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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [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: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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2
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Saputra PBT, Lamara AD, Saputra ME, Pasahari D, Kurniawan RB, Farabi MJA, Multazam CECZ, Oktaviono YH, Alkaff FF. Long-term systolic blood pressure variability independent of mean blood pressure is associated with mortality and cardiovascular events: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102343. [PMID: 38103812 DOI: 10.1016/j.cpcardiol.2023.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
The association between long-term systolic blood pressure variability (SBPV) and cardiovascular (CV) outcomes after being adjusted with mean blood pressure (BP) is questionable. This systematic review aims to evaluate the associations between mean BP adjusted long-term SBPV and CV outcomes. A systematic search was conducted on PubMed, Scopus, and Science Direct on January 4, 2023. A total of 9,944,254 subjects from 43 studies were included in this meta-analysis. Long-term SBPV increased the risk of all-cause mortality (HR 1.21 [95%CI 1.16-1.25], I2=100%), CV mortality (HR 1.10 [95%CI 1.07-11.4], I2 = 90%), MACE (HR 1.10 [1.07-1.13], I2 = 91%), cerebrovascular stroke (HR 1.22 [1.16-1.29], I2=100%), and myocardial infarction (HR 1.13 [95%CI (1.07-1.19)], I2=91%). European populations generally had higher risk compared to other continents. In conclusion, long-term SBPV is associated with all-cause mortality, CV mortality, MACE, MI, and stroke. Poor outcomes related to long-term SBPV seem more dominated by cerebrovascular than coronary events.
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Affiliation(s)
- Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Ariikah Dyah Lamara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mahendra Eko Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Diar Pasahari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | | | - Makhyan J Al Farabi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | | | - Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Firas F Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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3
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Garber L, Khodaei S, Maftoon N, Keshavarz-Motamed Z. Impact of TAVR on coronary artery hemodynamics using clinical measurements and image-based patient-specific in silico modeling. Sci Rep 2023; 13:8948. [PMID: 37268642 DOI: 10.1038/s41598-023-31987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 06/04/2023] Open
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has become the leading method for treating aortic stenosis. While the procedure has improved dramatically in the past decade, there are still uncertainties about the impact of TAVR on coronary blood flow. Recent research has indicated that negative coronary events after TAVR may be partially driven by impaired coronary blood flow dynamics. Furthermore, the current technologies to rapidly obtain non-invasive coronary blood flow data are relatively limited. Herein, we present a lumped parameter computational model to simulate coronary blood flow in the main arteries as well as a series of cardiovascular hemodynamic metrics. The model was designed to only use a few inputs parameters from echocardiography, computed tomography and a sphygmomanometer. The novel computational model was then validated and applied to 19 patients undergoing TAVR to examine the impact of the procedure on coronary blood flow in the left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) and various global hemodynamics metrics. Based on our findings, the changes in coronary blood flow after TAVR varied and were subject specific (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). Additionally, valvular pressure gradient, left ventricle (LV) workload and maximum LV pressure decreased by 61.5%, 4.5% and 13.0% respectively, while mean arterial pressure and cardiac output increased by 6.9% and 9.9% after TAVR. By applying this proof-of-concept computational model, a series of hemodynamic metrics were generated non-invasively which can help to better understand the individual relationships between TAVR and mean and peak coronary flow rates. In the future, tools such as these may play a vital role by providing clinicians with rapid insight into various cardiac and coronary metrics, rendering the planning for TAVR and other cardiovascular procedures more personalized.
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Affiliation(s)
- Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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4
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Minici R, Serra R, Giurdanella M, Talarico M, Siciliano MA, Carrafiello G, Laganà D. Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver. J Pers Med 2023; 13:jpm13040640. [PMID: 37109026 PMCID: PMC10142661 DOI: 10.3390/jpm13040640] [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: 03/12/2023] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. METHODS This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. RESULTS Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. CONCLUSIONS Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Marco Giurdanella
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Marisa Talarico
- Cardiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | | | | | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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5
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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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Sadeghi R, Tomka B, Khodaei S, Daeian M, Gandhi K, Garcia J, Keshavarz-Motamed Z. Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling. Sci Rep 2022; 12:9718. [PMID: 35690596 PMCID: PMC9188592 DOI: 10.1038/s41598-022-12894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/28/2023] Open
Abstract
Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn't change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.
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Affiliation(s)
- Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Benjamin Tomka
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - MohammadAli Daeian
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Krishna Gandhi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Julio Garcia
- grid.489011.50000 0004 0407 3514Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Cardiac Sciences, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, Calgary, AB Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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7
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Sekine T, Nakaza M, Matsumoto M, Ando T, Inoue T, Sakamoto SI, Maruyama M, Obara M, Leonowicz O, Usuda J, Kumita S. 4D Flow MR Imaging of the Left Atrium: What is Non-physiological Blood Flow in the Cardiac System? Magn Reson Med Sci 2022; 21:293-308. [PMID: 35185085 PMCID: PMC9680542 DOI: 10.2463/mrms.rev.2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/30/2024] Open
Abstract
Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masatoki Nakaza
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Mitsuo Matsumoto
- Department of Thoracic Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Nagayama Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Mitsunori Maruyama
- Department of Cardiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | | | | | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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8
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Itatani K, Sekine T, Yamagishi M, Maeda Y, Higashitani N, Miyazaki S, Matsuda J, Takehara Y. Hemodynamic Parameters for Cardiovascular System in 4D Flow MRI: Mathematical Definition and Clinical Applications. Magn Reson Med Sci 2022; 21:380-399. [PMID: 35173116 DOI: 10.2463/mrms.rev.2021-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Blood flow imaging becomes an emerging trend in cardiology with the recent progress in computer technology. It not only visualizes colorful flow velocity streamlines but also quantifies the mechanical stress on cardiovascular structures; thus, it can provide the detailed inspections of the pathophysiology of diseases and predict the prognosis of cardiovascular functions. Clinical applications include the comprehensive assessment of hemodynamics and cardiac functions in echocardiography vector flow mapping (VFM), 4D flow MRI, and surgical planning as a simulation medicine in computational fluid dynamics (CFD).For evaluation of the hemodynamics, novel mathematically derived parameters obtained using measured velocity distributions are essential. Among them, the traditional and typical parameters are wall shear stress (WSS) and its related parameters. These parameters indicate the mechanical damages to endothelial cells, resulting in degenerative intimal change in vascular diseases. Apart from WSS, there are abundant parameters that describe the strength of the vortical and/or helical flow patterns. For instance, vorticity, enstrophy, and circulation indicate the rotating flow strength or power of 2D vortical flows. In addition, helicity, which is defined as the cross-linking number of the vortex filaments, indicates the 3D helical flow strength and adequately describes the turbulent flow in the aortic root in cases with complicated anatomies. For the description of turbulence caused by the diseased flow, there exist two types of parameters based on completely different concepts, namely: energy loss (EL) and turbulent kinetic energy (TKE). EL is the dissipated energy with blood viscosity and evaluates the cardiac workload related to the prognosis of heart failure. TKE describes the fluctuation in kinetic energy during turbulence, which describes the severity of the diseases that cause jet flow. These parameters are based on intuitive and clear physiological concepts, and are suitable for in vivo flow measurements using inner velocity profiles.
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Affiliation(s)
- Keiichi Itatani
- Department of Cardiovascular Surgery, Osaka City University.,Cardio Flow Design Inc
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Norika Higashitani
- Cardio Flow Design Inc.,Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yasuo Takehara
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya university Graduate School of Medicine
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9
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Sadeghi R, Tomka B, Khodaei S, Garcia J, Ganame J, Keshavarz‐Motamed Z. Reducing Morbidity and Mortality in Patients With Coarctation Requires Systematic Differentiation of Impacts of Mixed Valvular Disease on Coarctation Hemodynamics. J Am Heart Assoc 2022; 11:e022664. [PMID: 35023351 PMCID: PMC9238522 DOI: 10.1161/jaha.121.022664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Despite ongoing advances in surgical techniques for coarctation of the aorta (COA) repair, the long-term results are not always benign. Associated mixed valvular diseases (various combinations of aortic and mitral valvular pathologies) are responsible for considerable postoperative morbidity and mortality. We investigated the impact of COA and mixed valvular diseases on hemodynamics. Methods and Results We developed a patient-specific computational framework. Our results demonstrate that mixed valvular diseases interact with COA fluid dynamics and contribute to speed up the progression of the disease by amplifying the irregular flow patterns downstream of COA (local) and exacerbating the left ventricular function (global) (N=26). Velocity downstream of COA with aortic regurgitation alone was increased, and the situation got worse when COA and aortic regurgitation coexisted with mitral regurgitation (COA with normal valves: 5.27 m/s, COA with only aortic regurgitation: 8.8 m/s, COA with aortic and mitral regurgitation: 9.36 m/s; patient 2). Workload in these patients was increased because of the presence of aortic stenosis alone, aortic regurgitation alone, mitral regurgitation alone, and when they coexisted (COA with normal valves: 1.0617 J; COA with only aortic stenosis: 1.225 J; COA with only aortic regurgitation: 1.6512 J; COA with only mitral regurgitation: 1.3599 J; patient 1). Conclusions Not only the severity of COA, but also the presence and the severity of mixed valvular disease should be considered in the evaluation of risks in patients. The results suggest that more aggressive surgical approaches may be required, because regularly chosen current surgical techniques may not be optimal for such patients.
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Affiliation(s)
- Reza Sadeghi
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Benjamin Tomka
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Seyedvahid Khodaei
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Julio Garcia
- Stephenson Cardiac Imaging CentreLibin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada,Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada,Department of Cardiac SciencesUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children’s Hospital Research InstituteCalgaryAlbertaCanada
| | - Javier Ganame
- Division of CardiologyDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Zahra Keshavarz‐Motamed
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada,School of Biomedical EngineeringMcMaster UniversityHamiltonOntarioCanada,School of Computational Science and EngineeringMcMaster UniversityHamiltonOntarioCanada,The Thrombosis & Atherosclerosis Research InstituteMcMaster UniversityHamiltonOntarioCanada
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10
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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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11
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Kocaoglu M, Pednekar A, Tkach JA, Taylor MD. Quantitative assessment of velocity and flow using compressed SENSE in children and young adults with adequate acquired temporal resolution. J Cardiovasc Magn Reson 2021; 23:113. [PMID: 34663351 PMCID: PMC8522244 DOI: 10.1186/s12968-021-00811-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phase contrast (PC) cardiovascular magnetic resonance (CMR) imaging with parallel imaging acceleration is established and validated for measuring velocity and flow. However, additional acceleration to further shorten acquisition times would be beneficial in patients with complex vasculature who need multiple PC-CMR measurements, especially pediatric patients with higher heart rates. METHODS PC-CMR images acquired with compressed sensitivity encoding (C-SENSE) factors of 3 to 6 and standard of care PC-CMR with sensitivity encoding (SENSE) factor of 2 (S2) acquired as part of clinical CMR examinations performed between November 2020 and January 2021 were analyzed retrospectively. The velocity and flow through the ascending aorta (AAo), descending aorta (DAo), and superior vena cava (SVC) in a transverse plane at the level of pulmonary artery bifurcation were compared. Additionally, frequency power distribution and dynamic time warp distance were calculated for these acquisitions. To further validate the adequate temporal resolution requirement, patients with S2 PC-CMR in the same acquisition plane were added in frequency power distribution analysis. RESULTS Twenty-eight patients (25 males; 15.9 ± 1.9 years; body surface area (BSA) 1.7 ± 0.2 m2; heart rate 81 ± 16 bpm) underwent all five PC-CMR acquisitions during the study period. An additional 22 patients (16 males; 17.5 ± 7.7 years; BSA 1.6 ± 0.5 m2; heart rate 91 ± 16 bpm) were included for frequency power spectrum analysis. As expected, scan time decreased with increasing C-SENSE acceleration factor = 3 (37.5 ± 6.5 s, 26.4 ± 7.6%), 4 (28.1 ± 4.9 s, 44.7 ± 5.6%), 5 (21.6 ± 3.6 s, 57.6 ± 4.4%), and 6 (19.1 ± 3.2 s, 62.3 ± 4.2%) relative to SENSE = 2 (51.3 ± 10.1 s) PC-CMR acquisition. Mean peak velocity, net flow, and cardiac output were comparable (p > 0.87) between the five PC-CMR acquisitions with mean differences less than < 4%, < 2%, and < 3% respectively. All individual blood vessels showed a non-significant dependence of difference in fmax99 (< 4 Hz, p > 0.2), and dynamic time warp distance (p > 0.3) on the C-SENSE acceleration factor used. There was a strongly correlated (r = 0.74) increase in fmax99 (10.5 ± 2.2, range: 7.1-16.4 Hz) with increasing heart rate. The computed minimum required cardiac phase number was 15 ± 2.0 (range: 11-20) over the heart rate of 86 ± 15 bpm (range: 58-113 bpm). CONCLUSIONS Stroke volume, cardiac output, and mean peak velocity measurements using PC-CMR with C-SENSE of up to 6 agree with measurements by standard of care PC-CMR with SENSE = 2 and resulted in up to a 65% reduction in acquisition time. Adequate temporal sampling can be ensured by acquiring 20 cardiac phases throughout the entire cardiac cycle over a wide range of pediatric and young adult heart rates.
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Affiliation(s)
- Murat Kocaoglu
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Amol Pednekar
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Jean A. Tkach
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, S1.533, 3333 Burnet Ave, Cincinnati, OH 45229 USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Michael D. Taylor
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
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12
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Cesarovic N, Weisskopf M, Kron M, Glaus L, Peper ES, Buoso S, Suendermann S, Canic M, Falk V, Kozerke S, Emmert MY, Stoeck CT. Septaly Oriented Mild Aortic Regurgitant Jets Negatively Influence Left Ventricular Blood Flow-Insights From 4D Flow MRI Animal Study. Front Cardiovasc Med 2021; 8:711099. [PMID: 34434980 PMCID: PMC8380779 DOI: 10.3389/fcvm.2021.711099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Paravalvular leakage (PVL) and eccentric aortic regurgitation remain a major clinical concern in patients receiving transcatheter aortic valve replacement (TAVR), and regurgitant volume remains the main readout parameter in clinical assessment. In this work we investigate the effect of jet origin and trajectory of mild aortic regurgitation on left ventricular hemodynamics in a porcine model. Methods: A pig model of mild aortic regurgitation/PVL was established by transcatheter piercing and dilating the non-coronary (NCC) or right coronary cusp (RCC) of the aortic valve close to the valve annulus. The interaction between regurgitant blood and LV hemodynamics was assessed by 4D flow cardiovascular MRI. Results: Six RCC, six NCC, and two control animals were included in the study and with one dropout in the NCC group, the success rate of model creation was 93%. Regurgitant jets originating from NCC were directed along the ventricular side of the anterior mitral leaflet and integrated well into the diastolic vortex forming in the left ventricular outflow tract. However, jets from the RCC were orientated along the septum colliding with flow within the vortex, and progressing down to the apex. As a consequence, the presence as well as the area of the vortex was reduced at the site of impact compared to the NCC group. Impairment of vortex formation was localized to the area of impact and not the entire vortex ring. Blood from the NCC jet was largely ejected during the following systole, whereas ejection of large portion of RCC blood was protracted. Conclusions: Even for mild regurgitation, origin and trajectory of the regurgitant jet does cause a different effect on LV hemodynamics. Septaly oriented jets originating from RCC collide with the diastolic vortex, reduce its size, and reach the apical region of the left ventricle where blood resides extendedly. Hence, RCC jets display hemodynamic features which may have a potential negative impact on the long-term burden to the heart.
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Affiliation(s)
- Nikola Cesarovic
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Miriam Weisskopf
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mareike Kron
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Glaus
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Eva S Peper
- Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
| | - Stefano Buoso
- Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
| | - Simon Suendermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marko Canic
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Christian T Stoeck
- Institute for Biomedical Engineering, University and ETH Zürich, Zurich, Switzerland
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13
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Baiocchi M, Barsoum S, Khodaei S, de la Torre Hernandez JM, Valentino SE, Dunford EC, MacDonald MJ, Keshavarz-Motamed Z. Effects of Choice of Medical Imaging Modalities on a Non-invasive Diagnostic and Monitoring Computational Framework for Patients With Complex Valvular, Vascular, and Ventricular Diseases Who Undergo Transcatheter Aortic Valve Replacement. Front Bioeng Biotechnol 2021; 9:643453. [PMID: 34307316 PMCID: PMC8297508 DOI: 10.3389/fbioe.2021.643453] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Due to the high individual differences in the anatomy and pathophysiology of patients, planning individualized treatment requires patient-specific diagnosis. Indeed, hemodynamic quantification can be immensely valuable for accurate diagnosis, however, we still lack precise diagnostic methods for numerous cardiovascular diseases including complex (and mixed) valvular, vascular, and ventricular interactions (C3VI) which is a complicated situation made even more challenging in the face of other cardiovascular pathologies. Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. In a recent paper, we developed a non-invasive and Doppler-based diagnostic and monitoring computational mechanics framework for C3VI, called C3VI-DE that uses input parameters measured reliably using Doppler echocardiography. In the present work, we have developed another computational-mechanics framework for C3VI (called C3VI-CT). C3VI-CT uses the same lumped-parameter model core as C3VI-DE but its input parameters are measured using computed tomography and a sphygmomanometer. Both frameworks can quantify: (1) global hemodynamics (metrics of cardiac function); (2) local hemodynamics (metrics of circulatory function). We compared accuracy of the results obtained using C3VI-DE and C3VI-CT against catheterization data (gold standard) using a C3VI dataset (N = 49) for patients with C3VI who undergo TAVR in both pre and post-TAVR with a high variability. Because of the dataset variability and the broad range of diseases that it covers, it enables determining which framework can yield the most accurate results. In contrast with C3VI-CT, C3VI-DE tracks both the cardiac and vascular status and is in great agreement with cardiac catheter data.
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Affiliation(s)
- Melissa Baiocchi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Shirley Barsoum
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | | | | | - Emily C Dunford
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | | | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.,School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada
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14
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Rafiei D, Abazari MA, Soltani M, Alimohammadi M. The effect of coarctation degrees on wall shear stress indices. Sci Rep 2021; 11:12757. [PMID: 34140562 PMCID: PMC8211800 DOI: 10.1038/s41598-021-92104-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Coarctation of the aorta (CoA) is a congenital tightening of the proximal descending aorta. Flow quantification can be immensely valuable for an early and accurate diagnosis. However, there is a lack of appropriate diagnostic approaches for a variety of cardiovascular diseases, such as CoA. An accurate understanding of the disease depends on measurements of the global haemodynamics (criteria for heart function) and also the local haemodynamics (detailed data on the dynamics of blood flow). Playing a significant role in clinical processes, wall shear stress (WSS) cannot be measured clinically; thus, computation tools are needed to give an insight into this crucial haemodynamic parameter. In the present study, in order to enable the progress of non-invasive approaches that quantify global and local haemodynamics for different CoA severities, innovative computational blueprint simulations that include fluid-solid interaction models are developed. Since there is no clear approach for managing the CoA regarding its severity, this study proposes the use of WSS indices and pressure gradient to better establish a framework for treatment procedures in CoA patients with different severities. This provides a platform for improving CoA therapy on a patient-specific level, in which physicians can perform treatment methods based on WSS indices on top of using a mere experience. Results show how severe CoA affects the aorta in comparison to the milder cases, which can give the medical community valuable information before and after any intervention.
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Affiliation(s)
- Deniz Rafiei
- Department of Mechanical Engineering, K. N. Toosi Univeristy of Technology, Tehran, Iran
| | - Mohammad Amin Abazari
- Department of Mechanical Engineering, K. N. Toosi Univeristy of Technology, Tehran, Iran
| | - M Soltani
- Department of Mechanical Engineering, K. N. Toosi Univeristy of Technology, Tehran, Iran
- Department of Electrical and Computer Engineering, Faculty of Engineering, School of Optometry and Vision Science, Faculty of Science, University of Waterloo, Waterloo, Canada
- Advanced Bioengineering Initiative Center, Multidisciplinary International Complex, K. N. Toosi University of Technology, Tehran, Iran
- Centre for Biotechnology and Bioengineering (CBB), University of Waterloo, Waterloo, ON, Canada
- Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Alimohammadi
- Department of Mechanical Engineering, K. N. Toosi Univeristy of Technology, Tehran, Iran.
