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Ramaekers MJFG, Te Kiefte BJC, Adriaans BP, Juffermans JF, van Assen HC, Winkens B, Wildberger JE, Lamb HJ, Schalla S, Westenberg JJM. Comprehensive sex-specific and age-dependent analysis of 4D-flow MRI assessed aortic blood flow-related parameters in normal subjects using single-vendor MR systems and single-vendor software. J Cardiovasc Magn Reson 2024:101083. [PMID: 39142568 DOI: 10.1016/j.jocmr.2024.101083] [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: 11/14/2023] [Revised: 06/14/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Aortic blood flow characterization by 4D flow MRI is increasingly performed in aneurysm research. A limited number of studies have established normal values that can aid the recognition of abnormal flow at an early stage. This study aims to establish additional sex-specific and age-dependent reference values for flow-related parameters in a large cohort of healthy adults. METHODS 212 volunteers were included, and 191 volunteers completed the full study protocol. All underwent 4D flow MRI of the entire aorta. Quantitative values for velocity, vorticity, helicity, as well as total, circumferential, and axial wall shear stress [WSS] were determined for the aortic root [AoR], ascending aorta [AAo], aortic arch [AoA], descending [DAo], suprarenal [SRA], and infrarenal aorta [IRA]. Vorticity and helicity were indexed for segment volume (mL). RESULTS The normal values were estimated per sex- and age-group, where significant differences between males (M) and females (F) were found only for specific age groups. More specifically, the following variables were significantly different after applying the false discovery rate correction for multiple testing: 1) velocity in the AAo and DAo in the 60-70 years age group (mean±SD: (M) 47.0 ± 8.2cm/s vs. (F) 38.4 ± 6.9cm/s, p=0.001 and, (M) 55.9 ± 9.9cm/s vs. (F) 46.5 ± 5.5cm/s, p=0.002), 2) normalized vorticity in AoR in the 50-59 years age group ((M) 27539 ± 5042s-1mL-1 vs. (F) 30849 ± 7285s-1mL-1, p=0.002), 3) axial WSS in the Aao in the 18-29 age group ((M) 1098 ± 203 mPa vs. (F) 921 ± 121 mPa, p=0.002). Good to strong negative correlations with age were seen for almost all variables, in different segments, and for both sexes. CONCLUSION This study describes reference values for aortic flow-related parameters as acquired by 4D flow MRI. We observed limited differences between males and females. A negative relationship with age was seen for almost all flow-related parameters and segments.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands.
| | - Bastiaan J C Te Kiefte
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Bjorn Winkens
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
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Calò K, Guala A, Mazzi V, Lodi Rizzini M, Dux-Santoy L, Rodriguez-Palomares J, Scarsoglio S, Ridolfi L, Gallo D, Morbiducci U. Pathophysiology of the ascending aorta: Impact of dilation and valve phenotype on large-scale blood flow coherence detected by 4D flow MRI. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108369. [PMID: 39146759 DOI: 10.1016/j.cmpb.2024.108369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/22/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The evidence on the role of hemodynamics in aorta pathophysiology has yet to be robustly translated into clinical applications, to improve risk stratification of aortic diseases. Motivated by the need to enrich the current understanding of the pathophysiology of the ascending aorta (AAo), this study evaluates in vivo how large-scale aortic flow coherence is affected by AAo dilation and aortic valve phenotype. METHODS A complex networks-based approach is applied to 4D flow MRI data to quantify subject-specific AAo flow coherence in terms of correlation between axial velocity waveforms and the aortic flow rate waveform along the cardiac cycle. The anatomical length of persistence of such correlation is quantified using the recently proposed network metric average weighted curvilinear distance (AWCD). The analysis considers 107 subjects selected to allow an ample stratification in terms of aortic valve morphology, absence/presence of AAo dilation and of aortic valve stenosis. RESULTS The analysis highlights that the presence of AAo dilation as well as of bicuspid aortic valve phenotype breaks the physiological AAo flow coherence, quantified in terms of AWCD. Of notice, it emerges that cycle-average blood flow rate and relative AAo dilation are main determinants of AWCD, playing opposite roles in promoting and hampering the persistence of large-scale flow coherence in AAo, respectively. CONCLUSIONS The findings of this study can contribute to broaden the current mechanistic link between large-scale blood flow coherence and aortic pathophysiology, with the prospect of enriching the existing tools for the in vivo non-invasive hemodynamic risk assessment for aortic diseases onset and progression.
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Affiliation(s)
- Karol Calò
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Valentina Mazzi
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio Lodi Rizzini
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Stefania Scarsoglio
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Luca Ridolfi
- PolitoBIOMed Lab, Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Park DC, Park DW. Measurement of Wall Shear Rate Across the Entire Vascular Wall Using Ultrasound Speckle Decorrelation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1203-1213. [PMID: 38688782 DOI: 10.1016/j.ultrasmedbio.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/28/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The accurate measurement of the wall shear rate (WSR) plays a crucial role in the early diagnosis of cardiovascular disease progression and acute events such as aneurysms and atherosclerotic plaque ruptures. To address this need, the speckle decorrelation (SDC) technique has been used to measure WSR based on the 2-D out-of-plane blood flow speed. This technique is particularly advantageous because it enables the use of a 1-D array transducer to measure WSR over the entire luminal area. This study aims to develop a region-based singular value decomposition (SVD) filtering technique that selectively suppresses clutter noise in the vascular region to measure WSR using SDC. METHOD Ultrasound simulations, in-vitro flow experiments, and an in-vivo human study were conducted to evaluate the feasibility of this method's clinical application. RESULTS The results demonstrated that WSR can be effectively measured across entire vascular walls using a conventional 1-D array transducer along with the proposed methodology. CONCLUSION This study successfully demonstrates a noninvasive and accurate SDC-based method for measuring vital vascular WSR. This approach holds significant promise for assessing vascular WSR in both healthy individuals and high-risk cardiovascular disease patients.
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Affiliation(s)
- Dong Chan Park
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea
| | - Dae Woo Park
- Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang 10408, South Korea.
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Martens A, Beckmann E, Kaufeld T, Arar M, Natanov R, Fleissner F, Korte W, Krueger H, Boethig D, Haverich A, Shrestha M. Features and risk factors of early intraluminal thrombus formation within the frozen elephant trunk stent graft. J Thorac Cardiovasc Surg 2024; 168:477-487.e9. [PMID: 36813586 DOI: 10.1016/j.jtcvs.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The frozen elephant trunk is a standard treatment method for aortic arch pathologies extending into the descending aorta. We previously described the phenomenon of early postoperative intraluminal thrombosis within the frozen elephant trunk. We investigated the features and predictors of intraluminal thrombosis. METHODS A total of 281 patients (66% male, mean age 60 ± 12 years) underwent frozen elephant trunk implantation between May 2010 and November 2019. In 268 patients (95%), early postoperative computed tomography angiography was available to assess intraluminal thrombosis. RESULTS The incidence of intraluminal thrombosis after frozen elephant trunk implantation was 8.2%. Intraluminal thrombosis was diagnosed early after the procedure (4.6 ± 2.9 days) and could be successfully treated with anticoagulation in 55% of patients. A total of 27% developed embolic complications. Mortality (27% vs 11%, P = .044) and morbidity were significantly higher in patients with intraluminal thrombosis. Our data showed a significant association of intraluminal thrombosis with prothrombotic medical conditions and anatomic slow flow features. The incidence of heparin-induced thrombopenia was higher in patients with intraluminal thrombosis (18% vs 3.3%, P = .011). Stent-graft diameter index, anticipated endoleak Ib, and degenerative aneurysm were significant independent predictors of intraluminal thrombosis. Therapeutic anticoagulation was a protective factor. Glomerular filtration rate, extracorporeal circulation time, postoperative rethoracotomy, and intraluminal thrombosis (odds ratio, 3.19, P = .047) were independent predictors of perioperative mortality. CONCLUSIONS Intraluminal thrombosis is an underrecognized complication after frozen elephant trunk implantation. In patients with risk factors of intraluminal thrombosis indication for frozen elephant trunk should be carefully evaluated and postoperative anticoagulation considered. Early thoracic endovascular aortic repair extension should be considered in patients with intraluminal thrombosis to prevent embolic complications. Stent-graft designs should be improved to prevent intraluminal thrombosis after frozen elephant trunk implantation.
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Affiliation(s)
- Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Morsi Arar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wilhelm Korte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krueger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Tamagawa Y, Kawamura M, Shibata K, Asada S, Ryugo M, Tsutsumi YI, Monta O. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 2024; 72:305-310. [PMID: 37656401 DOI: 10.1007/s11748-023-01970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Aortic dilatation concurrent with aortic valve disease is a common condition. However, the incidence of aortic dissection after aortic valve replacement for tricuspid aortic valve has not been fully investigated. Therefore, we performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. METHODS We retrospectively reviewed 599 patients who underwent aortic valve replacement at our hospital between January 2000 and December 2020. We performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. RESULTS Seven patients developed late aortic dissections during the follow-up period. All patients with aortic dissection underwent aortic valve replacement for aortic regurgitation. Multivariable analysis revealed that aortic regurgitation was an independent predictor of aortic dissection (p < 0.0001). The mean ascending aortic diameter at aortic valve replacement for aortic regurgitation was significantly greater in patients with aortic dissection than in those without aortic dissection (46 [43.5-46] mm vs. 39 [36-42] mm, p < 0.001). The predictive cutoff value of ascending aortic diameter was indicated using receiver operating characteristic curve analysis; 46.0 mm (area under the curve: 0.8987). Freedom rates from aortic dissection in patients with aortic regurgitation and an ascending aortic diameter ≥ 46 mm were significantly lower than those in patients with an ascending aortic diameter < 46 mm (66.7% vs. 100% at 5 years, p < 0.0001). CONCLUSION Aortic regurgitation combined with ascending aortic dilatation at aortic valve replacement could be a significant risk factor for late aortic dissection.
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Affiliation(s)
- Yuki Tamagawa
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan.
| | - Kana Shibata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Satoshi Asada
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Yasush I Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
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Aslan S, Liu X, Wu Q, Mass P, Loke YH, Johnson J, Huddle J, Olivieri L, Hibino N, Krieger A. Virtual Planning and Patient-Specific Graft Design for Aortic Repairs. Cardiovasc Eng Technol 2024; 15:123-136. [PMID: 37985613 DOI: 10.1007/s13239-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Patients presenting with coarctation of the aorta (CoA) may also suffer from co-existing transverse arch hypoplasia (TAH). Depending on the risks associated with the surgery and the severity of TAH, clinicians may decide to repair only CoA, and monitor the TAH to see if it improves as the patient grows. While acutely successful, eventually hemodynamics may become suboptimal if TAH is left untreated. The objective of this work aims to develop a patient-specific surgical planning framework for predicting and assessing postoperative outcomes of simple CoA repair and comprehensive repair of CoA and TAH. METHODS The surgical planning framework consisted of virtual clamp placement, stenosis resection, and design and optimization of patient-specific aortic grafts that involved geometrical modeling of the graft and computational fluid dynamics (CFD) simulation for evaluating various surgical plans. Time-dependent CFD simulations were performed using Windkessel boundary conditions at the outlets that were obtained from patient-specific non-invasive pressure and flow data to predict hemodynamics before and after the virtual repairs. We applied the proposed framework to investigate optimal repairs for six patients (n = 6) diagnosed with both CoA and TAH. Design optimization was performed by creating a combination of a tubular graft and a waterslide patch to reconstruct the aortic arch. The surfaces of the designed graft were parameterized to optimize the shape. RESULTS Peak systolic pressure drop (PSPD) and time-averaged wall shear stress (TAWSS) were used as performance metrics to evaluate surgical outcomes of various graft designs and implantation. The average PSPD improvements were 28% and 44% after the isolated CoA repair and comprehensive repair, respectively. Maximum values of TAWSS were decreased by 60% after CoA repair and further improved by 22% after the comprehensive repair. The oscillatory shear index was calculated and the values were confirmed to be in the normal range after the repairs. CONCLUSION The results showed that the comprehensive repair outperforms the simple CoA repair and may be more advantageous in the long term in some patients. We demonstrated that the surgical planning and patient-specific flow simulations could potentially affect the selection and outcomes of aorta repairs.
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Affiliation(s)
- Seda Aslan
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA.
| | - Xiaolong Liu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
- Department of Mechanical Engineering, Texas Tech University, Lubbock, TX, USA
| | - Qiyuan Wu
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Paige Mass
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | | | - Laura Olivieri
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
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Garg P, Markl M, Sathananthan J, Sellers SL, Meduri C, Cavalcante J. Restoration of flow in the aorta: a novel therapeutic target in aortic valve intervention. Nat Rev Cardiol 2024; 21:264-273. [PMID: 37880496 DOI: 10.1038/s41569-023-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
Aortic blood flow patterns are closely linked to the morphology and function of the left ventricle, aortic valve and aorta. These flow patterns demonstrate the exceptional adaptability of the cardiovascular system to maintain blood circulation under a broad range of haemodynamic workloads and can be altered in various pathophysiological states. For instance, normal ascending aortic systolic flow is predominantly laminar, whereas abnormal aortic systolic flow is associated with increased eccentricity, vorticity and flow reversal. These flow abnormalities result in reduced aortic conduit function and increased energy loss in the cardiovascular system. Emerging evidence details the association of these flow patterns with loss of aortic compliance, which leads to adverse left ventricular remodelling, poor tissue perfusion, and an increased risk of morbidity and death. In this Perspective article, we review the evidence for the link between aortic flow-related abnormalities and cardiovascular disease and how these changes in aortic flow patterns are emerging as a therapeutic target for aortic valve intervention in first-in-human studies.
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Affiliation(s)
- Pankaj Garg
- University of East Anglia, Norwich Medical School, Norwich, UK.
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
| | - Michael Markl
- Departments of Radiology & Biomedical Engineering, Northwestern University, Feinberg School of Medicine & McCormick School of Engineering, Chicago, IL, USA
| | | | - Stephanie L Sellers
- Cardiovascular Translational Lab, St. Paul's Hospital, University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | - Chris Meduri
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - João Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Mehmood Z, Assadi H, Grafton-Clarke C, Li R, Matthews G, Alabed S, Girling R, Underwood V, Kasmai B, Zhao X, Ricci F, Zhong L, Aung N, Petersen SE, Swift AJ, Vassiliou VS, Cavalcante J, Geest RJVD, Garg P. Validation of 2D flow MRI for helical and vortical flows. Open Heart 2024; 11:e002451. [PMID: 38458769 PMCID: PMC10928773 DOI: 10.1136/openhrt-2023-002451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/09/2023] [Indexed: 03/10/2024] Open
Abstract
PURPOSE The main objective of this study was to develop two-dimensional (2D) phase contrast (PC) methods to quantify the helicity and vorticity of blood flow in the aortic root. METHODS This proof-of-concept study used four-dimensional (4D) flow cardiovascular MR (4D flow CMR) data of five healthy controls, five patients with heart failure with preserved ejection fraction and five patients with aortic stenosis (AS). A PC through-plane generated by 4D flow data was treated as a 2D PC plane and compared with the original 4D flow. Visual assessment of flow vectors was used to assess helicity and vorticity. We quantified flow displacement (FD), systolic flow reversal ratio (sFRR) and rotational angle (RA) using 2D PC. RESULTS For visual vortex flow presence near the inner curvature of the ascending aortic root on 4D flow CMR, sFRR demonstrated an area under the curve (AUC) of 0.955, p<0.001. A threshold of >8% for sFRR had a sensitivity of 82% and specificity of 100% for visual vortex presence. In addition, the average late systolic FD, a marker of flow eccentricity, also demonstrated an AUC of 0.909, p<0.001 for visual vortex flow. Manual systolic rotational flow angle change (ΔsRA) demonstrated excellent association with semiautomated ΔsRA (r=0.99, 95% CI 0.9907 to 0.999, p<0.001). In reproducibility testing, average systolic FD (FDsavg) showed a minimal bias at 1.28% with a high intraclass correlation coefficient (ICC=0.92). Similarly, sFRR had a minimal bias of 1.14% with an ICC of 0.96. ΔsRA demonstrated an acceptable bias of 5.72°-and an ICC of 0.99. CONCLUSION 2D PC flow imaging can possibly quantify blood flow helicity (ΔRA) and vorticity (FRR). These imaging biomarkers of flow helicity and vorticity demonstrate high reproducibility for clinical adoption. TRIALS REGISTRATION NUMBER NCT05114785.
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Affiliation(s)
- Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Hosamadin Assadi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia Norwich Medical School, Norwich, UK
| | - Ciaran Grafton-Clarke
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Rui Li
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Gareth Matthews
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - Samer Alabed
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebekah Girling
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Victoria Underwood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Bahman Kasmai
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | | | - Fabrizio Ricci
- Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti Scalo, Italy
| | | | - Nay Aung
- Queen Mary University of London, London, UK
| | - Steffen Erhard Petersen
- Advanced Cardiovascular Imaging William Harvey Research Institute, The London Chest Hospital, London, UK
| | | | - Vassilios S Vassiliou
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
| | - João Cavalcante
- Cardiovascular, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Pankaj Garg
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Department of Cardiovascular and Metabolic Health, University of East Anglia, Norwich, UK
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9
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Ramaekers MJFG, Westenberg JJM, Venner MFGHM, Juffermans JF, van Assen HC, Te Kiefte BJC, Adriaans BP, Lamb HJ, Wildberger JE, Schalla S. Evaluating a Phase-Specific Approach to Aortic Flow: A 4D Flow MRI Study. J Magn Reson Imaging 2024; 59:1056-1067. [PMID: 37309838 DOI: 10.1002/jmri.28852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Aortic flow parameters can be quantified using 4D flow MRI. However, data are sparse on how different methods of analysis influence these parameters and how these parameters evolve during systole. PURPOSE To assess multiphase segmentations and multiphase quantification of flow-related parameters in aortic 4D flow MRI. STUDY TYPE Prospective. POPULATION 40 healthy volunteers (50% male, 28.9 ± 5.0 years) and 10 patients with thoracic aortic aneurysm (80% male, 54 ± 8 years). FIELD STRENGTH/SEQUENCE 4D flow MRI with a velocity encoded turbo field echo sequence at 3 T. ASSESSMENT Phase-specific segmentations were obtained for the aortic root and the ascending aorta. The whole aorta was segmented in peak systole. In all aortic segments, time to peak (TTP; for flow velocity, vorticity, helicity, kinetic energy, and viscous energy loss) and peak and time-averaged values (for velocity and vorticity) were calculated. STATISTICAL TESTS Static vs. phase-specific models were assessed using Bland-Altman plots. Other analyses were performed using phase-specific segmentations for aortic root and ascending aorta. TTP for all parameters was compared to TTP of flow rate using paired t-tests. Time-averaged and peak values were assessed using Pearson correlation coefficient. P < 0.05 was considered statistically significant. RESULTS In the combined group, velocity in static vs. phase-specific segmentations differed by 0.8 cm/sec for the aortic root, and 0.1 cm/sec (P = 0.214) for the ascending aorta. Vorticity differed by 167 sec-1 mL-1 (P = 0.468) for the aortic root, and by 59 sec-1 mL-1 (P = 0.481) for the ascending aorta. Vorticity, helicity, and energy loss in the ascending aorta, aortic arch, and descending aorta peaked significantly later than flow rate. Time-averaged velocity and vorticity values correlated significantly in all segments. DATA CONCLUSION Static 4D flow MRI segmentation yields comparable results as multiphase segmentation for flow-related parameters, eliminating the need for time-consuming multiple segmentations. However, multiphase quantification is necessary for assessing peak values of aortic flow-related parameters. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Max F G H M Venner
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans C van Assen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Simon Schalla
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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10
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Bouaou K, Dietenbeck T, Soulat G, Bargiotas I, Houriez-Gombaud-Saintonge S, De Cesare A, Gencer U, Giron A, Jiménez E, Messas E, Lucor D, Bollache E, Mousseaux E, Kachenoura N. Four-dimensional flow cardiovascular magnetic resonance aortic cross-sectional pressure changes and their associations with flow patterns in health and ascending thoracic aortic aneurysm. J Cardiovasc Magn Reson 2024; 26:101030. [PMID: 38403074 PMCID: PMC10950879 DOI: 10.1016/j.jocmr.2024.101030] [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: 12/01/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Ascending thoracic aortic aneurysm (ATAA) is a silent and threatening dilation of the ascending aorta (AscAo). Maximal aortic diameter which is currently used for ATAA patients management and surgery planning has been shown to inadequately characterize risk of dissection in a large proportion of patients. Our aim was to propose a comprehensive quantitative evaluation of aortic morphology and pressure-flow-wall associations from four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) data in healthy aging and in patients with ATAA. METHODS We studied 17 ATAA patients (64.7 ± 14.3 years, 5 females) along with 17 age- and sex-matched healthy controls (59.7 ± 13.3 years, 5 females) and 13 younger healthy subjects (33.5 ± 11.1 years, 4 females). All subjects underwent a CMR exam, including 4D flow and three-dimensional anatomical images of the aorta. This latter dataset was used for aortic morphology measurements, including AscAo maximal diameter (iDMAX) and volume, indexed to body surface area. 4D flow MRI data were used to estimate 1) cross-sectional local AscAo spatial (∆PS) and temporal (∆PT) pressure changes as well as the distance (∆DPS) and time duration (∆TPT) between local pressure peaks, 2) AscAo maximal wall shear stress (WSSMAX) at peak systole, and 3) AscAo flow vorticity amplitude (VMAX), duration (VFWHM), and eccentricity (VECC). RESULTS Consistency of flow and pressure indices was demonstrated through their significant associations with AscAo iDMAX (WSSMAX:r = -0.49, p < 0.001; VECC:r = -0.29, p = 0.045; VFWHM:r = 0.48, p < 0.001; ∆DPS:r = 0.37, p = 0.010; ∆TPT:r = -0.52, p < 0.001) and indexed volume (WSSMAX:r = -0.63, VECC:r = -0.51, VFWHM:r = 0.53, ∆DPS:r = 0.54, ∆TPT:r = -0.63, p < 0.001 for all). Intra-AscAo cross-sectional pressure difference, ∆PS, was significantly and positively associated with both VMAX (r = 0.55, p = 0.002) and WSSMAX (r = 0.59, p < 0.001) in the 30 healthy subjects (48.3 ± 18.0 years). Associations remained significant after adjustment for iDMAX, age, and systolic blood pressure. Superimposition of ATAA patients to normal aging trends between ∆PS and WSSMAX as well as VMAX allowed identifying patients with substantially high pressure differences concomitant with AscAo dilation. CONCLUSION Local variations in pressures within ascending aortic cross-sections derived from 4D flow MRI were associated with flow changes, as quantified by vorticity, and with stress exerted by blood on the aortic wall, as quantified by wall shear stress. Such flow-wall and pressure interactions might help for the identification of at-risk patients.
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Affiliation(s)
- Kevin Bouaou
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Thomas Dietenbeck
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Gilles Soulat
- Hôpital Européen Georges Pompidou, INSERM 970, Paris, France.
| | - Ioannis Bargiotas
- CMLA, ENS Cachan, CNRS, Université Paris-Saclay, 94235 Cachan, France.
| | | | - Alain De Cesare
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Umit Gencer
- Hôpital Européen Georges Pompidou, INSERM 970, Paris, France.
| | - Alain Giron
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Elena Jiménez
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Emmanuel Messas
- Hôpital Européen Georges Pompidou, INSERM 970, Paris, France.
| | - Didier Lucor
- Université Paris-Saclay, CNRS, Laboratoire Interdisciplinaire des Sciences du Numérique, Orsay, France.
| | - Emilie Bollache
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
| | - Elie Mousseaux
- Hôpital Européen Georges Pompidou, INSERM 970, Paris, France.
| | - Nadjia Kachenoura
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.
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11
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Trenti C, Fedak PWM, White JA, Garcia J, Dyverfeldt P. Oscillatory shear stress is elevated in patients with bicuspid aortic valve and aortic regurgitation: a 4D flow cardiovascular magnetic resonance cross-sectional study. Eur Heart J Cardiovasc Imaging 2024; 25:404-412. [PMID: 37878753 PMCID: PMC10883729 DOI: 10.1093/ehjci/jead283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Patients with bicuspid aortic valve (BAV) and aortic regurgitation have higher rate of aortic complications compared with patients with BAV and stenosis, as well as BAV without valvular disease. Aortic regurgitation alters blood haemodynamics not only in systole but also during diastole. We therefore sought to investigate wall shear stress (WSS) during the whole cardiac cycle in BAV with aortic regurgitation. METHODS AND RESULTS Fifty-seven subjects that underwent 4D flow cardiovascular magnetic resonance imaging were included: 13 patients with BAVs without valve disease, 14 BAVs with aortic regurgitation, 15 BAVs with aortic stenosis, and 22 normal controls with tricuspid aortic valve. Peak and time averaged WSS in systole and diastole and the oscillatory shear index (OSI) in the ascending aorta were computed. Student's t-tests were used to compare values between the four groups where the data were normally distributed, and the non-parametric Wilcoxon rank sum tests were used otherwise. BAVs with regurgitation had similar peak and time averaged WSS compared with the patients with BAV without valve disease and with stenosis, and no regions of elevated WSS were found. BAV with aortic regurgitation had twice as high OSI as the other groups (P ≤ 0.001), and mainly in the outer mid-to-distal ascending aorta. CONCLUSION OSI uniquely characterizes altered WSS patterns in BAVs with aortic regurgitation, and thus could be a haemodynamic marker specific for this specific group that is at higher risk of aortic complications. Future longitudinal studies are needed to verify this hypothesis.
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Affiliation(s)
- Chiara Trenti
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - James A White
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, 4448 Front St SE, Calgary, AB T3M 1M4, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Petter Dyverfeldt
- Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Universitetssjukhuset, 581 83 Linköping, Sweden
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12
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Ma P, Zhu L, Wen R, Lv F, Li Y, Li X, Zhang Z. Revolutionizing vascular imaging: trends and future directions of 4D flow MRI based on a 20-year bibliometric analysis. Quant Imaging Med Surg 2024; 14:1873-1890. [PMID: 38415143 PMCID: PMC10895087 DOI: 10.21037/qims-23-1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/08/2023] [Indexed: 02/29/2024]
Abstract
Background Four-dimensional flow magnetic resonance imaging (4D flow MRI) is a promising new technology with potential clinical value in hemodynamic quantification. Although an increasing number of articles on 4D flow MRI have been published over the past decades, few studies have statistically analyzed these published articles. In this study, we aimed to perform a systematic and comprehensive bibliometric analysis of 4D flow MRI to explore the current hotspots and potential future directions. Methods The Web of Science Core Collection searched for literature on 4D flow MRI between 2003 and 2022. CiteSpace was utilized to analyze the literature data, including co-citation, cooperative network, cluster, and burst keyword analysis. Results A total of 1,069 articles were extracted for this study. The main research hotspots included the following: quantification and visualization of blood flow in different clinical settings, with keywords such as "cerebral aneurysm", "heart", "great vessel", "tetralogy of Fallot", "portal hypertension", and "stiffness"; optimization of image acquisition schemes, such as "resolution" and "reconstruction"; measurement and analysis of flow components and patterns, as indicated by keywords "pattern", "KE", "WSS", and "fluid dynamics". In addition, international consensus for metrics derived from 4D flow MRI and multimodality imaging may also be the future research direction. Conclusions The global domain of 4D flow MRI has grown over the last 2 decades. In the future, 4D flow MRI will evolve towards becoming a relatively short scan duration with adequate spatiotemporal resolution, expansion into the diagnosis and treatment of vascular disease in other related organs, and a shift in focus from vascular structure to function. In addition, artificial intelligence (AI) will assist in the clinical promotion and application of 4D flow MRI.
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Affiliation(s)
- Peisong Ma
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lishu Zhu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ru Wen
- Department of Radiology, Guizhou Provincial People Hospital, Guiyang, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyou Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiwei Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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13
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Shang Y, Theilenberg S, Gajdošík M, Schreiber LM, Juchem C. High resolution simulation and measurement demonstrate oscillatory spatiotemporal B 0 fluctuations across the human cardiac cycle. Magn Reson Med 2024; 91:91-104. [PMID: 37598417 DOI: 10.1002/mrm.29831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Functional cardiac MRI scans employing balanced steady-state free precession sequences suffer from dark band artifacts in the myocardium due to B0 inhomogeneity. We recently introduced a novel method for the theoretical derivation of B0 distributions in the human heart. This study aims to simulate the B0 distributions in the heart across the cardiac cycle using structural MR images and validate the simulations via in vivo measured cardiac phase-specific B0 maps on the same subjects at 3T. METHODS Cardiac phase-specific B0 field maps were acquired from eight healthy subjects at 3T. B0 conditions were simulated based on tissue masks created from the cardiac-phase specific structural images from the in vivo B0 map scan and anatomical images from a thoracic MRI scan, adopting our recently published approach. The simulations and in vivo measurements were compared by calculating the spatial correlation of their B0 distributions and temporal correlation of the derived spherical harmonic coefficients throughout the cardiac cycle. RESULTS The spatial comparison of B0 maps between the simulation and in vivo measurement indicates an overall average correlation coefficient of 0.91 across the cardiac cycle in all subjects. Both groups show consistent high-level B0 patterns. Temporal variations of B0 conditions exhibit sinusoidal characteristics and are strongly correlated between simulation and in vivo. CONCLUSION Theoretical simulations employing regional anatomical features were validated by direct in vivo B0 mapping in the same subjects. The spatial B0 condition throughout the cardiac cycle exhibits oscillatory characteristics due to structural distortions of cardiac motion.
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Affiliation(s)
- Yun Shang
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, New York, USA
| | - Sebastian Theilenberg
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, New York, USA
| | - Martin Gajdošík
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, New York, USA
| | - Laura M Schreiber
- Chair of Molecular and Cellular Imaging, Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Cardiovascular Imaging, Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University in the City of New York, New York, New York, USA
- Department of Radiology, Columbia University in the City of New York, New York, New York, USA
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14
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Ebel S, Köhler B, Aggarwal A, Preim B, Behrendt B, Jung B, Gohmann RF, Riekena B, Borger M, Lurz P, Denecke T, Grothoff M, Gutberlet M. Comparison of aortic blood flow rotational direction in healthy volunteers and patients with bicuspid aortic valves using volumetric velocity-sensitive cardiovascular magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:7973-7986. [PMID: 38106267 PMCID: PMC10722022 DOI: 10.21037/qims-23-183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Background The rotational direction (RD) of helical blood flow can be classified as either a clockwise (RD+) or counter-clockwise (RD-) flow. We hypothesized that this simple classification might not be sufficient for analysis in vivo and a simultaneous existence of RD+/- may occur. We utilized volumetric velocity-sensitive cardiovascular magnetic resonance imaging (4D flow MRI) to analyze rotational blood flow in the thoracic aorta. Methods Forty volunteers (22 females; mean age, 41±16 years) and seventeen patients with bicuspid aortic valves (BAVs) (9 females; mean age, 42±14 years) were prospectively included. The RDs and the calculation of the rotating blood volumes (RBVs) in the thoracic aorta were performed using a pathline-projection strategy. Results We could confirm a mainly clockwise RD in the ascending, descending aorta and in the aortic arch. Furthermore, we found a simultaneous existence of RD+/RD-. The RD+/--volume in the ascending aorta was significantly higher in BAV patients, the mean RD+/RD- percentage was approximately 80%/20% vs. 60%/40% in volunteers (P<0.01). The maximum RBV always occurred during systole. There was significantly more clockwise than counter-clockwise rotational flow in the ascending aorta (P<0.01) and the aortic arch (P<0.01), but no significant differences in the descending aorta (P=0.48). Conclusions A simultaneous occurrence of RD+/RD- indicates that a simple categorization in either of both is insufficient to describe blood flow in vivo. Rotational flow in the ascending aorta and in the aortic arch differs significantly from flow in the descending aorta. BAV patients show significantly more clockwise rotating volume in the ascending aorta compared to healthy volunteers.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Benjamin Köhler
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | | | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Bern, Switzerland
| | - Robin F. Gohmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Boris Riekena
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, University Leipzig – Heart Centre, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, University Leipzig – Heart Centre, Leipzig, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig – Heart Centre, Leipzig, Germany
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15
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Aalbregt E, Rijken L, Nederveen A, van Ooij P, Yeung KK, Jongkind V. Quantitative Magnetic Resonance Imaging to Assess Progression and Rupture Risk of Aortic Aneurysms: A Scoping Review. J Endovasc Ther 2023:15266028231204830. [PMID: 37853734 DOI: 10.1177/15266028231204830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE In current practice, the diameter of an aortic aneurysm is utilized to estimate the rupture risk and decide upon timing of elective repair, although it is known to be imprecise and not patient-specific. Quantitative magnetic resonance imaging (MRI) enables the visualization of several biomarkers that provide information about processes within the aneurysm and may therefore facilitate patient-specific risk stratification. We performed a scoping review of the literature on quantitative MRI techniques to assess aortic aneurysm progression and rupture risk, summarized these findings, and identified knowledge gaps. METHODS Literature concerning primary research was of interest and the medical databases PubMed, Scopus, Embase, and Cochrane were systematically searched. This study used the PRISMA protocol extension for scoping reviews. Articles published between January 2010 and February 2023 involving animals and/or humans were included. Data were extracted by 2 authors using a predefined charting method. RESULTS A total of 1641 articles were identified, of which 21 were included in the scoping review. Quantitative MRI-derived biomarkers were categorized into hemodynamic (8 studies), wall (5 studies) and molecular biomarkers (8 studies). Fifteen studies included patients and/or healthy human subjects. Animal models were investigated in the other 6 studies. A cross-sectional study design was the most common, whereas 5 animal studies had a longitudinal component and 2 studies including patients had a prospective design. A promising hemodynamic biomarker is wall shear stress (WSS), which is estimated based on 4D-flow MRI. Molecular biomarkers enable the assessment of inflammatory and wall deterioration processes. The ADAMTS4-specific molecular magnetic resonance (MR) probe showed potential to predict abdominal aortic aneurysm (AAA) formation and rupture in a murine model. Wall biomarkers assessed using dynamic contrast-enhanced (DCE) MRI showed great potential for assessing AAA progression independent of the maximum diameter. CONCLUSION This scoping review provides an overview of quantitative MRI techniques studied and the biomarkers derived from them to assess aortic aneurysm progression and rupture risk. Longitudinal studies are needed to validate the causal relationships between the identified biomarkers and aneurysm growth, rupture, or repair. In the future, quantitative MRI could play an important role in the personalized risk assessment of aortic aneurysm rupture. CLINICAL IMPACT The currently used maximum aneurysm diameter fails to accurately assess the multifactorial pathology of an aortic aneurysm and precisely predicts rupture in a patient-specific manner. Quantitative magnetic resonance imaging (MRI) enables the detection of various quantitative parameters involved in aneurysm progression and subsequent rupture. This scoping review provides an overview of the studied quantitative MRI techniques, the biomarkers derived from them, and recommendations for future research needed for the implementation of these biomarkers. Ultimately, quantitative MRI could facilitate personalized risk assessment for patients with aortic aneurysms, thereby reducing untimely repairs and improving rupture prevention.
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Affiliation(s)
- Eva Aalbregt
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Lotte Rijken
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Aart Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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16
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Scarselli D, Lopez JM, Varshney A, Hof B. Turbulence suppression by cardiac-cycle-inspired driving of pipe flow. Nature 2023; 621:71-74. [PMID: 37673988 DOI: 10.1038/s41586-023-06399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/04/2023] [Indexed: 09/08/2023]
Abstract
Flows through pipes and channels are, in practice, almost always turbulent, and the multiscale eddying motion is responsible for a major part of the encountered friction losses and pumping costs1. Conversely, for pulsatile flows, in particular for aortic blood flow, turbulence levels remain low despite relatively large peak velocities. For aortic blood flow, high turbulence levels are intolerable as they would damage the shear-sensitive endothelial cell layer2-5. Here we show that turbulence in ordinary pipe flow is diminished if the flow is driven in a pulsatile mode that incorporates all the key features of the cardiac waveform. At Reynolds numbers comparable to those of aortic blood flow, turbulence is largely inhibited, whereas at much higher speeds, the turbulent drag is reduced by more than 25%. This specific operation mode is more efficient when compared with steady driving, which is the present situation for virtually all fluid transport processes ranging from heating circuits to water, gas and oil pipelines.
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Affiliation(s)
- D Scarselli
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - J M Lopez
- Institute of Science and Technology Austria, Klosterneuburg, Austria
- Universidad de Málaga, Málaga, Spain
| | - A Varshney
- Institute of Science and Technology Austria, Klosterneuburg, Austria
- School of Physical Sciences, National Institute of Science Education and Research, HBNI, Bhubaneswar, India
| | - B Hof
- Institute of Science and Technology Austria, Klosterneuburg, Austria.
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17
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Busse A. Cardiac cycle inspires optimized pipe flow. Nature 2023; 621:43-44. [PMID: 37673986 DOI: 10.1038/d41586-023-02739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
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Garg I, Grist TM, Nagpal P. MR Angiography for Aortic Diseases. Magn Reson Imaging Clin N Am 2023; 31:373-394. [PMID: 37414467 DOI: 10.1016/j.mric.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Aortic pathologic conditions represent diverse disorders, including aortic aneurysm, acute aortic syndrome, traumatic aortic injury, and atherosclerosis. Given the nonspecific clinical features, noninvasive imaging is critical in screening, diagnosis, management, and posttherapeutic surveillance. Of the commonly used imaging modalities, including ultrasound, computed tomography, and MR imaging, the final choice often depends on a combination of factors: acuity of clinical presentation, suspected underlying diagnosis, and institutional practice. Further research is needed to identify the potential clinical role and define appropriate use criteria for advanced MR applications such as four-dimenional flow to manage patients with aortic pathologic conditions.
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Affiliation(s)
- Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University Of New Mexico, Albuquerque, NM 87131, USA
| | - Thomas M Grist
- Department of Radiology, University of Wisconsin-Madison, E3/366 Clinical Science Center 600 Highland Avenue Madison, WI 53792, USA
| | - Prashant Nagpal
- Cardiovascular and Thoracic Radiology, University of Wisconsin School of Medicine and Public Health, E3/366 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
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19
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Ramaekers MJFG, Westenberg JJM, Adriaans BP, Nijssen EC, Wildberger JE, Lamb HJ, Schalla S. A clinician's guide to understanding aortic 4D flow MRI. Insights Imaging 2023; 14:114. [PMID: 37395817 DOI: 10.1186/s13244-023-01458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/03/2023] [Indexed: 07/04/2023] Open
Abstract
Four-dimensional flow magnetic resonance imaging is an emerging technique which may play a role in diagnosis and risk-stratification of aortic disease. Some knowledge of flow dynamics and related parameters is necessary to understand and apply this technique in clinical workflows. The purpose of the current review is to provide a guide for clinicians to the basics of flow imaging, frequently used flow-related parameters, and their relevance in the context of aortic disease.Clinical relevance statement Understanding normal and abnormal aortic flow could improve clinical care in patients with aortic disease.
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Affiliation(s)
- Mitch J F G Ramaekers
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bouke P Adriaans
- Department of Cardiology and Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Estelle C Nijssen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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20
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Jabagi H, Levine D, Gharibeh L, Camillo C, Castillero E, Ferrari G, Takayama H, Grau JB. Implications of Bicuspid Aortic Valve Disease and Aortic Stenosis/Insufficiency as Risk Factors for Thoracic Aortic Aneurysm. Rev Cardiovasc Med 2023; 24:178. [PMID: 39077527 PMCID: PMC11264121 DOI: 10.31083/j.rcm2406178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 07/31/2024] Open
Abstract
Bicuspid Aortic Valves (BAV) are associated with an increased incidence of thoracic aortic aneurysms (TAA). TAA are a common aortic pathology characterized by enlargement of the aortic root and/or ascending aorta, and may become life threatening when left untreated. Typically occurring as the sole pathology in a patient, TAA are largely asymptomatic. However, in some instances, they are accompanied by aortic valve (AV) diseases: either congenital BAV or acquired in the form of Aortic Insufficiency (AI) or aortic stenosis (AS). When TAA are associated with aortic valve disease, determining an accurate and predictable prognosis becomes especially challenging. Patients with AV disease and concomitant TAA lack a widely accepted diagnostic approach, one that integrates our knowledge on aortic valve pathophysiology and encompasses multi-modality imaging approaches. This review summarizes the most recent scientific knowledge regarding the association between AV diseases (BAV, AI, AS) and ascending aortopathies (dilatation, aneurysm, and dissection). We aimed to pinpoint the gaps in monitoring practices and prediction of disease progression in TAA patients with concomitant AV disease. We propose that a morphological and functional analysis of the AV with multi-modality imaging should be included in aortic surveillance programs. This strategy would allow for improved risk stratification of these patients, and possibly new AV phenotypic-specific guidelines with more vigilant surveillance and earlier prophylactic surgery to improve patient outcomes.
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Affiliation(s)
- Habib Jabagi
- Division of Cardiothoracic Surgery, The Valley Hospital, NJ 07450, USA
- Department of Cardiovascular Surgery, Mt. Sinai Hospital, Icahn School of Medicine, New York, NY 10029, USA
| | - Dov Levine
- Department of Surgery, Columbia University, New York, NY 10027, USA
| | - Lara Gharibeh
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Chiara Camillo
- Department of Surgery, Columbia University, New York, NY 10027, USA
| | | | - Giovanni Ferrari
- Department of Surgery, Columbia University, New York, NY 10027, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University, New York, NY 10027, USA
| | - Juan B. Grau
- Division of Cardiothoracic Surgery, The Valley Hospital, NJ 07450, USA
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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21
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Cantinotti M, Marchese P, Scalese M, Giordano R, Franchi E, Assanta N, Koestenberger M, Barnes BT, Celi S, Jani V, Voges I, Kutty S. Characterization of Aortic Flow Patterns by High-Frame-Rate Blood Speckle Tracking Echocardiography in Children. J Am Heart Assoc 2023; 12:e026335. [PMID: 37066781 PMCID: PMC10227241 DOI: 10.1161/jaha.122.026335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/26/2022] [Indexed: 04/18/2023]
Abstract
Background Blood speckle tracking echocardiography allows for direct quantification of interventricular and aortic flow profiles, principally in children. Here, we sought to demonstrate the feasibility and reproducibility of blood speckle tracking echocardiography in the aortas of healthy children. Methods and Results One hundred healthy White children evaluated for the screening of congenital heart disease were prospectively enrolled. Echocardiographic examinations were performed using a Vivid E 95 ultrasound system, with blood speckle tracking from a focused and zoomed view of the aortic root and the ascending aorta. Vortex position, height (mm), width (mm), sphericity index, and area (cm2) were measured and indexed by body surface area. Median (interquartile range) age was 8.2 (5.6-11.0) years, median (interquartile range) weight was 28 (19-35) kg, and median (interquartile range) body surface area was 1.01 (0.79-1.16) m2. Vortices were visualized in only a single phase of the cardiac cycle in 25 subjects-14 (56.0%) were evident in early diastole and 11 (44.0%) in late systole. Vortices visualized in diastole had a mean area of 0.27±0.1 cm2/m2, while those in systole had a mean area of 0.34±0.12 cm2/m2. In a subset of 20 patients, inter- and intraobserver coefficient of variation and intraclass correlation coefficients were determined and showed good reproducibility. Conclusions We demonstrate feasibility and reproducibility of blood speckle tracking and identified vortical flow patterns in the aortic root and ascending aorta in healthy children. These data may serve as a baseline for evaluating aortic flow patterns in children with congenital and acquired heart disease.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Adult Institute of Clinical PhysiologyPisaItaly
| | - Pietro Marchese
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
- Scuola Superiore Sant’AnnaPisaItaly
| | | | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department Advanced Biomedical SciencesUniversity of Naples “Federico II”NapoliItaly
| | - Eliana Franchi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Nadia Assanta
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of PediatricsMedical University GrazGrazAustria
| | - Benjamin T. Barnes
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Simona Celi
- Fondazione G. Monasterio CNR‐Regione ToscanaMassa, PisaItaly
| | - Vivek Jani
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
| | - Inga Voges
- Department for Congenital Cardiology and Pediatric CardiologyUniversity Hospital Schleswig‐HolsteinCampus KielGermany
| | - Shelby Kutty
- Department of PediatricsTaussig Heart Center, Johns Hopkins HospitalBaltimoreMDUSA
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22
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Schafstedde M, Jarmatz L, Brüning J, Hüllebrand M, Nordmeyer S, Harloff A, Hennemuth A. Population-based reference values for 4D flow MRI derived aortic blood flow parameters. Physiol Meas 2023; 44. [PMID: 36735968 DOI: 10.1088/1361-6579/acb8fd] [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: 07/25/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023]
Abstract
Objective. This study assesses age-related differences of thoracic aorta blood flow profiles and provides age- and sex-specific reference values using 4D flow cardiovascular magnetic resonance (CMR) data.Approach. 126 volunteers (age 20-80 years, female 51%) underwent 4D flow CMR and 12 perpendicular analysis planes in the thoracic aorta were specified. For these planes the following parameters were evaluated: body surface area-adjusted aortic area (A'), normalized flow displacement (NFD), the degree of wall parallelism (WPD), the minimal relative cross-sectional area through which 80% of the volume flow passes (A80) and the angle between flow direction and centerline (α).Main results. Age-related differences in blood flow parameters were seen in the ascending aorta with higher values for NFD and angle and lower values for WPD and A80 in older subjects. All parameters describing blood flow patterns correlated with the cross-sectional area in the ascending aorta. No relevant sex-differences regarding blood flow profiles were found.Significance. These age- and sex-specific reference values for quantitative parameters describing blood flow within the aorta might help to study the clinical relevance of flow profiles in the future.
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Affiliation(s)
- Marie Schafstedde
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Lina Jarmatz
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany
| | - Jan Brüning
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Markus Hüllebrand
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Fraunhofer MEVIS, Bremen, Germany
| | - Sarah Nordmeyer
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany
| | - Andreas Harloff
- Department of Neurology, University Medical Center Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Germany
| | - Anja Hennemuth
- Institute of Congenital Heart Disease, German Heart Center Charité, Berlin, Germany.,Partner Site Berlin, German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,Fraunhofer MEVIS, Bremen, Germany
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23
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Weiss EK, Jarvis K, Maroun A, Malaisrie SC, Mehta CK, McCarthy PM, Bonow RO, Avery RJ, Allen BD, Carr JC, Rigsby CK, Markl M. Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects. J Cardiovasc Magn Reson 2023; 25:3. [PMID: 36698129 PMCID: PMC9878800 DOI: 10.1186/s12968-022-00906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole. METHODS 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole. RESULTS BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1). CONCLUSION 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.
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Affiliation(s)
- Elizabeth K. Weiss
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Kelly Jarvis
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Anthony Maroun
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Patrick M. McCarthy
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Robert O. Bonow
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
| | - Cynthia K. Rigsby
- Department of Medical Imaging, Lurie Children’s Hospital, Chicago, IL USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611 USA
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24
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Gravholt CH, Viuff M, Just J, Sandahl K, Brun S, van der Velden J, Andersen NH, Skakkebaek A. The Changing Face of Turner Syndrome. Endocr Rev 2023; 44:33-69. [PMID: 35695701 DOI: 10.1210/endrev/bnac016] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 01/20/2023]
Abstract
Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is considered a rare genetic condition and is associated with a wide range of clinical stigmata, such as short stature, ovarian dysgenesis, delayed puberty and infertility, congenital malformations, endocrine disorders, including a range of autoimmune conditions and type 2 diabetes, and neurocognitive deficits. Morbidity and mortality are clearly increased compared with the general population and the average age at diagnosis is quite delayed. During recent years it has become clear that a multidisciplinary approach is necessary toward the patient with TS. A number of clinical advances has been implemented, and these are reviewed. Our understanding of the genomic architecture of TS is advancing rapidly, and these latest developments are reviewed and discussed. Several candidate genes, genomic pathways and mechanisms, including an altered transcriptome and epigenome, are also presented.
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Affiliation(s)
- Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Mette Viuff
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Jesper Just
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Kristian Sandahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Sara Brun
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark
| | - Janielle van der Velden
- Department of Pediatrics, Radboud University Medical Centre, Amalia Children's Hospital, 6525 Nijmegen, the Netherlands
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Anne Skakkebaek
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus 8200 N, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus 8200 N, Denmark
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25
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Osztrogonacz P, Berczeli M, Chinnadurai P, Chang SM, Shah DJ, Lumsden AB. Dynamic Imaging of Aortic Pathologies: Review of Clinical Applications and Imaging Protocols. Methodist Debakey Cardiovasc J 2023; 19:4-14. [PMID: 36910554 PMCID: PMC10000327 DOI: 10.14797/mdcvj.1172] [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: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 03/09/2023] Open
Abstract
The past decade has seen significant advances in dynamic imaging of the aorta. Today's vascular surgeons have the opportunity to choose from a wide array of imaging modalities to evaluate different aortic pathologies. While vascular ultrasound and aortography are considered to be the bread and butter imaging modalities, newer dynamic imaging techniques provide time-resolved information in various aortic pathologies. However, despite growing evidence of their advantages in the literature, they have not been routinely adopted. In order to understand the role of these emerging modalities, one must understand their principles, advantages, and limitations in the context of various clinical scenarios. In this review, we provide an overview of dynamic imaging techniques for aortic pathologies and describe various dynamic computed tomography and magnetic resonance imaging protocols, clinical applications, and potential future directions.
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Affiliation(s)
- Peter Osztrogonacz
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Marton Berczeli
- Houston Methodist Hospital, Houston, Texas, US.,Semmelweis University, Budapest, Hungary
| | - Ponraj Chinnadurai
- Houston Methodist Hospital, Houston, Texas, US.,Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, US
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26
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Iffrig E, Timmins LH, El Sayed R, Taylor WR, Oshinski JN. A New Method for Quantifying Abdominal Aortic Wall Shear Stress Using Phase Contrast Magnetic Resonance Imaging and the Womersley Solution. J Biomech Eng 2022; 144:091011. [PMID: 35377416 PMCID: PMC9125867 DOI: 10.1115/1.4054236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/19/2022] [Indexed: 11/08/2022]
Abstract
Wall shear stress (WSS) is an important mediator of cardiovascular pathologies and there is a need for its reliable evaluation as a potential prognostic indicator. The purpose of this work was to develop a method that quantifies WSS from two-dimensional (2D) phase contrast magnetic resonance (PCMR) imaging derived flow waveforms, apply this method to PCMR data acquired in the abdominal aorta of healthy volunteers, and to compare PCMR-derived WSS values to values predicted from a computational fluid dynamics (CFD) simulation. The method uses PCMR-derived flow versus time waveforms constrained by the Womersley solution for pulsatile flow in a cylindrical tube. The method was evaluated for sensitivity to input parameters, intrastudy repeatability and was compared with results from a patient-specific CFD simulation. 2D-PCMR data were acquired in the aortas of healthy men (n = 12) and women (n = 15) and time-averaged WSS (TAWSS) was compared. Agreement was observed when comparing TAWSS between CFD and the PCMR flow-based method with a correlation coefficient of 0.88 (CFD: 15.0 ± 1.9 versus MRI: 13.5 ± 2.4 dyn/cm2) though comparison of WSS values between the PCMR-based method and CFD predictions indicate that the PCMR method underestimated instantaneous WSS by 3.7 ± 7.6 dyn/cm2. We found no significant difference in TAWSS magnitude between the sexes; 8.19 ± 2.25 versus 8.07 ± 1.71 dyn/cm2, p = 0.16 for men and women, respectively.
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Affiliation(s)
- Elizabeth Iffrig
- Department of Medicine, Department of Biomedical Engineering, School of Medicine, Emory University, 101 Woodruff Circle, Atlanta, GA 30322; Georgia Institute of Technology, Emory University, 101 Woodruff Circle, Atlanta, GA 30322
| | - Lucas H. Timmins
- Department of Biomedical Engineering, Scientific Computing and Imaging Institute, University of Utah, 36 S. Wasatch Drive SMBB, Rm. 3100, Salt Lake City, UT 84112
| | - Retta El Sayed
- Department of Biomedical Engineering, School of Medicine, Emory University, 1364 Clifton Road, Atlanta, GA 30322; Georgia Institute of Technology, 1364 Clifton Road, Atlanta, GA 30322
| | - W. Robert Taylor
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 101 Woodruff Cir, Atlanta, GA 30322; Department of Biomedical Engineering, Emory University School of Medicine, 101 Woodruff Cir, Atlanta, GA 30322; Cardiology Division, Georgia Institute of Technology, Atlanta Veterans Affairs Medical Center, Atlanta, GA 30322
| | - John N. Oshinski
- Department of Radiology & Imaging Sciences, Department of Biomedical Engineering, School of Medicine, Emory University, 1364 Clifton Road, Atlanta, GA 30322; Georgia Institute of Technology, 1364 Clifton Road, Atlanta, GA 30322
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27
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Bazzi MS, Balouchzadeh R, Pavey SN, Quirk JD, Yanagisawa H, Vedula V, Wagenseil JE, Barocas VH. Experimental and Mouse-Specific Computational Models of the Fbln4 SMKO Mouse to Identify Potential Biomarkers for Ascending Thoracic Aortic Aneurysm. Cardiovasc Eng Technol 2022; 13:558-572. [PMID: 35064559 PMCID: PMC9304450 DOI: 10.1007/s13239-021-00600-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/28/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To use computational methods to explore geometric, mechanical, and fluidic biomarkers that could correlate with mouse lifespan in the Fbln4SMKO mouse. Mouse lifespan was used as a surrogate for risk of a severe cardiovascular event in cases of ascending thoracic aortic aneurysm. METHODS Image-based, mouse-specific fluid-structure-interaction models were developed for Fbln4SMKO mice (n = 10) at ages two and six months. The results of the simulations were used to quantify potential biofluidic biomarkers, complementing the geometrical biomarkers obtained directly from the images. RESULTS Comparing the different geometrical and biofluidic biomarkers to the mouse lifespan, it was found that mean oscillatory shear index (OSImin) and minimum time-averaged wall shear stress (TAWSSmin) at six months showed the largest correlation with lifespan (r2 = 0.70, 0.56), with both correlations being positive (i.e., mice with high OSImean and high TAWSSmin tended to live longer). When change between two and six months was considered, the change in TAWSSmin showed a much stronger correlation than OSImean (r2 = 0.75 vs. 0.24), and the correlation was negative (i.e., mice with increasing TAWSSmin over this period tended to live less long). CONCLUSION The results highlight potential biomarkers of ATAA outcomes that can be obtained through noninvasive imaging and computational simulations, and they illustrate the potential synergy between small-animal and computational models.
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Affiliation(s)
- Marisa S Bazzi
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Ramin Balouchzadeh
- Department of Mechanical Engineering & Materials Science, Washington University, St. Louis, MO, 63110, USA
| | - Shawn N Pavey
- Department of Mechanical Engineering & Materials Science, Washington University, St. Louis, MO, 63110, USA
| | - James D Quirk
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Hiromi Yanagisawa
- Life Science Center for Survival Dynamics, Tsukuba Advanced Research Alliance, University of Tsukuba, Tsukuba, Japan
| | - Vijay Vedula
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - Jessica E Wagenseil
- Department of Mechanical Engineering & Materials Science, Washington University, St. Louis, MO, 63110, USA
| | - Victor H Barocas
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA.
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McLennan D, Schäfer M, Barker AJ, Mitchell MB, Ing RJ, Browne LP, Ivy DD, Morgan GJ. Abnormal flow conduction through pulmonary arteries is associated with right ventricular volume and function in patients with repaired tetralogy of Fallot: does flow quality affect afterload? Eur Radiol 2022; 33:302-311. [DOI: 10.1007/s00330-022-09017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/27/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
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Kiema M, Sarin JK, Kauhanen SP, Torniainen J, Matikka H, Luoto ES, Jaakkola P, Saari P, Liimatainen T, Vanninen R, Ylä-Herttuala S, Hedman M, Laakkonen JP. Wall Shear Stress Predicts Media Degeneration and Biomechanical Changes in Thoracic Aorta. Front Physiol 2022; 13:934941. [PMID: 35874533 PMCID: PMC9301078 DOI: 10.3389/fphys.2022.934941] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives: In thoracic aortic aneurysm (TAA) of the ascending aorta (AA), AA is progressively dilating due to the weakening of the aortic wall. Predicting and preventing aortic dissections and ruptures in TAA continues to be challenging, and more accurate assessment of the AA dilatation, identification of high-risk patients, and timing of repair surgery are required. We investigated whether wall shear stress (WSS) predicts pathological and biomechanical changes in the aortic wall in TAA. Methods: The study included 12 patients with bicuspid (BAV) and 20 patients with the tricuspid aortic valve (TAV). 4D flow magnetic resonance imaging (MRI) was performed a day before aortic replacement surgery. Biomechanical and histological parameters, including assessing of wall strength, media degeneration, elastin, and cell content were analyzed from the resected AA samples. Results: WSSs were greater in the outer curves of the AA compared to the inner curves in all TAA patients. WSSs correlated with media degeneration of the aortic wall (ρ = -0.48, p < 0.01), elastin content (ρ = 0.47, p < 0.01), and aortic wall strength (ρ = -0.49, p = 0.029). Subsequently, the media of the outer curves was thinner, more rigid, and tolerated lower failure strains. Failure values were shown to correlate with smooth muscle cell (SMC) density (ρ = -0.45, p < 0.02), and indicated the more MYH10+ SMCs the lower the strength of the aortic wall structure. More macrophages were detected in patients with severe media degeneration and the areas with lower WSSs. Conclusion: The findings indicate that MRI-derived WSS predicts pathological and biomechanical changes in the aortic wall in patients with TAA and could be used for identification of high-risk patients.
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Affiliation(s)
- Miika Kiema
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jaakko K. Sarin
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - S. Petteri Kauhanen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Torniainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Hanna Matikka
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Emma-Sofia Luoto
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jaakkola
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Liimatainen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Research Unit of Medical Imaging, Physics and Technology, Oulu University Hospital, Oulu, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
- Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Johanna P. Laakkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- *Correspondence: Johanna P. Laakkonen,
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Jauhiainen S, Kiema M, Hedman M, Laakkonen JP. Large Vessel Cell Heterogeneity and Plasticity: Focus in Aortic Aneurysms. Arterioscler Thromb Vasc Biol 2022; 42:811-818. [PMID: 35587695 DOI: 10.1161/atvbaha.121.316237] [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] [Indexed: 01/08/2023]
Abstract
Smooth muscle cells and endothelial cells have a remarkable level of plasticity in vascular pathologies. In thoracic and abdominal aortic aneurysms, smooth muscle cells have been suggested to undergo phenotypic switching and to contribute to degradation of the aortic wall structure in response to, for example, inflammatory mediators, dysregulation of growth factor signaling or oxidative stress. Recently, endothelial-to-mesenchymal transition, and a clonal expansion of degradative smooth muscle cells and immune cells, as well as mesenchymal stem-like cells have been suggested to contribute to the progression of aortic aneurysms. What are the factors driving the aortic cell phenotype changes and how vascular flow, known to affect aortic wall structure and to be altered in aortic aneurysms, could affect aortic cell remodeling? In this review, we summarize the current literature on aortic cell heterogeneity and phenotypic switching in relation to changes in vascular flow and aortic wall structure in aortic aneurysms in clinical samples with special focus on smooth muscle and endothelial cells. The differences between thoracic and abdominal aortic aneurysms are discussed.
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Affiliation(s)
- Suvi Jauhiainen
- A.I. Virtanen Institute for Molecular Sciences (S.J., M.K., J.P.L.), University of Eastern Finland, Kuopio
| | - Miika Kiema
- A.I. Virtanen Institute for Molecular Sciences (S.J., M.K., J.P.L.), University of Eastern Finland, Kuopio
| | - Marja Hedman
- Institute of Clinical Medicine (M.H.), University of Eastern Finland, Kuopio
- Department of Clinical Radiology, Kuopio University Hospital, Finland (M.H.)
- Department of Heart and Thoracic Surgery, Kuopio University Hospital, Heart Center, Kuopio, Finland (M.H.)
| | - Johanna P Laakkonen
- A.I. Virtanen Institute for Molecular Sciences (S.J., M.K., J.P.L.), University of Eastern Finland, Kuopio
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Ebel S, Kühn A, Aggarwal A, Köhler B, Behrendt B, Gohmann R, Riekena B, Lücke C, Ziegert J, Vogtmann C, Preim B, Kropf S, Jung B, Denecke T, Grothoff M, Gutberlet M. Quantitative normal values of helical flow, flow jets and wall shear stress of healthy volunteers in the ascending aorta. Eur Radiol 2022; 32:8597-8607. [PMID: 35612663 DOI: 10.1007/s00330-022-08866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/08/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 4D flow MRI enables quantitative assessment of helical flow. We sought to generate normal values and elucidate changes of helical flow (duration, volume, length, velocities and rotational direction) and flow jet (displacement, flow angle) as well as wall shear stress (WSS). METHODS We assessed the temporal helical existence (THEX), maximum helical volume (HVmax), accumulated helical volume (HVacc), accumulated helical volume length (HVLacc), maximum forward velocity (maxVfor), maximum circumferential velocity (maxVcirc), rotational direction (RD) and maximum wall shear stress (WSS) as reported elsewhere using the software tool Bloodline in 86 healthy volunteers (46 females, mean age 41 ± 13 years). RESULTS WSS decreased by 42.1% and maxVfor by 55.7% across age. There was no link between age and gender regarding the other parameters. CONCLUSION This study provides age-dependent normal values regarding WSS and maxVfor and age- and gender-independent normal values regarding THEX, HVmax, HVacc, HVLacc, RD and maxVcirc. KEY POINTS • 4D flow provides numerous new parameters; therefore, normal values are mandatory. • Wall shear stress decreases over age. • Maximum helical forward velocity decreases over age.
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Affiliation(s)
- Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany.
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Alexander Kühn
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Abhinav Aggarwal
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
- Department of Radiology, Mata Chanan Devi Hospital of New Delhi, New Delhi, India
| | - Benjamin Köhler
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Benjamin Behrendt
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Robin Gohmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Boris Riekena
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Juliane Ziegert
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Charlotte Vogtmann
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Siegfried Kropf
- Department for Biometry and Medical Informatics, University of Magdeburg, Magdeburg, Germany
| | - Bernd Jung
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Bern, Switzerland
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Matthias Grothoff
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, University of Leipzig - Heart Centre, Leipzig, Germany
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Sotelo J, Franco P, Guala A, Dux-Santoy L, Ruiz-Muñoz A, Evangelista A, Mella H, Mura J, Hurtado DE, Rodríguez-Palomares JF, Uribe S. Fully Three-Dimensional Hemodynamic Characterization of Altered Blood Flow in Bicuspid Aortic Valve Patients With Respect to Aortic Dilatation: A Finite Element Approach. Front Cardiovasc Med 2022; 9:885338. [PMID: 35665243 PMCID: PMC9157575 DOI: 10.3389/fcvm.2022.885338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposePrognostic models based on cardiovascular hemodynamic parameters may bring new information for an early assessment of patients with bicuspid aortic valve (BAV), playing a key role in reducing the long-term risk of cardiovascular events. This work quantifies several three-dimensional hemodynamic parameters in different patients with BAV and ranks their relationships with aortic diameter.Materials and MethodsUsing 4D-flow CMR data of 74 patients with BAV (49 right-left and 25 right-non-coronary) and 48 healthy volunteers, aortic 3D maps of seventeen 17 different hemodynamic parameters were quantified along the thoracic aorta. Patients with BAV were divided into two morphotype categories, BAV-Non-AAoD (where we include 18 non-dilated patients and 7 root-dilated patients) and BAV-AAoD (where we include the 49 patients with dilatation of the ascending aorta). Differences between volunteers and patients were evaluated using MANOVA with Pillai's trace statistic, Mann–Whitney U test, ROC curves, and minimum redundancy maximum relevance algorithm. Spearman's correlation was used to correlate the dilation with each hemodynamic parameter.ResultsThe flow eccentricity, backward velocity, velocity angle, regurgitation fraction, circumferential wall shear stress, axial vorticity, and axial circulation allowed to discriminate between volunteers and patients with BAV, even in the absence of dilation. In patients with BAV, the diameter presented a strong correlation (> |+/−0.7|) with the forward velocity and velocity angle, and a good correlation (> |+/−0.5|) with regurgitation fraction, wall shear stress, wall shear stress axial, and vorticity, also for morphotypes and phenotypes, some of them are correlated with the diameter. The velocity angle proved to be an excellent biomarker in the differentiation between volunteers and patients with BAV, BAV morphotypes, and BAV phenotypes, with an area under the curve bigger than 0.90, and higher predictor important scores.ConclusionsThrough the application of a novel 3D quantification method, hemodynamic parameters related to flow direction, such as flow eccentricity, velocity angle, and regurgitation fraction, presented the best relationships with a local diameter and effectively differentiated patients with BAV from healthy volunteers.
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Affiliation(s)
- Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
| | - Pamela Franco
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Hernan Mella
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Electrical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Mura
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Mechanical Engineering, Universidad Técnica Federico Santa María, Santiago, Chile
| | - Daniel E. Hurtado
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Department of Structural and Geotechnical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José F. Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- *Correspondence: Sergio Uribe
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Almeida GDC, Gomes BADA, Azevedo FSD, Kalaun K, Ibanez I, Teixeira PS, Gottlieb I, Melo MM, Oliveira GMMD, Nieckele AO. Fluidodinâmica Computacional na Avaliação do Risco Futuro de Aneurismas de Aorta Ascendente. Arq Bras Cardiol 2022; 118:448-460. [PMID: 35262580 PMCID: PMC8856676 DOI: 10.36660/abc.20200926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.
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Geeraert P, Jamalidinan F, Burns F, Jarvis K, Bristow MS, Lydell C, Hidalgo Tobon SS, de Celis Alonso B, Fedak PWM, White JA, Garcia J. Hemodynamic Assessment in Bicuspid Aortic Valve Disease and Aortic Dilation: New Insights From Voxel-By-Voxel Analysis of Reverse Flow, Stasis, and Energetics. Front Bioeng Biotechnol 2022; 9:725113. [PMID: 35096784 PMCID: PMC8793887 DOI: 10.3389/fbioe.2021.725113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/27/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Clinical management decisions surrounding ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) disease benefit from personalized predictive tools. 4D-flow MRI may provide patient-specific markers reflective of BAV-associated aortopathy. This study aims to explore novel 4D-flow MRI parametric voxel-by-voxel forward flow, reverse flow, kinetic energy and stasis in BAV disease. We hypothesize that novel parametric voxel-by-voxel markers will be associated with aortic dilation and referral for surgery and can enhance our understanding of BAV hemodynamics beyond standard metrics. Methods: A total of 96 subjects (73 BAV patients, 23 healthy controls) underwent MRI scan. Healthy controls had no known cardiovascular disease. Patients were clinically referred for AAo dilation assessment. Indexed diameters were obtained by dividing the aortic diameter by the patient’s body surface area. Patients were followed for the occurrence of aortic surgery. 4D-flow analysis was performed by a single observer in five regions: left ventricular outflow tract (LVOT), AAo, arch, proximal descending aorta (PDAo), and distal descending aorta (DDAo). In each region peak velocity, kinetic energy (KE), forward flow (FF), reverse flow (RF), and stasis were measured on a voxel-by-voxel basis. T-tests (or non-parametric equivalent) compared flow parameters between cohorts. Univariate and multivariate analyses explored associations between diameter and parametric voxel-by-voxel parameters. Results: Compared to controls, BAV patients showed reduced stasis (p < 0.01) and increased RF and FF (p < 0.01) throughout the aorta, and KE remained similar. In the AAo, indexed diameter correlated with age (R = 0.326, p = 0.01), FF (R = −0.648, p < 0.001), RF (R = −0.441, p < 0.001), and stasis (R = −0.288, p < 0.05). In multivariate analysis, FF showed a significant inverse association with AAo indexed diameter, independent of age. During a median 179 ± 180 days of follow-up, 23 patients (32%) required aortic surgery. Compared to patients not requiring surgery, they showed increased KE and peak velocity in the proximal aorta (p < 0.01), accompanied by increased RF and reduced stasis throughout the entire aorta (p < 0.01). Conclusion: Novel voxel-by-voxel reverse flow and stasis were altered in BAV patients and are associated with aortic dilation and surgical treatment.
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Affiliation(s)
- Patrick Geeraert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fatemehsadat Jamalidinan
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fiona Burns
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Michael S. Bristow
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Carmen Lydell
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Benito de Celis Alonso
- Faculty of Mathematical and Physical Sciences, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
| | - Paul W. M. Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - James A. White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Julio Garcia,
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Desai L, Stefek H, Berhane H, Robinson J, Rigsby C, Markl M. Four-Dimensional flow Magnetic Resonance Imaging for Assessment of Pediatric Coarctation of the Aorta. J Magn Reson Imaging 2022; 55:200-208. [PMID: 34173693 PMCID: PMC9084555 DOI: 10.1002/jmri.27802] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Coarctation of the aorta (CoA) typically requires repair, but re-interventions and vascular complications occur, particularly with associated defects like bicuspid aortic valve (BAV). Magnetic resonance imaging (MRI) may identify anatomic and hemodynamic factors contributing to clinical complications. PURPOSE To investigate 4D flow MRI characteristics in pediatric CoA to determine parameters for long-term clinical surveillance. STUDY TYPE Retrospective. POPULATION CoA (n = 21), CoA with BAV (n = 24), BAV alone (n = 29), and healthy control (n = 25). FIELD STRENGTH/SEQUENCE A 1.5 T, 3D CE IR FLASH MRA, 4D flow MRI using 3D time resolved PC-MRI with velocity encoding. ASSESSMENT Thoracic aorta diameters were measured from 3D CE-MRA. Peak systolic velocities and wall shear stress were calculated and flow patterns were visualized throughout the thoracic aorta using 4D flow. Repair characteristics, re-interventions, and need for anti-hypertensive medications were recorded. STATISTICS Descriptive statistics, ANOVA with post hoc t-testing and Bonferroni correction, Kruskal-Wallis H, intraclass correlation coefficient, Fleiss' kappa. RESULTS Patients with CoA with or without repair had smaller transverse arch diameters compared to BAV alone and control cohorts (P < 0.05), higher peak systolic flow velocities and wall shear stress compared to controls in the transverse arch and descending aorta (P < 0.05), and flow derangements in the descending aorta. The most common CoA repairs were extended end-to-end anastomosis (n = 22/45, 48.9%, age at repair 1 ± 2 years, seven re-interventions) and stent/interposition graft placement (n = 10/45, 22.2%, age at repair 12 ± 3 years, one re-intervention). Anti-hypertensive medications were prescribed to 33.3% (n = 15/45) of CoA and 34.4% of BAV alone patients (n = 10/29). DATA CONCLUSIONS Despite repair, CoA alters hemodynamics and flow patterns in the transverse arch and descending aorta. These findings may contribute to vascular remodeling and secondary complications. 4D flow MRI may be valuable in risk stratification, treatment selection and postintervention assessment. Long-term, prospective studies are warranted to correlate patient and MRI factors with clinical outcomes. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lajja Desai
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | | | - Haben Berhane
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Joshua Robinson
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA,Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
| | - Cynthia Rigsby
- Ann and Robert H. Lurie Children’s Hospital of
Chicago, Chicago, Illinois, USA
| | - Michael Markl
- Northwestern University Feinberg School of Medicine,
Chicago, Illinois, USA
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Prisco AR, Aguado-Sierra J, Butakoff C, Vazquez M, Houzeaux G, Eguzkitza B, Bartos JA, Yannopoulos D, Raveendran G, Holm M, Iles T, Mahr C, Iaizzo PA. Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO. J Cardiovasc Transl Res 2022; 15:217-226. [PMID: 33624260 PMCID: PMC7901681 DOI: 10.1007/s12265-021-10110-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022]
Abstract
Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for acute cardiogenic shock in patients who also have acute lung injury predisposes development of a serious complication called "north-south syndrome" (NSS) which causes cerebral hypoxia. NSS is poorly characterized and hemodynamic studies have focused on cerebral perfusion ignoring the heart. We hypothesized in NSS the heart would be more likely to receive hypoxemic blood than the brain due to the proximity of the coronary arteries to the aortic annulus. To test this, we conducted a computational fluid dynamics simulation of blood flow in a human supported by VA-ECMO. Simulations quantified the fraction of blood at each aortic branching vessel originating from residual native cardiac output versus VA-ECMO. As residual cardiac function was increased, simulations demonstrated myocardial hypoxia would develop prior to cerebral hypoxia. These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia. Illustration of the impact of north-south syndrome on organ-specific oxygen delivery. Patients on VA-ECMO have two sources of blood flow, one from the VA-ECMO circuit and one from the residual cardiac function. When there is no residual cardiac function, all organs are perfused with oxygenated blood. As myocardial recovery progresses, blood supply from the two sources will begin to mix resulting in non-homogeneous mixing and differential oxygenation based upon the anatomical site of branching vessels.
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Affiliation(s)
- Anthony R Prisco
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Jazmin Aguado-Sierra
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | | | - Mariano Vazquez
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Beatriz Eguzkitza
- Barcelona Supercomputing Center - Centro Nacional de Supercomputación, Barcelona, Spain
| | - Jason A Bartos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Demetris Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Ganesh Raveendran
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Mikayle Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Tinen Iles
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Paul A Iaizzo
- Department of Surgery, Visible Heart® Laboratories, University of Minnesota Medical School, B172 Mayo, MMC 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
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Moravia A, Simoëns S, El Hajem M, Bou-Saïd B, Kulisa P, Della-Schiava N, Lermusiaux P. In vitro flow study in a compliant abdominal aorta phantom with a non-Newtonian blood-mimicking fluid. J Biomech 2021; 130:110899. [PMID: 34923186 DOI: 10.1016/j.jbiomech.2021.110899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
In vitro aortic flow simulators allow studying hemodynamics with a wider range of flow visualization techniques compared to in vivo medical imaging and without the limitations of invasive examinations. This work aims to develop an experimental bench to emulate the pulsatile circulation in a realistic aortic phantom. To mimic the blood shear thinning behavior, a non-Newtonian aqueous solution is prepared with glycerin and xanthan gum polymer. The flow is compared to a reference flow of Newtonian fluid. Particle image velocimetry is carried out to visualize 2D velocity fields in a phantom section. The experimental loop accurately recreates flowrates and pressure conditions and preserves the shear-thinning properties of the non-Newtonian fluid. Velocity profiles, shear rate, and shear stress distribution maps show that the Newtonian fluid tends to dampen the observed velocities. Preferential asymmetrical flow paths are observed in a diameter narrowing region and amplified in the non-Newtonian case. Wall shear stresses are about twice higher in the non-Newtonian case. This study shows new insights on flow patterns, velocity and shear stress distributions compared to rigid and simplified geometry aorta phantom with Newtonian fluid flows studies. The use of a non-Newtonian blood analog shows clear differences in flows compared to the Newtonian one in this compliant patient-specific geometry. The development of this aortic simulator is a promising tool to better analyze and understand aortic hemodynamics and to aid in clinical decision-making.
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Affiliation(s)
- Anaïs Moravia
- Université de Lyon, INSA de Lyon, Ecole Centrale de Lyon, Université Claude Bernard Lyon 1, CNRS, LMFA UMR 5509, Villeurbanne, France.
| | - Serge Simoëns
- Université de Lyon, INSA de Lyon, Ecole Centrale de Lyon, Université Claude Bernard Lyon 1, CNRS, LMFA UMR 5509, Villeurbanne, France
| | - Mahmoud El Hajem
- Université de Lyon, INSA de Lyon, Ecole Centrale de Lyon, Université Claude Bernard Lyon 1, CNRS, LMFA UMR 5509, Villeurbanne, France
| | - Benyebka Bou-Saïd
- Université de Lyon, CNRS, INSA de Lyon, LaMCoS UMR5259, Villeurbanne, France
| | - Pascale Kulisa
- Université de Lyon, INSA de Lyon, Ecole Centrale de Lyon, Université Claude Bernard Lyon 1, CNRS, LMFA UMR 5509, Villeurbanne, France
| | | | - Patrick Lermusiaux
- Vascular and Endovascular Department, Hospices Civils de Lyon, Lyon, France
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McClarty D, Ouzounian M, Tang M, Eliathamby D, Romero D, Nguyen E, Simmons CA, Amon C, Chung JCY. Ascending aortic aneurysm haemodynamics are associated with aortic wall biomechanical properties. Eur J Cardiothorac Surg 2021; 61:367-375. [PMID: 34718497 DOI: 10.1093/ejcts/ezab471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effect of aortic haemodynamics on arterial wall properties in ascending thoracic aortic aneurysms (ATAAs) is not well understood. We aim to delineate the relationship between shear forces along the aortic wall and loco-regional biomechanical properties associated with the risk of aortic dissection. METHODS Five patients with ATAA underwent preoperative magnetic resonance angiogram and four-dimensional magnetic resonance imaging. From these scans, haemodynamic models were constructed to estimate maximum wall shear stress (WSS), maximum time-averaged WSS, average oscillating shear index and average relative residence time. Fourteen resected aortic samples from these patients underwent bi-axial tensile testing to determine energy loss (ΔUL) and elastic modulus (E10) in the longitudinal (ΔULlong, E10long) and circumferential (ΔULcirc, E10circ) directions and the anisotropic index (AI) for each parameter. Nine resected aortic samples underwent peel testing to determine the delamination strength (Sd). Haemodynamic indices were then correlated to the biomechanical properties. RESULTS A positive correlation was found between maximum WSS and ΔULlong rs=0.75, P = 0.002 and AIΔUL (rs=0.68, P=0.01). Increasing maximum time-averaged WSS was found to be associated with increasing ΔULlong (rs=0.73, P = 0.003) and AIΔUL (rs=0.62, P=0.02). Average oscillating shear index positively correlated with Sd (rs=0.73,P=0.04). No significant relationship was found between any haemodynamic index and E10, or between relative residence time and any biomechanical property. CONCLUSIONS Shear forces at the wall of ATAAs are associated with local degradation of arterial wall viscoelastic hysteresis (ΔUL) and delamination strength, a surrogate for aortic dissection. Haemodynamic indices may provide insights into aortic wall integrity, ultimately leading to novel metrics for assessing risks associated with ATAAs.
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Affiliation(s)
- Davis McClarty
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mingyi Tang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Daniella Eliathamby
- Department of Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - David Romero
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Elsie Nguyen
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Craig A Simmons
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.,Department of Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Cristina Amon
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.,Department of Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jennifer Chia-Ying Chung
- Division of Cardiovascular Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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Takahashi K, Sekine T, Ando T, Ishii Y, Kumita S. Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence. Magn Reson Med Sci 2021; 21:327-339. [PMID: 34497166 DOI: 10.2463/mrms.rev.2021-0046] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite the recent technical developments, surgery on the thoracic aorta remains challenging and is associated with significant mortality and morbidity. Decisions about when and if to operate are based on a balance between surgical risk and the hazard of aortic rupture. These decisions are sometimes difficult in elective cases of thoracic aortic diseases, including aneurysms and dissections. Abnormal wall stress derived from flow alterations influences disease progression. Therefore, a better understanding of the complex hemodynamic environment inside the aortic lumen will facilitate patient-specific risk assessments of complications, which enable clinicians to provide timely prophylactic interventions. Time-resolved 3D phase-contrast (4D flow) MRI has many advantages for the in vivo assessment of flow dynamics. Recent developments in 4D flow imaging techniques has led to significant advances in our understanding of physiological flow dynamics in healthy subjects and patients with thoracic aortic diseases. In this clinically focused review of thoracic aortic diseases, we demonstrate the clinical advances acquired with 4D flow MRI from published studies. We provide a systematic overview of key evidences and considerations regarding normal thoracic aortas, thoracic aortic aneurysms, aortic dissections, and thoracic aortas with prosthetic graft replacement.
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Affiliation(s)
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School
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Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg 2021; 11:4193-4210. [PMID: 34476199 DOI: 10.21037/qims-20-1234] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) four-dimensional (4D) flow is a type of phase-contrast (PC) MRI that uses blood flow encoded in 3 directions, which is resolved relative to 3 spatial and temporal dimensions of cardiac circulation. It can be used to simultaneously quantify and visualize hemodynamics or morphology disorders. 4D flow MRI is more comprehensive and accurate than two-dimensional (2D) PC MRI and echocardiography. 4D flow MRI provides numerous hemodynamic parameters that are not limited to the basic 2D parameters, including wall shear stress (WSS), pulse wave velocity (PWV), kinetic energy, turbulent kinetic energy (TKE), pressure gradient, and flow component analysis. 4D flow MRI is widely used to image many parts of the body, such as the neck, brain, and liver, and has a wide application spectrum to cardiac diseases and large vessels. This present review aims to summarize the hemodynamic parameters of 4D flow MRI technology and generalize their usefulness in clinical practice in relation to the cardiovascular system. In addition, we note the improvements that have been made to 4D flow MRI with the application of new technologies. The application of new technologies can improve the speed of 4D flow, which would benefit clinical applications.
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Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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41
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Gomes VC, Silvestre GC, Queiroz A, Marques MA, Leão PP, da Silva ES. Biomechanical Analysis of Cadaveric Thoracic Aorta Zones: The Isthmus is the Weakest Region. Ann Vasc Surg 2021; 77:263-273. [PMID: 34411677 DOI: 10.1016/j.avsg.2021.06.004] [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: 02/22/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The thoracic aorta is a site of multiple pathological processes, such as aneurysms and dissections. When considering the development of endovascular devices, this vessel has been extensively manipulated because of aortic diseases, as well as to serve as a route for procedures involving the head and neck vessels. Therefore, the aim of the present study was to obtain biomechanical experimental information about the strength and deformability of this vessel. MATERIALS AND METHODS Thirty-one thoracic aorta specimens were harvested during the autopsy procedure. They were carefully dissected and transversally sectioned according to Criado's aortic arch map landing zones (0 to 4). The supra-aortic trunks were removed, and the aortic rings were opened in their convexity, which resulted in flat tissue segments. Four millimeter-wide strips were prepared from each zone after which they were attached to a clip system connected to the INSTRON SPEC 2200 device, which was responsible for pulling the fragment up to its rupture during the uniaxial tension test. The INSPEC software was used to coordinate the test, and data management was conducted via the SERIES IX software. The biomechanical variables that were measured included failure stress, failure tension, and failure strain. RESULTS When comparing the five segments from all 31 aortas, three different strength levels were observed. Zones 0 and 1 exhibited the highest failure stress and failure tension values, followed by Zones 2 and 4. Zone 3 (aortic isthmus) was the weakest segment that was tested when compared to the stress and tension of Zones 0 and 1 (P < 0.001), the stress and tension of Zone 2 (P = 0.005 and P = 0.002, respectively) and the stress and tension of Zone 4 (P = 0.023 and P = 0.006, respectively). Among donors > 65 years-old, women presented significantly weaker descending aortas than men in regards to stress (P = 0.049) and tension (P = 0.014). Among male donors, the elderly donors presented significantly stiffer aortic walls and weaker ascending (P = 0.029 for stress) and descending (P = 0.004 for stress; P = 0.031 for tension) aortas than younger men. CONCLUSIONS Uniaxial tensile strength tests revealed that the thoracic aorta is a very heterogeneous vessel. Isthmus frailty may add to the understanding of the pathophysiology of some aortic diseases that commonly compromise this region. The lower strength that was verifiedin some aortic segments from elderly donors may contribute to the genesis of some thoracic aorta diseases among that group of donors. These data can contribute to the development of new endovascular devices that are specifically designed for this vessel.
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Affiliation(s)
- Vivian Carla Gomes
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil.
| | - Gina Camillo Silvestre
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Queiroz
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Michele Alberto Marques
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Pedro Puech Leão
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
| | - Erasmo Simão da Silva
- Department of Surgery, Division of Vascular and Endovascular Surgery, Laboratory of Medical Investigation, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Sao Paulo, Brazil
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Ramaekers MJFG, Adriaans BP, Juffermans JF, van Assen HC, Bekkers SCAM, Scholte AJHA, Kenjeres S, Lamb HJ, Wildberger JE, Westenberg JJM, Schalla S. Characterization of Ascending Aortic Flow in Patients With Degenerative Aneurysms: A 4D Flow Magnetic Resonance Study. Invest Radiol 2021; 56:494-500. [PMID: 33653992 DOI: 10.1097/rli.0000000000000768] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Degenerative thoracic aortic aneurysm (TAA) patients are known to be at risk of life-threatening acute aortic events. Guidelines recommend preemptive surgery at diameters of greater than 55 mm, although many patients with small aneurysms show only mild growth rates and more than half of complications occur in aneurysms below this threshold. Thus, assessment of hemodynamics using 4-dimensional flow magnetic resonance has been of interest to obtain more insights in aneurysm development. Nonetheless, the role of aberrant flow patterns in TAA patients is not yet fully understood. MATERIALS AND METHODS A total of 25 TAA patients and 22 controls underwent time-resolved 3-dimensional phase contrast magnetic resonance imaging with 3-directional velocity encoding (ie, 4-dimensional flow magnetic resonance imaging). Hemodynamic parameters such as vorticity, helicity, and wall shear stress (WSS) were calculated from velocity data in 3 anatomical segments of the ascending aorta (root, proximal, and distal). Regional WSS distribution was assessed for the full cardiac cycle. RESULTS Flow vorticity and helicity were significantly lower for TAA patients in all segments. The proximal ascending aorta showed a significant increase in peak WSS in the outer curvature in TAA patients, whereas WSS values at the inner curvature were significantly lower as compared with controls. Furthermore, positive WSS gradients from sinotubular junction to midascending aorta were most prominent in the outer curvature, whereas from midascending aorta to brachiocephalic trunk, the outer curvature showed negative WSS gradients in the TAA group. Controls solely showed a positive gradient at the inner curvature for both segments. CONCLUSIONS Degenerative TAA patients show a decrease in flow vorticity and helicity, which is likely to cause perturbations in physiological flow patterns. The subsequent differing distribution of WSS might be a contributor to vessel wall remodeling and aneurysm formation.
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Affiliation(s)
| | | | | | | | | | | | - Sasa Kenjeres
- Department of Chemical Engineering, Transport Phenomena Section, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center
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Truedsson F, Polte CL, Gao SA, Johnsson ÅA, Bech-Hanssen O, Lagerstrand KM. Importance of complex blood flow in the assessment of aortic regurgitation severity using phase contrast magnetic resonance imaging. Int J Cardiovasc Imaging 2021; 37:3561-3572. [PMID: 34273066 PMCID: PMC8604828 DOI: 10.1007/s10554-021-02341-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate if and how complex flow influences the assessment of aortic regurgitation (AR) using phase contrast MRI in patients with chronic AR. Patients with moderate (n = 15) and severe (n = 28) chronic AR were categorized into non-complex flow (NCF) or complex flow (CF) based on the presence of systolic backward flow volume. Phase contrast MRI was performed repeatedly at the level of the sinotubular junction (Ao1) and 1 cm distal to the sinotubular junction (Ao2). All AR patients were assessed to have non-severe AR or severe AR (cut-off values: regurgitation volume (RVol) ≥ 60 ml and regurgitation fraction (RF) ≥ 50%) in both measurement positions. The repeatability was significantly lower, i.e. variation was larger, for patients with CF than for NCF (≥ 12 ± 12% versus ≥ 6 ± 4%, P ≤ 0.03). For patients with CF, the repeatability was significantly lower at Ao2 compared to Ao1 (≥ 21 ± 20% versus ≥ 12 ± 12%, P ≤ 0.02), as well as the assessment of regurgitation (RVol: 42 ± 34 ml versus 54 ± 42 ml, P < 0.001; RF: 30 ± 18% versus 34 ± 16%, P = 0.01). This was not the case for patients with NCF. The frequency of patients that changed in AR grade from severe to non-severe when the position of the measurement changed from Ao1 to Ao2 was higher for patients with CF compared to NCF (RVol: 5/26 (19%) versus 1/17 (6%), P = 0.2; RF: 4/26 (15%) versus 0/17 (0%), P = 0.09). Our study shows that complex flow influences the quantification of chronic AR, which can lead to underestimation of AR severity when using PC-MRI.
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Affiliation(s)
- Frida Truedsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden. .,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden. .,Sahlgrenska University Hospital, MR-Centre, Bruna stråket 13, 413 45, Gothenburg, Sweden.
| | - Christian L Polte
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Cardiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Sinsia A Gao
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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Paddock S, Tsampasian V, Assadi H, Mota BC, Swift AJ, Chowdhary A, Swoboda P, Levelt E, