. Vortex blood flow in the thoracic aorta could be consistently described in all healthy volunteers. In patient data, pathologically altered vortex flow was observed.
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Affiliation(s)
- Jochen von Spiczak
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
- * E-mail:
| | - Gerard Crelier
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Daniel Giese
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - David Maintz
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
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Assessment of Hemodynamic Conditions in the Aorta Following Root Replacement with Composite Valve-Conduit Graft. Ann Biomed Eng 2015; 44:1392-404. [PMID: 26369636 DOI: 10.1007/s10439-015-1453-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
This paper presents the analysis of detailed hemodynamics in the aortas of four patients following replacement with a composite bio-prosthetic valve-conduit. Magnetic resonance image-based computational models were set up for each patient with boundary conditions comprising subject-specific three-dimensional inflow velocity profiles at the aortic root and central pressure waveform at the model outlet. Two normal subjects were also included for comparison. The purpose of the study was to investigate the effects of the valve-conduit on flow in the proximal and distal aorta. The results suggested that following the composite valve-conduit implantation, the vortical flow structure and hemodynamic parameters in the aorta were altered, with slightly reduced helical flow index, elevated wall shear stress and higher non-uniformity in wall shear compared to normal aortas. Inter-individual analysis revealed different hemodynamic conditions among the patients depending on the conduit configuration in the ascending aorta, which is a key factor in determining post-operative aortic flow. Introducing a natural curvature in the conduit to create a smooth transition between the conduit and native aorta may help prevent the occurrence of retrograde and recirculating flow in the aortic arch, which is particularly important when a large portion or the entire ascending aorta needs to be replaced.
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Dyverfeldt P, Bissell M, Barker AJ, Bolger AF, Carlhäll CJ, Ebbers T, Francios CJ, Frydrychowicz A, Geiger J, Giese D, Hope MD, Kilner PJ, Kozerke S, Myerson S, Neubauer S, Wieben O, Markl M. 4D flow cardiovascular magnetic resonance consensus statement. J Cardiovasc Magn Reson 2015; 17:72. [PMID: 26257141 PMCID: PMC4530492 DOI: 10.1186/s12968-015-0174-5] [Citation(s) in RCA: 548] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/17/2015] [Indexed: 02/07/2023] Open
Abstract
Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5×1.5×1.5 - 3×3×3 mm(3), typical temporal resolution of 30-40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.
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Affiliation(s)
- Petter Dyverfeldt
- 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.
| | - Malenka Bissell
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, USA.
| | - Ann F Bolger
- 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.
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.
| | - 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.
- Department of Clinical Physiology, Department of Medical and Health Sciences, 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.
| | | | - Alex Frydrychowicz
- Klinik für Radiologie und Nuklearmedizin, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Julia Geiger
- Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Daniel Giese
- Department of Radiology, University Hospital of Cologne, Cologne, Germany.
| | - Michael D Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, United States.
| | - Philip J Kilner
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK.
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.
| | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, USA.
- Department of Biomedical Engineering, Northwestern University, Chicago, IL, USA.
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Al-Wakeel N, Fernandes JF, Amiri A, Siniawski H, Goubergrits L, Berger F, Kuehne T. Hemodynamic and energetic aspects of the left ventricle in patients with mitral regurgitation before and after mitral valve surgery. J Magn Reson Imaging 2015; 42:1705-12. [DOI: 10.1002/jmri.24926] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/07/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nadya Al-Wakeel
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology; Berlin Germany
| | - Joao Filipe Fernandes
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology; Berlin Germany
| | - Aref Amiri
- German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery; Berlin Germany
| | - Henryk Siniawski
- German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery; Berlin Germany
| | - Leonid Goubergrits
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology; Berlin Germany
| | - Felix Berger
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology; Berlin Germany
| | - Titus Kuehne
- German Heart Institute Berlin, Department of Congenital Heart Disease and Pediatric Cardiology; Berlin Germany
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Hutter J, Schmitt P, Saake M, Stubinger A, Grimm R, Forman C, Greiser A, Hornegger J, Maier A. Multi-dimensional flow-preserving compressed sensing (MuFloCoS) for time-resolved velocity-encoded phase contrast MRI. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:400-414. [PMID: 25252278 DOI: 10.1109/tmi.2014.2359238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
4-D time-resolved velocity-encoded phase-contrast MRI (4-D PCI) is a fully non-invasive technique to assess hemodynamics in vivo with a broad range of potential applications in multiple cardiovascular diseases. It is capable of providing quantitative flow values and anatomical information simultaneously. The long acquisition time, however, still inhibits its wider clinical use. Acceleration is achieved at present using parallel MRI (pMRI) techniques which can lead to substantial loss of image quality for higher acceleration factors. Both the high-dimensionality and the significant degree of spatio-temporal correlation in 4-D PCI render it ideally suited for recently proposed compressed sensing (CS) techniques. We propose the Multi-Dimensional Flow-preserving Compressed Sensing (MuFloCoS) method to exploit these properties. A multi-dimensional iterative reconstruction is combined with an interleaved sampling pattern (I-VT), an adaptive masked and weighted temporal regularization (TMW) and fully automatically obtained vessel-masks. The performance of the novel method was analyzed concerning image quality, feasibility of acceleration factors up to 15, quantitative flow values and diagnostic accuracy in phantom experiments and an in vivo carotid study with 18 volunteers. Comparison with iterative state-of-the-art methods revealed significant improvements using the new method, the temporal normalized root mean square error of the peak velocity was reduced by 45.32% for the novel MuFloCoS method with acceleration factor 9. The method was furthermore applied to two patient cases with diagnosed high-grade stenosis of the ICA, which confirmed the performance of MuFloCoS to produce valuable results in the presence of pathological findings in 56 s instead of over 8 min (full sampling).
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Oberhuber A, Schabhasian D, Kohlschmitt R, Rottbauer W, Orend KH, Rasche V. The bird beak configuration has no adverse effect in a magnetic resonance functional analysis of thoracic stent grafts after traumatic aortic transection. J Vasc Surg 2014; 61:365-73. [PMID: 25449004 DOI: 10.1016/j.jvs.2014.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study used magnetic resonance imaging (MRI) to analyze functional long-term outcome after endovascular repair of blunt aortic injury. METHODS This prospective study enrolled 27 of 53 patients who were treated between 1999 and 2008. Patients underwent functional multidimensional contrast-enhanced MRI with flow analysis or compliance measurements of the aorta, or both. Ten patients were treated with the Medtronic Valiant (Medtronic World Medical, Sunrise, Fla), 14 patients received a Gore TAG (W. L. Gore & Associates, Flagstaff, Ariz), and two received a C (conformable)-TAG (W. L. Gore & Associates) stent graft. For several patients, repetitive measurements over time could be done. Median follow-up was 3.92 ± 2.7 years. The MRI parameters were: three-dimensional flow: echo time/repetition time = 3.1/5.3 ms, Δx(pixel density) = 2.5 × 2.5 × 3 mm(3); respiratory navigator, α = 15°, venc(encoding velocity) = 200 cm/s along anterior-posterior, right-left, and foot-head direction, 40 cardiac phases. Cine: echo time/repetition time = 1.7/3.4 ms, Δx(pixel density) = 1.2 × 1.2 × 6 mm(3), breathhold, α = 60°, 40 cardiac phases. RESULTS The flow analysis showed flow acceleration at the proximal end of the stent graft, with higher values in patients with a nonoptimal alignment of the stent graft. No differences were found between different devices (median acceleration was 75.99 ± 37.98 cm/s for Gore and 71.59 ± 17.22 cm/s for Medtronic). The values were stable during follow-up. In the compliance analysis, the part of the aorta covered with the stent graft showed nearly no expansion, whereas the ascending and descending aorta showed normal expansion. This behavior did not change over the time. At the proximal end of the stent graft, a slight compression could be noted (-0.5 ± 0.14 mm), except in those patients with a C-TAG device from Gore. CONCLUSIONS Functional analysis showed no adverse long-term outcome of the bird beak configuration of stent grafts in the aortic arch after endovascular repair after blunt aortic injury.
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Affiliation(s)
- Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University of Düsseldorf, Düsseldorf, Germany.
| | - David Schabhasian
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Robert Kohlschmitt
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | | | - Karl-Heinz Orend
- Department of Cardiothoracic and Vascular Surgery, University of Ulm, Ulm, Germany
| | - Volker Rasche
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
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