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15
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Khodaei S, Henstock A, Sadeghi R, Sellers S, Blanke P, Leipsic J, Emadi A, Keshavarz-Motamed Z. Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework. Sci Rep 2021; 11:10888. [PMID: 34035325 PMCID: PMC8149684 DOI: 10.1038/s41598-021-85500-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
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Affiliation(s)
- Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Alison Henstock
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Stephanie Sellers
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Philipp Blanke
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Jonathon Leipsic
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Ali Emadi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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16
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Marlevi D, Edelman ER. Vascular Lesion-Specific Drug Delivery Systems: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2413-2431. [PMID: 33985687 PMCID: PMC8238531 DOI: 10.1016/j.jacc.2021.03.307] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 01/15/2023]
Abstract
Drug delivery is central to modern cardiovascular care, where drug-eluting stents, bioresorbable scaffolds, and drug-coated balloons all aim to restore perfusion while inhibiting exuberant healing. The promise and enthusiasm of these devices has in some cases exceeded demonstration of efficacy and even understanding of driving mechanisms. The authors review the means of drug delivery in each device, outlining how the technologies affect vascular behavior. They focus on how drug retention and response are governed by lesion morphology: lipid displacing drug-specific binding sites, calcium inhibiting diffusion, blocking thrombi or promoting luminal washout, and vascular healing steering hyperplastic developments. In this regard, the authors outline the fundamental impact of vascular structure on drug delivery and review the development of contemporary and future devices for coronary and peripheral intervention. They look toward a future where incorporating information on lesion distribution is central to therapeutic success and envision a transition toward lesion-specific treatment for improved interventional outcomes.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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17
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Radial Artery Occlusion With Distal Radial Access Compared to Conventional Transradial Access: A Pathophysiology Outlook. JACC Cardiovasc Interv 2021; 14:1043. [PMID: 33958164 DOI: 10.1016/j.jcin.2021.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022]
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18
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Stuart T, Cai L, Burton A, Gutruf P. Wireless and battery-free platforms for collection of biosignals. Biosens Bioelectron 2021; 178:113007. [PMID: 33556807 PMCID: PMC8112193 DOI: 10.1016/j.bios.2021.113007] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
Recent progress in biosensors have quantitively expanded current capabilities in exploratory research tools, diagnostics and therapeutics. This rapid pace in sensor development has been accentuated by vast improvements in data analysis methods in the form of machine learning and artificial intelligence that, together, promise fantastic opportunities in chronic sensing of biosignals to enable preventative screening, automated diagnosis, and tools for personalized treatment strategies. At the same time, the importance of widely accessible personal monitoring has become evident by recent events such as the COVID-19 pandemic. Progress in fully integrated and chronic sensing solutions is therefore increasingly important. Chronic operation, however, is not truly possible with tethered approaches or bulky, battery-powered systems that require frequent user interaction. A solution for this integration challenge is offered by wireless and battery-free platforms that enable continuous collection of biosignals. This review summarizes current approaches to realize such device architectures and discusses their building blocks. Specifically, power supplies, wireless communication methods and compatible sensing modalities in the context of most prevalent implementations in target organ systems. Additionally, we highlight examples of current embodiments that quantitively expand sensing capabilities because of their use of wireless and battery-free architectures.
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Affiliation(s)
- Tucker Stuart
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Le Cai
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Alex Burton
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Philipp Gutruf
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA; Department of Electrical Engineering, University of Arizona, Tucson, AZ, 85721, USA; Bio5 Institute, University of Arizona, Tucson, AZ, 85721, USA; Neuroscience GIDP, University of Arizona, Tucson, AZ, 85721, USA.
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19
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Intracardiac and Vascular Hemodynamics with Cardiovascular Magnetic Resonance in Heart Failure. Heart Fail Clin 2021; 17:135-147. [PMID: 33220882 DOI: 10.1016/j.hfc.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In heart failure (HF), the impaired heart loses its ability to competently eject blood during systole or fill with blood during diastole, manifesting in multifaceted abnormal intracardiac or intravascular flow dynamics. Conventional imaging techniques are limited in their ability to evaluate multidirectional multidimensional flow alterations in HF. Four-dimensional (4-D) flow magnetic resonance imaging (MRI) has emerged as a promising technique to comprehensively visualize and quantify changes in 3-dimensional blood flow dynamics in complex cardiovascular diseases. This article reviews emerging applications of 4-D flow MRI hemodynamic markers in HF and etiologies at risk of progressing to HF.
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20
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Non-invasive estimation of relative pressure for intracardiac flows using virtual work-energy. Med Image Anal 2020; 68:101948. [PMID: 33383332 DOI: 10.1016/j.media.2020.101948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023]
Abstract
Intracardiac blood flow is driven by differences in relative pressure, and assessing these is critical in understanding cardiac disease. Non-invasive image-based methods exist to assess relative pressure, however, the complex flow and dynamically moving fluid domain of the intracardiac space limits assessment. Recently, we proposed a method, νWERP, utilizing an auxiliary virtual field to probe relative pressure through complex, and previously inaccessible flow domains. Here we present an extension of νWERP for intracardiac flow assessments, solving the virtual field over sub-domains to effectively handle the dynamically shifting flow domain. The extended νWERP is validated in an in-silico benchmark problem, as well as in a patient-specific simulation model of the left heart, proving accurate over ranges of realistic image resolutions and noise levels, as well as superior to alternative approaches. Lastly, the extended νWERP is applied on clinically acquired 4D Flow MRI data, exhibiting realistic ventricular relative pressure patterns, as well as indicating signs of diastolic dysfunction in an exemplifying patient case. Summarized, the extended νWERP approach represents a directly applicable implementation for intracardiac flow assessments.
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21
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Sundin J, Engvall J, Nylander E, Ebbers T, Bolger AF, Carlhäll CJ. Improved Efficiency of Intraventricular Blood Flow Transit Under Cardiac Stress: A 4D Flow Dobutamine CMR Study. Front Cardiovasc Med 2020; 7:581495. [PMID: 33324686 PMCID: PMC7724031 DOI: 10.3389/fcvm.2020.581495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: The effects of heart rate, inotropy, and lusitropy on multidimensional flow patterns and energetics within the human heart remain undefined. Recently, reduced volume and end-diastolic kinetic energy (KE) of the portion of left ventricular (LV) inflow passing directly to outflow, Direct flow (DF), have been shown to reflect inefficient LV pumping and to be a marker of LV dysfunction in heart failure patients. In this study, we hypothesized that increasing heart rate, inotropy, and lusitropy would result in an increased efficiency of intraventricular blood flow transit. Therefore, we sought to investigate LV 4D blood flow patterns and energetics with dobutamine infusion. Methods: 4D flow and morphological cardiovascular magnetic resonance (CMR) data were acquired in twelve healthy subjects: at rest and with dobutamine infusion to achieve a target heart rate ~60% higher than the resting heart rate. A previously validated method was used for flow analysis: pathlines were emitted from the end-diastolic (ED) LV blood volume and traced forward and backward in time to separate four functional LV flow components. For each flow component, KE/mL blood volume at ED was calculated. Results: With dobutamine infusion there was an increase in heart rate (64%, p < 0.001), systolic blood pressure (p = 0.02) and stroke volume (p = 0.01). Of the 4D flow parameters, the most efficient flow component (DF), increased its proportion of EDV (p < 0.001). The EDV proportion of Residual volume, the blood residing in the ventricle over at least two cardiac cycles, decreased (p < 0.001). The KE/mL at ED for all flow components increased (p < 0.001). DF had the largest absolute and relative increase while Residual volume had the smallest absolute and relative increase. Conclusions: This study demonstrates that it is feasible to compare 4D flow patterns within the normal human heart at rest and with stress. At higher heart rate, inotropy and lusitropy, elicited by dobutamine infusion, the efficiency of intraventricular blood flow transit improves, as quantified by an increased relative volume and pre-systolic KE of the most efficient DF component of the LV volume. The change in these markers may allow a novel assessment of LV function and LV dysfunction over a range of stress.
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Affiliation(s)
- Jonathan Sundin
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carl-Johan Carlhäll
- Unit of Cardiovascular Sciences and Center for Medical Image Science and Visualization, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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22
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Jinnouchi H, Sato Y, Cheng Q, Janifer C, Kutyna M, Cornelissen A, Wijeratne R, Sakamoto A, Guo L, Kolodgie FD, Tunev S, Virmani R, Finn AV. Thromboresistance and endothelial healing in polymer-coated versus polymer-free drug-eluting stents: Implications for short-term dual anti-platelet therapy. Int J Cardiol 2020; 327:52-57. [PMID: 33242506 DOI: 10.1016/j.ijcard.2020.11.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/11/2020] [Accepted: 11/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Short-term dual antiplatelet therapy (DAPT) is a suitable strategy after stent implantation especially in patients at high risk for bleeding. The thromboresistant characteristics and the healing profile permanent polymer stents such as the Resolute Onyx- drug-eluting stent (DES) has never been tested against the current approved stents for short-term DAPT, the polymer free (PF) biolimus-eluting stent (PF-BES) and bare metal stents (BMS) in dedicated preclinical models. METHODS An ex-vivo porcine arteriovenous shunt and in-vivo flow loop model were used to evaluate thromboresistance. The healing profile was assessed in the rabbit model at 28 days by confocal microscopy (CM), scanning electron microscopy (SEM) and histology. Onyx-DES was separately compared with Onyx-BMS in first experiment and PF-BES in second experiment. RESULTS In an ex-vivo shunt model, CM and SEM showed significantly less platelet adhesion for Onyx-DES relative to Onyx-BMS and PF-BES. In a flow loop model using human blood, platelet adhesion was also significantly less in Onyx-DES as compared to PF-BES and Onyx-BMS. In the healing study, Onyx-BMS showed significantly greater healing profile relative to Onyx-DES as expected, whereas Onyx-DES showed equivalent endothelial coverage by SEM and significantly less Evan's blue uptake and comparable colocalization of p120 and vascular endothelial-cadherin when compared with PF-BES. CONCLUSIONS Onyx-DES showed qualities of thomboresistance and healing which appear to be compatible with short-term DAPT. Thromboresistance was superior to PF-BES and healing was equivalent to PF-BES in this pre-clinical study. Onyx-DES might provide advantages when considering short-term DAPT especially in patients at high risk of bleeding.
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Affiliation(s)
| | - Yu Sato
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Qi Cheng
- CVPath Institute, Gaithersburg, MD, United States of America
| | | | - Matthew Kutyna
- CVPath Institute, Gaithersburg, MD, United States of America
| | | | | | | | - Liang Guo
- CVPath Institute, Gaithersburg, MD, United States of America
| | | | - Stefan Tunev
- Medtronic CardioVascular, Santa Rosa, CA, United States of America
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD, United States of America
| | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, United States of America; University of Maryland, Baltimore, MD, United States of America.
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23
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Chang KH, Lee YH, Chen CY, Lin MF, Lin YC, Chen JH, Chan WP. Inter- and Intra-Rater Reliability of Individual Cerebral Blood Flow Measured by Quantitative Vessel-Flow Phase-Contrast MRI. J Clin Med 2020; 9:E3099. [PMID: 32992892 PMCID: PMC7601288 DOI: 10.3390/jcm9103099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Vessel flow quantification by two-dimensional (2D) phase-contrast magnetic resonance imaging (PC-MRI) using a three-dimensional (3D) magnetic resonance angiography (MRA) model to measure cerebral blood flow has unclear analytical reliability. The present study aimed to determine the inter- and intra-rater reliability of quantitative vessel-flow PC-MRI and potential factors influencing its consistency. We prospectively recruited 30 Asian participants (aged 20-90 years; 16 women; 22 healthy and 8 stroke patients) for performing 1.5-T MR equipped with a head coil. Each participant was first scanned for time-of-flight magnetic resonance angiography (TOF-MRA) images for localization of intracranial arteries. The 2D PC-MRI for each cerebral artery (total 13 arteries in fixed order) was performed twice by two well-trained operators in optimal position. Using the same 3D MRA as a map and facilitated with the non-invasive optimal vessel analysis (NOVA) system, each scan was taken on a plane perpendicular to the target artery. Two consecutive full 13-artery scans were performed at least 15 min apart after participants were removed from the scanner table and then repositioned. A total of four PC flow images obtained from each target artery were transmitted to a workstation facilitated with the NOVA system. Flow data were calculated semi-automatically by the NOVA system after a few simple steps. Two-way mixed-effect models and standard errors of measurements were used. In 13 cerebral arteries, repeatability, using the intra-rater estimate expressed as the average-measures intraclass correlation coefficient, ranged from 0.641 to 0.954, and reproducibility, using the inter-rater estimate, ranged from 0.672 to 0.977. Except in the middle cerebral artery and the distal segment of the anterior cerebral artery, repeatability and reproducibility were excellent (intraclass correlation coefficient exceeded 0.8). The use of quantitative vessel-flow PC-MRI is a precise means to measure blood flow in most target cerebral arteries. This was evidenced by inter-rater and intra-rater correlations that were good/excellent, indicating good reproducibility and repeatability.
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Affiliation(s)
- Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 110, Taiwan
| | - Yuan-Hao Lee
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.L.); (M.-F.L.); (W.P.C.)
| | - Chia-Yuen Chen
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.L.); (M.-F.L.); (W.P.C.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ming-Fang Lin
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.L.); (M.-F.L.); (W.P.C.)
- Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu 30015, Taiwan
| | - Ying Chin Lin
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jyh-Horng Chen
- Department of Electrical Engineering, National Taiwan University, Taipei 10617, Taiwan;
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei 10051, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.L.); (M.-F.L.); (W.P.C.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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24
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Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol 2020; 31:1160-1174. [PMID: 32870392 DOI: 10.1007/s00330-020-07210-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in a growing population of patients surviving well into adulthood and requiring lifelong follow-up. Flow quantification is a central component in the assessment of patients with CHD. 4D flow magnetic resonance imaging (MRI) has emerged as a tool that enables comprehensive study of flow. It involves the acquisition of a three-dimensional time-resolved volume with velocity encoding in all three spatial directions along the cardiac cycle. This allows flow quantification and visualization of blood flow patterns as well as the study of advanced hemodynamic parameters as kinetic energy and wall shear stress. 4D flow MRI-based study of flow has given insight into the altered hemodynamics in CHD particularly in bicuspid aortic valve disease and Fontan circulation. The aim of this review is to discuss the expanding clinical and research applications of 4D flow MRI in CHD as well its limitations.Key Points• Three-dimensional velocity encoding allows not only flow quantification but also the visualization of multidirectional flow patterns and the study of advanced hemodynamic parameters.• 4D flow MRI has added insight into the abnormal hemodynamics involved in congenital heart disease in particular in bicuspid aortic valve and Fontan circulation.• The main limitation of 4D flow MRI in congenital heart disease is the relatively long scan duration required for the complete coverage of the heart and great vessels with adequate spatiotemporal resolution.
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Affiliation(s)
- Judy Rizk
- Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria, 21521, Egypt.
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25
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Sadeghi R, Khodaei S, Ganame J, Keshavarz-Motamed Z. Towards non-invasive computational-mechanics and imaging-based diagnostic framework for personalized cardiology for coarctation. Sci Rep 2020; 10:9048. [PMID: 32493936 PMCID: PMC7271217 DOI: 10.1038/s41598-020-65576-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (COA) is a congenital narrowing of the proximal descending aorta. Although accurate and early diagnosis of COA hinges on blood flow quantification, proper diagnostic methods for COA are still lacking because fluid-dynamics methods that can be used for accurate flow quantification are not well developed yet. Most importantly, COA and the heart interact with each other and because the heart resides in a complex vascular network that imposes boundary conditions on its function, accurate diagnosis relies on quantifications of the global hemodynamics (heart-function metrics) as well as the local hemodynamics (detailed information of the blood flow dynamics in COA). In this study, to enable the development of new non-invasive methods that can quantify local and global hemodynamics for COA diagnosis, we developed an innovative fast computational-mechanics and imaging-based framework that uses Lattice Boltzmann method and lumped-parameter modeling that only need routine non-invasive clinical patient data. We used clinical data of patients with COA to validate the proposed framework and to demonstrate its abilities to provide new diagnostic analyses not possible with conventional diagnostic methods. We validated this framework against clinical cardiac catheterization data, calculations using the conventional finite-volume method and clinical Doppler echocardiographic measurements. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
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Affiliation(s)
- Reza Sadeghi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Javier Ganame
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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26
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Jinnouchi H, Guo L, Sakamoto A, Sato Y, Cornelissen A, Kawakami R, Mori M, Torii S, Kuntz S, Harari E, Mori H, Fuller D, Gadhoke N, Fernandez R, Paek KH, Surve D, Romero M, Kolodgie FD, Virmani R, Finn AV. Advances in mammalian target of rapamycin kinase inhibitors: application to devices used in the treatment of coronary artery disease. Future Med Chem 2020; 12:1181-1195. [PMID: 32431177 PMCID: PMC7333590 DOI: 10.4155/fmc-2019-0304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
Mammalian target of rapamycin (mTOR) inhibitors have been applied to vascular coronary devices to avoid neointimal growth and have become the predominant pharmacological agents used to prevent restenosis. mTOR inhibitors can affect not only proliferating vascular smooth muscle cells but also endothelial cells and therefore can result in delayed healing of the vessel including endothelialization. Emerging evidence suggests accelerated atherosclerosis due to the downstream negative effects on endothelial barrier functional recovery. The development of neoatherosclerosis within the neointima of drug-eluting stents can result in late thrombotic events. This type of problematic healing response may open the way for specific mTOR kinase inhibitors, such as ATP-competitive mTOR inhibitors. These inhibitors demonstrate a better healing profile than traditional limus-based drug-eluting stent and their clinical efficacy remains unknown.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Liang Guo
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Atsushi Sakamoto
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Yu Sato
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Anne Cornelissen
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Rika Kawakami
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Masayuki Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Sho Torii
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Salome Kuntz
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Emanuel Harari
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Hiroyoshi Mori
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Daniela Fuller
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Neel Gadhoke
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Raquel Fernandez
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Ka Hyun Paek
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Dipti Surve
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Maria Romero
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Frank D Kolodgie
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
| | - Aloke V Finn
- Cardiovascular Department, CVPath Institute, Gaithersburg, MD 20878, USA
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27
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Keshavarz-Motamed Z. A diagnostic, monitoring, and predictive tool for patients with complex valvular, vascular and ventricular diseases. Sci Rep 2020; 10:6905. [PMID: 32327673 PMCID: PMC7181740 DOI: 10.1038/s41598-020-63728-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/31/2020] [Indexed: 01/03/2023] Open
Abstract
Hemodynamics quantification is critically useful for accurate and early diagnosis, but we still lack proper diagnosticmethods for many cardiovascular diseases. Furthermore, as most interventions intend to recover the healthy condition, the ability to monitor and predict hemodynamics following interventions can have significant impacts on saving lives. Predictive methods are rare, enabling prediction of effects of interventions, allowing timely and personalized interventions and helping critical clinical decision making about life-threatening risks based on quantitative data. In this study, an innovative non-invasive imaged-based patient-specific diagnostic, monitoring and predictive tool (called C3VI-CMF) was developed, enabling quantifying (1) details of physiological flow and pressures through the heart and circulatory system; (2) heart function metrics. C3VI-CMF also predicts the breakdown of the effects of each disease constituents on the heart function. Presently, neither of these can be obtained noninvasively in patients and when invasive procedures are undertaken, the collected metrics cannot be by any means as complete as the ones C3VI-CMF provides. C3VI-CMF purposefully uses a limited number of noninvasive input parameters all of which can be measured using Doppler echocardiography and sphygmomanometer. Validation of C3VI-CMF, against cardiac catheterization in forty-nine patients with complex cardiovascular diseases, showed very good agreement with the measurements.
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Affiliation(s)
- Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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28
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Computational fluid dynamic study of multiple sequential coronary artery bypass anastomoses in a native coronary stenosis model. Coron Artery Dis 2020; 31:458-463. [PMID: 32271246 DOI: 10.1097/mca.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the hemodynamic characteristics of multiple sequential coronary artery bypass grafting using a computational fluid dynamics study. METHODS First anastomosis was configured into parallel and diamond anastomoses, and the second anastomosis was set as end-side anastomosis. The anastomosis incision lengths were fixed at 2 mm. Various combinations of the degree of first and second stenoses were studied. The diameter of both the native and graft vessels was set at 2 mm. The inlet boundary condition was set by a sample of the transient time flow measurement, which was measured intraoperatively. RESULTS Both swirl and stagnation were observed at the outlets of the stenosis and the anastomosis sites. When the severity of the second stenosis was larger than that of the first, the flow at the outlet of the second stenosis was more unstable. Higher wall shear stress and larger oscillatory shear index regions were observed when the severe stenosis was bypassed by the first anastomosis, especially with diamond anastomoses. Less energy loss and higher energy efficiency were present when the vessel with more severe stenosis was bypassed as the second anastomosis. Energy loss was lower and energy efficiency was higher with parallel anastomosis than diamond anastomosis when the severity of the two stenoses was the same. CONCLUSIONS It is ideal to bypass the less severe stenosis vessel first with a parallel anastomosis method when employing multiple sequential bypass grafting. This improves hemodynamic stability and energy efficiency, according to a computational fluid dynamics model.
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29
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Keshavarz-Motamed Z, Khodaei S, Rikhtegar Nezami F, Amrute JM, Lee SJ, Brown J, Ben-Assa E, Garcia Camarero T, Ruano Calvo J, Sellers S, Blanke P, Leipsic J, de la Torre Hernandez JM, Edelman ER. Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based Patient-Specific In Silico Modeling. J Am Heart Assoc 2020; 9:e015063. [PMID: 32106747 PMCID: PMC7335548 DOI: 10.1161/jaha.119.015063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Mixed valvular disease (MVD), mitral regurgitation (MR) from pre‐existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre‐existing MVD, PVL, LV, and post‐TAVR recovery is meager. Methods and Results We quantified the effects of MVD on valvular‐ventricular hemodynamics using an image‐based patient‐specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P<0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post‐TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post‐TAVR. MR worsened in 32 patients post‐TAVR and did not improve in 18 other patients. Conclusions PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post‐TAVR, most MVD patients (75% of N=72; P<0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre‐existing MR condition (60% of N=48; P<0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.
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Affiliation(s)
- Zahra Keshavarz-Motamed
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada.,Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada
| | - Farhad Rikhtegar Nezami
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Junedh M Amrute
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Division of Biology and Biological Engineering California Institute of Technology Pasadena CA
| | | | - Jonathan Brown
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Eyal Ben-Assa
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiology Division Massachusetts General Hospital
| | | | | | - Stephanie Sellers
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Philipp Blanke
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jonathon Leipsic
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jose M de la Torre Hernandez
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Hospital Universitario Marques de Valdecilla IDIVAL Santander Spain
| | - Elazer R Edelman
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiovascular Division Brigham and Women's Hospital
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30
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Hayashi H, Akiyama K, Itatani K, DeRoo S, Sanchez J, Ferrari G, Colombo PC, Takeda K, Wu IY, Kainuma A, Takayama H. A novel in vivo assessment of fluid dynamics on aortic valve leaflet using epi-aortic echocardiogram. Echocardiography 2020; 37:323-330. [PMID: 32003907 DOI: 10.1111/echo.14596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/27/2019] [Accepted: 01/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mechanical stress caused by blood flow, such as wall shear stress (WSS) and its related parameters, is key moderator of endothelial degeneration. However, an in vivo method to measure WSS on heart valves has not been developed. METHODS We developed a novel approach, based on vector flow mapping using intraoperative epi-aortic echocardiogram, to measure WSS and oscillatory shear index (OSI) on the aortic valve. We prospectively enrolled 15 patients with normal valves, who underwent coronary artery bypass graft. RESULTS Systolic WSS on the ventricularis (2.40 ± 0.44 Pa [1.45-3.00 Pa]) was higher than systolic WSS on the fibrosa (0.33 ± 0.08 Pa [0.14-0.47 Pa], P < .001) and diastolic WSS on the ventricularis (0.18 ± 0.07 Pa [0.04-0.28 Pa], P < .001). Oscillatory shear index on the fibrosa was higher than on the ventricularis (0.29 ± 0.04 [0.24-0.36] vs 0.05 ± 0.03 [0.01-0.12], P < .001). A pilot study involving two patients with severe aortic regurgitation showed significantly different values in fluid dynamics. CONCLUSION Vector flow mapping method using intraoperative epi-aortic echocardiogram is an effective way of measuring WSS and OSI on normal aortic leaflet in vivo, allowing for better understanding of the pathophysiology of aortic valve diseases.
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Affiliation(s)
- Hideyuki Hayashi
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koichi Akiyama
- Department of Anesthesiology, Yodogawa Christian Hospital, Osaka, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Scott DeRoo
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joseph Sanchez
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Giovanni Ferrari
- Department of Surgery and Biomedical Engineering, Columbia University Medical, New York, NY, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Isaac Y Wu
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Atsushi Kainuma
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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31
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Abstract
Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, which permanently cage the vessel wall, thereby preventing normal coronary vasomotion, preclude bypass grafting and can provoke long-term foreign-body responses. Although multiple scaffolds have been or are in development, the Absorb Bioresorbable Vascular Scaffold (BVS; Abbott Vascular) was the first FDA-approved device and was widely expected to fulfil the dream of interventional cardiologists of a transient scaffold that would disappear 'when the job was done' and would not hamper further treatment options. Although early, small studies and even large, randomized trials showed beneficial outcomes up to 1 year of follow-up, longer-term results have been disappointing, with increased rates of device thrombosis and target-lesion revascularization. The Absorb BVS device was withdrawn from the market because of low demand. In this Review, we summarize the preclinical and clinical data available for BRS to understand how the vascular biological reactions to these devices differ from biological reactions to metallic drug-eluting stents and how these responses translate into clinical outcomes. We also discuss next-generation BRS and outline modifications that are needed to improve the long-term outcomes with these devices so that they eventually become a viable option for patients with symptomatic obstructive coronary artery disease.
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32
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Annio G, Torii R, Ariff B, O'Regan DP, Muthurangu V, Ducci A, Tsang V, Burriesci G. Enhancing Magnetic Resonance Imaging With Computational Fluid Dynamics. ACTA ACUST UNITED AC 2019. [DOI: 10.1115/1.4045493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
The analysis of the blood flow in the great thoracic arteries does provide valuable information about the cardiac function and can diagnose the potential development of vascular diseases. Flow-sensitive four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) is often used to characterize patients' blood flow in the clinical environment. Nevertheless, limited spatial and temporal resolution hinders a detailed assessment of the hemodynamics. Computational fluid dynamics (CFD) could expand this information and, integrated with experimental velocity field, enable to derive the pressure maps. However, the limited resolution of the 4D flow CMR and the simplifications of CFD modeling compromise the accuracy of the computed flow parameters. In this article, a novel approach is proposed, where 4D flow CMR and CFD velocity fields are integrated synergistically to obtain an enhanced MR imaging (EMRI). The approach was first tested on a two-dimensional (2D) portion of a pipe, to understand the behavior of the parameters of the model in this novel framework, and afterwards in vivo, to apply it to the analysis of blood flow in a patient-specific human aorta. The outcomes of EMRI are assessed by comparing the computed velocities with the experimental one. The results demonstrate that EMRI preserves flow structures while correcting for experimental noise. Therefore, it can provide better insights into the hemodynamics of cardiovascular problems, overcoming the limitations of MRI and CFD, even when considering a small region of interest. EMRI confirmed its potential to provide more accurate noninvasive estimation of major cardiovascular risk predictors (e.g., flow patterns, endothelial shear stress) and become a novel diagnostic tool.
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Affiliation(s)
- Giacomo Annio
- Department Medical Physics and Bioengineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Ryo Torii
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Ben Ariff
- MRC London Institute of Medical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Declan P. O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, University College London, 62 Huntley Street, Fitzrovia, London WC1E 6DD, UK; Great Ormond Street Hospital for Children, Great Ormond Street, Holborn, London WC1N 3JH, UK
| | - Andrea Ducci
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Victor Tsang
- Cardiothoracic Surgery Unit, Great Ormond Street Hospital for Children, Great Ormond Street, Holborn, London WC1N 3JH, UK
| | - Gaetano Burriesci
- UCL Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Ri.MED Foundation, Via Bandiera, 11, Palermo 90133, Italy
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Dux-Santoy L, Guala A, Sotelo J, Uribe S, Teixidó-Turà G, Ruiz-Muñoz A, Hurtado DE, Valente F, Galian-Gay L, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Ferreira I, Evangelista A, Rodríguez-Palomares JF. Low and Oscillatory Wall Shear Stress Is Not Related to Aortic Dilation in Patients With Bicuspid Aortic Valve: A Time-Resolved 3-Dimensional Phase-Contrast Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol 2019; 40:e10-e20. [PMID: 31801375 PMCID: PMC7771642 DOI: 10.1161/atvbaha.119.313636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: To assess the relationship between regional wall shear stress (WSS) and oscillatory shear index (OSI) and aortic dilation in patients with bicuspid aortic valve (BAV). Approach and Results: Forty-six consecutive patients with BAV (63% with right-left-coronary-cusp fusion, aortic diameter ≤ 45 mm and no severe valvular disease) and 44 healthy volunteers were studied by time-resolved 3-dimensional phase-contrast magnetic resonance imaging. WSS and OSI were quantified at different levels of the ascending aorta and the aortic arch, and regional WSS and OSI maps were obtained. Seventy percent of BAV had ascending aorta dilation. Compared with healthy volunteers, patients with BAV had increased WSS and decreased OSI in most of the ascending aorta and the aortic arch. In both BAV and healthy volunteers, regions of high WSS matched regions of low OSI and vice versa. No regions of both low WSS and high OSI were identified in BAV compared with healthy volunteers. Patients with BAV with dilated compared with nondilated aorta presented low and oscillatory WSS in the aortic arch, but not in the ascending aorta where dilation is more prevalent. Furthermore, no regions of concomitant low WSS and high OSI were identified when BAV were compared according to leaflet fusion pattern, despite the well-known differences in regional dilation prevalence. Conclusions: Regions with low WSS and high OSI do not match those with the highest prevalence of dilation in patients with BAV, thus providing no evidence to support the low and oscillatory shear stress theory in the pathogenesis of proximal aorta dilation in the presence of BAV.
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Affiliation(s)
- Lydia Dux-Santoy
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Andrea Guala
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Julio Sotelo
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Electrical Engineering, School of Engineering (J.S.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Sergio Uribe
- Biomedical Imaging Center (J.S., S.U.), Pontificia Universidad Católica de Chile, Santiago.,Department of Radiology, School of Medicine (S.U.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Gisela Teixidó-Turà
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Aroa Ruiz-Muñoz
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Daniel E Hurtado
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological Sciences (D.E.H.), Pontificia Universidad Católica de Chile, Santiago.,Department of Structural and Geotechnical Engineering, Schools of Engineering (D.E.H.), Pontificia Universidad Católica de Chile, Santiago.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile (J.S., S.U., D.E.H.)
| | - Filipa Valente
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Laura Galian-Gay
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Laura Gutiérrez
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Teresa González-Alujas
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Kevin M Johnson
- Department of Medical Physics (K.M.J., O.W.), University of Wisconsin-Madison.,Department of Radiology (K.M.J., O.W.), University of Wisconsin-Madison
| | - Oliver Wieben
- Department of Medical Physics (K.M.J., O.W.), University of Wisconsin-Madison.,Department of Radiology (K.M.J., O.W.), University of Wisconsin-Madison
| | - Ignacio Ferreira
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - Arturo Evangelista
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
| | - José F Rodríguez-Palomares
- From the Department of Cardiology, CIBERCV, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d´Hebron, Barcelona, Spain (L.D.-S., A.G., G.T.-.T., A.R.-M., F.V., L.G.-.G., L.G., T.G.-A., I.F., A.E., J.F.R.P.)
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Jinnouchi H, Mori H, Cheng Q, Kutyna M, Torii S, Sakamoto A, Guo L, Acampado E, Gupta A, Kolodgie FD, Virmani R, Finn AV. Thromboresistance and functional healing in the COBRA PzF stent versus competitor DES: implications for dual antiplatelet therapy. EUROINTERVENTION 2019; 15:e342-e353. [DOI: 10.4244/eij-d-18-00740] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Patients with heart failure show myocardial, valvular, and electrical dysfunction, which results in enlarged cardiac chambers and increased intracardiac volume and pressure. Intracardiac flow analysis can provide information regarding the shape and wall properties, chamber dimensions, and flow efficiency throughout the cardiac cycle. There is increasing interest in vortex flow analysis for patients with heart failure to overcome limitations of conventional parameters. In conjunction with the conventional structural and functional parameters, vortex flow analysis-guided treatment in heart failure might be a novel option for cardiac physicians.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalsung-ro Jung-gu, Daegu 41931, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodae mun-gu, Seoul 03722, Republic of Korea.
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36
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Rizk J, Latus H, Shehu N, Mkrtchyan N, Zimmermann J, Martinoff S, Ewert P, Hennemuth A, Stern H, Meierhofer C. Elevated diastolic wall shear stress in regurgitant semilunar valvular lesions. J Magn Reson Imaging 2019; 50:763-770. [PMID: 30714251 DOI: 10.1002/jmri.26680] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Alterations in wall shear stress (WSS) assessed using 4D flow MRI have been shown to play a role in various vascular pathologies, such as bicuspid aortic valve aortopathy. Most studies have focused on systolic WSS, whereas altered diastolic hemodynamics in regurgitant semilunar valvular lesions have not so far been well characterized. PURPOSE To investigate diastolic WSS in aortic and pulmonary regurgitation. STUDY TYPE Retrospective data analysis. POPULATION Thirty tetralogy of Fallot patients, 19 bicuspid aortic valve patients, 11 healthy volunteers. FIELD STRENGTH/SEQUENCE 5 T, 3D time-resolved phase-contrast MRI with 3D velocity encoding. ASSESSMENT Estimation of WSS and its axial and circumferential vector components along cardiac cycle timeframes in the proximal main pulmonary artery in pulmonary regurgitation (PR) and in the proximal ascending aorta in aortic regurgitation (AR) as well as in healthy volunteers. STATISTICAL TESTS Wilcoxon matched pairs test was used for intra-group comparisons and Mann-Whitney test for intergroup comparisons. Correlations were assessed using Spearman correlation. RESULTS WSS along the entire cardiac cycle was higher in PR and AR in comparison with controls (mean WSS 0.381 ± 0.070 vs. 0.220 ± 0.018, P < 0.0001; 0.361 ± 0.099 vs. 0.212 ± 0.030, P < 0.0001; respectively). Peak diastolic WSS was significantly higher than the mean WSS in AR and PR (P < 0.0001-0.005). The severity of PR correlated with the peak diastolic axial WSS (Spearman's r s = 0.454, P = 0.018), whereas the severity of AR correlated with both peak systolic and diastolic tangential WSS (Spearman's r s = 0.458, P = 0.049; r s = 0.539, P = 0.017, respectively). DATA CONCLUSION Elevated diastolic WSS is a component of the altered flow hemodynamics in AR and PR. This may give more insight into the pathophysiologic role of WSS in vascular remodeling in AR and PR. LEVEL OF EVIDENCE 4 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;50:763-770.
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Affiliation(s)
- Judy Rizk
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany.,Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Heiner Latus
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
| | - Naira Mkrtchyan
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
| | - Judith Zimmermann
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center at Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
| | - Anja Hennemuth
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany.,Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - Heiko Stern
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Pediatric Cardiology and Congenital Heart Disease, German Heart Center at Technical University of Munich, Munich, Germany
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Matsuura K, Jin WW, Liu H, Matsumiya G. Computational fluid dynamic study of different incision length of coronary artery bypass grafting in a native coronary stenosis model. J Thorac Dis 2019; 11:393-399. [PMID: 30962982 DOI: 10.21037/jtd.2019.01.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The objective of this study was to evaluate hemodynamic patterns in end-side coronary artery bypass grafting with different anastomosis length by computational fluid dynamic study in the native coronary stenosis model. Methods The fluid dynamic computations were carried out using ANSYS CFX. Incision length was set to be 2, 4, 6, 8, 10 mm. The angle between the two blood vessels corresponded to the length of the incision. Native vessels were set to be 90% stenosis. The radius of both native and graft vessels was set to be 2 mm. The inlet boundary condition was set by the sample of the transient time flow which was measured intraoperatively. Results The energy efficiency was higher and energy loss was lower when the anastomosis length was longer until 8 mm. However, energy efficiency was lowest and energy loss was highest in the 10-mm model. In the 10-mm incision model, the streamline showed the scanty bypass flow in the bottom. Vortex showed that only 10-mm model showed the vortex just distal to the stenosis in the native inlet, and more vortex in native outlet than other length models. The oscillatory shear index (OSI) was higher in the outlet top in all models. And only 10-mm model showed high oscillatory index just distal to the stenosis. Conclusions In the end-side anastomosis, an anastomosis length of 8 mm was the ideal length with less flow complexity, low OSI, and less energy loss and high energy efficiency in the native 90% stenosis model.
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Affiliation(s)
- Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Wei Wei Jin
- Graduate School of Engineering, Chiba University, Chiba, Japan.,Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Hao Liu
- Graduate School of Engineering, Chiba University, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
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38
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Xu J, Ding N, Chen L, Zhang Y, Huang M, Wang Y, Meng Z, Zhang X. Inducers of post-apneic blood pressure fluctuation monitored by pulse transfer time measurement in obstructive sleep apnea varied with syndrome severity. Sleep Breath 2019; 23:769-776. [PMID: 30637570 DOI: 10.1007/s11325-018-1770-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/12/2018] [Accepted: 12/07/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated the properties of blood pressure (BP) fluctuation and sympathovagal imbalance with the severity of OSAS. METHODS Nocturnal BP was continuously monitored by polysomnography for mild (n = 33), moderate (n = 34), and severe (n = 37) OSAS patients. Apnea-related systolic BP elevation (△SBP) indicated the amplitude of BP fluctuation. The SBP index, number of △SBP > 10 mmHg/h of sleep, indicated the frequency of significant BP fluctuations. The low frequency/high frequency (LF/HF) ratios indicated heart rate variability and sympathovagal imbalance. RESULTS △SBP and the SBP index were the highest in severe OSAS (12.9 ± 2.3 mmHg and 33.7 ± 14.7/h), followed by moderate OSAS (9.5 ± 2.6 mmHg and 7.1 ± 4.4/h), and mild OSAS (8.3 ± 1.6 mmHg and 3.4 ± 2.1/h). The LF/HF ratios in severe OSAS were significantly higher than that in moderate and mild OSAS. In mild OSAS, arousal played a more important role in BP fluctuation. In moderate OSAS, the oxygen desaturation index (ODI) and the SBP index were correlated. The difference in △SBP induced by hypoxia or by arousal was not significant. In severe OSAS, the apnea-hypopnea index (AHI) and LF/HF ratio were correlated with the SBP index, and △SBP was larger with hypoxia than arousal. CONCLUSIONS BP fluctuation and sympathovagal imbalance were both related to obstructive sleep apnea severity. The influence of arousal and hypoxia on BP fluctuation varied with OSAS severity. TRIAL REGISTRATION NCT02876471.
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Affiliation(s)
- Jing Xu
- Department of Respiratory, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, People's Republic of China
| | - Ning Ding
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Liang Chen
- Department of Respiratory, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, People's Republic of China
| | - Yi Zhang
- Department of Respiratory, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, People's Republic of China
| | - Mao Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yanli Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zili Meng
- Department of Respiratory, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, 223300, Jiangsu, People's Republic of China.
| | - Xilong Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Pruitt AA, Jin N, Liu Y, Simonetti OP, Ahmad R. A method to correct background phase offset for phase-contrast MRI in the presence of steady flow and spatial wrap-around artifact. Magn Reson Med 2018; 81:2424-2438. [PMID: 30431176 DOI: 10.1002/mrm.27572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE Background phase offsets in phase-contrast MRI are often corrected using polynomial regression; however, correction performance degrades when temporally invariant outliers such as steady flow or spatial wrap-around artifact are present. We describe and validate an iterative method called automatic rejection of temporally invariant outliers (ARTO), which excludes these outliers from the fitting process. METHODS The ARTO method iteratively removes pixels with large polynomial regression errors analyzed by a Gaussian mixture model fitting of the residual distribution. A total of 150 trials of a simulated phantom (75 with wrap-around artifact) and 125 phase-contrast MRI cines from 22 healthy subjects (48 with wrap-around artifact) were used for validation. Background phase offsets were corrected using second-order weighted regularized least squares (WRLS) with and without ARTO. Flow volumes after WRLS and WRLS+ARTO corrections were compared with the known truth (phantom) and stationary phantom reference (in vivo) using Bland-Altman analysis. The ratio between the pulmonary flow and the systemic flow was also computed in a subset of 6 subjects. RESULTS In the simulated phantom, compared with WRLS and no correction, correction with WRLS+ARTO produced superior agreement in volumetric flow quantification with the known truth. In vivo, WRLS+ARTO also produced superior agreement with stationary phantom-corrected volumetric flow compared with WRLS and no correction. In data sets with wrap-around artifact, WRLS produced significantly larger variance in the pulmonary flow and systemic flow ratio than stationary phantom correction (P = .0008). CONCLUSION The proposed method provides automatic exclusion of temporally invariant outliers and produces flow quantification results comparable to stationary phantom correction.
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Affiliation(s)
- Aaron A Pruitt
- Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Columbus, Ohio
| | - Yingmin Liu
- Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio
| | - Orlando P Simonetti
- Biomedical Engineering, Ohio State University, Columbus, Ohio.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio.,Internal Medicine, Ohio State University, Columbus, Ohio
| | - Rizwan Ahmad
- Biomedical Engineering, Ohio State University, Columbus, Ohio.,Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio.,Electrical and Computer Engineering, Ohio State University, Columbus, Ohio
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40
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Rijnberg FM, Hazekamp MG, Wentzel JJ, de Koning PJ, Westenberg JJ, Jongbloed MR, Blom NA, Roest AA. Energetics of Blood Flow in Cardiovascular Disease. Circulation 2018; 137:2393-2407. [DOI: 10.1161/circulationaha.117.033359] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Jolanda J. Wentzel
- Leiden University Medical Center, The Netherlands. Department of Biomechanical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands (J.J.W.)
| | | | | | | | - Nico A. Blom
- Department of Pediatric Cardiology (N.A.B., A.A.W.R.)
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41
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Zimmermann J, Demedts D, Mirzaee H, Ewert P, Stern H, Meierhofer C, Menze B, Hennemuth A. Wall shear stress estimation in the aorta: Impact of wall motion, spatiotemporal resolution, and phase noise. J Magn Reson Imaging 2018; 48:718-728. [PMID: 29607574 DOI: 10.1002/jmri.26007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wall shear stress (WSS) presents an important parameter for assessing blood flow characteristics and evaluating flow-mediated lesions in the aorta. PURPOSE To investigate the robustness of WSS and oscillatory shear index (OSI) estimation based on 4D flow MRI against vessel wall motion, spatiotemporal resolution, and velocity encoding (VENC). STUDY TYPE Simulated and prospective. POPULATION Synthetic 4D flow MRI data of the aorta, simulated using the Lattice-Boltzmann method; in vivo 4D flow MRI data of the aorta from healthy volunteers (n = 11) and patients with congenital heart defects (n = 17). FIELD STRENGTH/SEQUENCE 1.5T; 4D flow MRI with PEAK-GRAPPA acceleration and prospective electrocardiogram triggering. ASSESSMENT Predicated upon 3D cubic B-splines interpolation of the image velocity field, WSS was estimated in mid-systole, early-diastole, and late-diastole and OSI was derived. We assessed the impact of spatiotemporal resolution and phase noise, and compared results based on tracked-using deformable registration-and static vessel wall location. STATISTICAL TESTS Bland-Altman analysis to assess WSS/OSI differences; Hausdorff distance (HD) to assess wall motion; and Pearson's correlation coefficient (PCC) to assess correlation of HD with WSS. RESULTS Synthetic data results show systematic over-/underestimation of WSS when different spatial resolution (mean ± 1.96 SD up to -0.24 ± 0.40 N/m2 and 0.5 ± 1.38 N/m2 for 8-fold and 27-fold voxel size, respectively) and VENC-depending phase noise (mean ± 1.96 SD up to 0.31 ± 0.12 N/m2 and 0.94 ± 0.28 N/m2 for 2-fold and 4-fold VENC increase, respectively) are given. Neglecting wall motion when defining the vessel wall perturbs WSS estimates to a considerable extent (1.96 SD up to 1.21 N/m2 ) without systematic over-/underestimation (Bland-Altman mean range -0.06 to 0.05). DATA CONCLUSION In addition to sufficient spatial resolution and velocity to noise ratio, accurate tracking of the vessel wall is essential for reliable image-based WSS estimation and should not be neglected if wall motion is present. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Judith Zimmermann
- Department of Computer Science, Technical University of Munich, Munich, Germany
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Daniel Demedts
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
| | - Hanieh Mirzaee
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center at Technical University of Munich, Munich, Germany
| | - Bjoern Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Anja Hennemuth
- Fraunhofer MEVIS Institute for Medical Image Computing, Bremen, Germany
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité Universitätsmedizin, Berlin, Germany
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42
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Nocturnal blood pressure fluctuation and associated influential factors in severe obstructive sleep apnea patients with hypertension. Sleep Breath 2018. [PMID: 29524090 DOI: 10.1007/s11325-018-1634-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome (OSAS) can induce dramatic blood pressure (BP) fluctuations during sleep and it can be associated with hypertension. We investigated the properties and associated influential factors of BP fluctuation in severe OSAS with and without hypertension. METHODS Two hundred one severe OSAS subjects were divided into hypertensive and normotensive groups. BP was continuously monitored via measurement of pulse transmit time (PTT). The value of apnea-related systolic BP elevation (ΔSBP) was used to reflect the amplitude of BP fluctuation, and the SBP index (the number of ΔSBP > 10 mmHg per hour of sleep time) was used to stand for the frequency of significant BP fluctuations. RESULTS Compared with the normotensive group, △SBP and SBP index were higher in the hypertensive group (13.8 ± 4.4 mmHg vs 10.9 ± 3.1 mmHg; 44.8 ± 21.3 events/h vs 26.8 ± 15.8 events/h, all p < 0.001). Multiple regression analysis showed that percentage of sleep time with oxygen saturation < 90% (TST90) and SBP index correlated more with mean level of awakeness and sleep SBP than with apnea-hypopnea index (AHI). Analysis of all apnea events demonstrated that △SBP and the frequency of BP fluctuations were more remarkable following hypoxia than following arousal; △SBP correlated more with oxygen desaturation degree (r = 0.388, p < 0.01) and minimal SpO2 (r = 0.392, p < 0.01) than with apnea length and desaturation duration. CONCLUSIONS In severe OSAS, nocturnal and awake BP levels are associated more with the nocturnal hypoxic duration and BP fluctuation than with AHI. Nocturnal BP fluctuation can be induced by both hypoxia and arousal, and especially by hypoxia. TRIAL REGISTRATION NCT02876471.
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Stoll VM, Loudon M, Eriksson J, Bissell MM, Dyverfeldt P, Ebbers T, Myerson SG, Neubauer S, Carlhäll CJ, Hess AT. Test-retest variability of left ventricular 4D flow cardiovascular magnetic resonance measurements in healthy subjects. J Cardiovasc Magn Reson 2018; 20:15. [PMID: 29499706 PMCID: PMC5833126 DOI: 10.1186/s12968-018-0432-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Quantification and visualisation of left ventricular (LV) blood flow is afforded by three-dimensional, time resolved phase contrast cardiovascular magnetic resonance (CMR 4D flow). However, few data exist upon the repeatability and variability of these parameters in a healthy population. We aimed to assess the repeatability and variability over time of LV 4D CMR flow measurements. METHODS Forty five controls underwent CMR 4D flow data acquisition. Of these, 10 underwent a second scan within the same visit (scan-rescan), 25 returned for a second visit (interval scan; median interval 52 days, IQR 28-57 days). The LV-end diastolic volume (EDV) was divided into four flow components: 1) Direct flow: inflow that passes directly to ejection; 2) Retained inflow: inflow that enters and resides within the LV; 3) Delayed ejection flow: starts within the LV and is ejected and 4) Residual volume: blood that resides within the LV for > 2 cardiac cycles. Each flow components' volume was related to the EDV (volume-ratio). The kinetic energy at end-diastole (ED) was measured and divided by the components' volume. RESULTS The dominant flow component in all 45 controls was the direct flow (volume ratio 38 ± 4%) followed by the residual volume (30 ± 4%), then delayed ejection flow (16 ± 3%) and retained inflow (16 ± 4%). The kinetic energy at ED for each component was direct flow (7.8 ± 3.0 microJ/ml), retained inflow (4.1 ± 2.0 microJ/ml), delayed ejection flow (6.3 ± 2.3 microJ/ml) and the residual volume (1.2 ± 0.5 microJ/ml). The coefficients of variation for the scan-rescan ranged from 2.5%-9.2% for the flow components' volume ratio and between 13.5%-17.7% for the kinetic energy. The interval scan results showed higher coefficients of variation with values from 6.2-16.1% for the flow components' volume ratio and 16.9-29.0% for the kinetic energy of the flow components. CONCLUSION LV flow components' volume and their associated kinetic energy values are repeatable and stable within a population over time. However, the variability of these measurements in individuals over time is greater than can be attributed to sources of error in the data acquisition and analysis, suggesting that additional physiological factors may influence LV flow measurements.
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Affiliation(s)
- Victoria M. Stoll
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Margaret Loudon
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Jonatan Eriksson
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Malenka M. Bissell
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Saul G. Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Stefan Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | | | - Aaron T. Hess
- University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
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Computational fluid dynamics study of the end-side and sequential coronary artery bypass anastomoses in a native coronary occlusion model†. Interact Cardiovasc Thorac Surg 2017; 26:583-589. [DOI: 10.1093/icvts/ivx376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/27/2017] [Indexed: 11/14/2022] Open
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45
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Menacho J, Rotllant L, Molins JJ, Reyes G, García-Granada AA, Balcells M, Martorell J. Arterial pulse attenuation prediction using the decaying rate of a pressure wave in a viscoelastic material model. Biomech Model Mechanobiol 2017; 17:589-603. [PMID: 29168070 PMCID: PMC5845065 DOI: 10.1007/s10237-017-0980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
Abstract
The present study examines the possibility of attenuating blood pulses by means of introducing prosthetic viscoelastic materials able to absorb energy and damp such pulses. Vascular prostheses made of polymeric materials modify the mechanical properties of blood vessels. The effect of these materials on the blood pulse propagation remains to be fully understood. Several materials for medical applications, such as medical polydimethylsiloxane or polytetrafluoroethylene, show viscoelastic behavior, modifying the original vessel stiffness and affecting the propagation of blood pulses. This study focuses on the propagation of pressure waves along a pipe with viscoelastic materials using the Maxwell and the Zener models. An expression of exponential decay has been obtained for the Maxwell material model and also for low viscous coefficient values in the Zener model. For relatively high values of the viscous term in the Zener model, the steepest part of the pulse can be damped quickly, leaving a smooth, slowly decaying wave. These mathematical models are critical to tailor those materials used in cardiovascular implants to the mechanical environment they are confronted with to repair or improve blood vessel function.
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Affiliation(s)
- J Menacho
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain
| | - L Rotllant
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain.,Department of Applied Sciences, CBSET, 500 Shire Way, Lexington, MA, USA
| | - J J Molins
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain
| | - G Reyes
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain
| | - A A García-Granada
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain
| | - M Balcells
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain. .,IMES - MIT, 77 Massachusetts Av., E25-229, Cambridge, MA, 02139, USA.
| | - J Martorell
- IQS School of Engineering, Universitat Ramon Llull, Via Augusta 390, 08017, Barcelona, Spain
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Itatani K, Miyazaki S, Furusawa T, Numata S, Yamazaki S, Morimoto K, Makino R, Morichi H, Nishino T, Yaku H. New imaging tools in cardiovascular medicine: computational fluid dynamics and 4D flow MRI. Gen Thorac Cardiovasc Surg 2017; 65:611-621. [PMID: 28929446 DOI: 10.1007/s11748-017-0834-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 11/28/2022]
Abstract
Blood flow imaging is a novel technology in cardiovascular medicine and surgery. Today, two types of blood flow imaging tools are available: measurement-based flow visualization including 4D flow MRI (or 3D cine phase-contrast magnetic resonance imaging), or echocardiography flow visualization software, and computer flow simulation modeling based on computational fluid dynamics (CFD). MRI and echocardiography flow visualization provide measured blood flow but have limitations in temporal and spatial resolution, whereas CFD flow calculates the flow according to assumptions instead of flow measurement, and it has sufficiently fine resolution up to the computer memory limit, and it enables even virtual surgery when combined with computer graphics. Blood flow imaging provides profound insight into the pathophysiology of cardiovascular diseases, because it quantifies and visualizes mechanical stress on the vessel walls or heart ventricle. Wall shear stress (WSS) is a stress on the endothelial wall caused by the near wall blood flow, and it is thought to be a predictor of atherosclerosis progression in coronary or aortic diseases. Flow energy loss (EL) is the loss of blood flow energy caused by viscous friction of turbulent diseased flow, and it is expected to be a predictor of ventricular workload on various heart diseases including heart valve disease, cardiomyopathy, and congenital heart diseases. Blood flow imaging can provide useful information for developing predictive medicine in cardiovascular diseases, and may lead to breakthroughs in cardiovascular surgery, especially in the decision-making process.
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Affiliation(s)
- Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | | | | | - Satoshi Numata
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rina Makino
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroko Morichi
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Cardiovascular Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji Kajicho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Pedrizzetti G, Arvidsson PM, Töger J, Borgquist R, Domenichini F, Arheden H, Heiberg E. On estimating intraventricular hemodynamic forces from endocardial dynamics: A comparative study with 4D flow MRI. J Biomech 2017; 60:203-210. [PMID: 28711164 DOI: 10.1016/j.jbiomech.2017.06.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 05/26/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
Abstract
Intraventricular pressure gradients or hemodynamic forces, which are their global measure integrated over the left ventricular volume, have a fundamental importance in ventricular function. They may help revealing a sub-optimal cardiac function that is not evident in terms of tissue motion, which is naturally heterogeneous and variable, and can influence cardiac adaptation. However, hemodynamic forces are not utilized in clinical cardiology due to the unavailability of simple non-invasive measurement tools. Hemodynamic forces depend on the intraventricular flow; nevertheless, most of them are imputable to the dynamics of the endocardial flow boundary and to the exchange of momentum across the mitral and aortic orifices. In this study, we introduce a simplified model based on first principles of fluid dynamics that allows estimating hemodynamic forces without knowing the velocity field inside the LV. The model is validated with 3D phase-contrast MRI (known as 4D flow MRI) in 15 subjects, (5 healthy and 10 patients) using the endocardial surface reconstructed from the three standard long-axis projections. Results demonstrate that the model provides consistent estimates for the base-apex component (mean correlation coefficient r=0.77 for instantaneous values and r=0.88 for root mean square) and good estimates of the inferolateral-anteroseptal component (r=0.50 and 0.84, respectively). The present method represents a potential integration to the existing ones quantifying endocardial deformation in MRI and echocardiography to add a physics-based estimation of the corresponding hemodynamic forces. These could help the clinician to early detect sub-clinical diseases and differentiate between different cardiac dysfunctional states.
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Affiliation(s)
- Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
| | - Per M Arvidsson
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Johannes Töger
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Rasmus Borgquist
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden
| | - Federico Domenichini
- Department of Civil and Environmental Engineering, University of Firenze, Firenze, Italy
| | - Håkan Arheden
- Lund University, Skane University Hospital, Department of Clinical Sciences, Clinical Physiology, Lund, Sweden
| | - Einar Heiberg
- Lund University, Skane University Hospital, Department of Arrhythmias, Lund, Sweden; Department of Biomedical Engineering, Lund University, Lund, Sweden
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Rossini L, Martinez-Legazpi P, Benito Y, Del Villar CP, Gonzalez-Mansilla A, Barrio A, Borja MG, Yotti R, Kahn AM, Shadden SC, Fernández-Avilés F, Bermejo J, Del Álamo JC. Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy. MECCANICA 2017; 52:563-576. [PMID: 31080296 PMCID: PMC6508690 DOI: 10.1007/s11012-015-0322-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/05/2015] [Indexed: 06/03/2023]
Abstract
In the healthy heart, left ventricular (LV) filling generates different flow patterns which have been proposed to optimize blood transport by coupling diastole and systole. This work presents a novel image-based method to assess how different flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Our approach is based on solving the advection equation for a passive scalar field from time-resolved blood velocity fields. Imposing time-varying inflow boundary conditions for the scalar field provides a straightforward method to distinctly track the transport of blood entering the LV in the different filling waves of a given cardiac cycle, as well as the transport barriers which couple filling and ejection. We applied this method to analyze flow transport in a group of patients with implanted CRT devices and a group of healthy volunteers. Velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular conduction delay, and to model tachycardia (100 bpm). Using this method, we show how CRT influences the transit of blood inside the left ventricle, contributes to conserving kinetic energy, and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract. These novel aspects of ventricular function are clinically accessible by quantitative analysis of color-Doppler echocardiograms.
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Affiliation(s)
- Lorenzo Rossini
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Pablo Martinez-Legazpi
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Yolanda Benito
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Candelas Pérez Del Villar
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Ana Gonzalez-Mansilla
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Alicia Barrio
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - María-Guadalupe Borja
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Raquel Yotti
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain
| | - Andrew M Kahn
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Shawn C Shadden
- Mechanical Engineering Department, University of California Berkeley, Berkeley, CA, USA
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañó n, Hospital General Universitario Gregorio Marañón , Dr. Esquerdo 46, 28007 Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan C Del Álamo
- Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA 92093, USA, Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA, USA
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Zaromytidou M, Antoniadis AP, Siasos G, Coskun AU, Andreou I, Papafaklis MI, Lucier M, Feldman CL, Stone PH. Heterogeneity of Coronary Plaque Morphology and Natural History: Current Understanding and Clinical Significance. Curr Atheroscler Rep 2016; 18:80. [PMID: 27822680 DOI: 10.1007/s11883-016-0626-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Disturbed Intracardiac Flow Organization After Atrioventricular Septal Defect Correction as Assessed With 4D Flow Magnetic Resonance Imaging and Quantitative Particle Tracing. Invest Radiol 2016. [PMID: 26222698 DOI: 10.1097/rli.0000000000000194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Four-dimensional (3 spatial directions and time) velocity-encoded flow magnetic resonance imaging with quantitative particle tracing analysis allows assessment of left ventricular (LV) blood flow organization. Corrected atrioventricular septal defect (AVSD) patients have an abnormal left atrioventricular valve shape. We aimed to analyze flow organization in corrected AVSD patients and healthy controls. METHODS A total of 32 patients (age, 25 ± 14 years), 21 after partial AVSD correction and 11 after complete/intermediate AVSD correction, and 30 healthy volunteers (26 ± 12 years) underwent whole-heart four-dimensional velocity-encoded flow magnetic resonance imaging. Particle tracing in the 16-segment LV cavity model was used to quantitatively evaluate blood flow organization discriminating multiple components. RESULTS Patients showed a smaller percentage of direct flow compared with controls (30% ± 9% vs 44% ± 11%; P < 0.001). In patients, more inflow was observed in the basal inferior segment (22% ± 11% vs controls, 17% ± 5%; P = 0.005), with less direct but more retained inflow (ie, part of inflow that is not ejected from LV in subsequent systole). In patients, more inflow reached the midventricular level (68% ± 13% vs controls, 58% ± 9%; P < 0.001), most notably as retained inflow in the lateral segments. Subsequently, in patients, more (mostly retained) inflow reached the apex (23% ± 13% vs 14% ± 7%; P < 0.001), which correlated with early peak filling velocity (r = 0.637, P < 0.001). Patients with a corrected complete or intermediate AVSD presented with less direct flow (24% ± 8% vs 33% ± 8%; P = 0.003) and more apical inflow (30% ± 14% vs 18% ± 12%; P = 0.014) compared with a corrected partial AVSD. CONCLUSION Multicomponent particle tracing combined with 16-segment analysis quantitatively demonstrated altered LV flow organization after AVSD correction, with less direct and more retained inflow in apical and lateral LV cavity segments, which may contribute to decreased cardiac pumping efficiency.
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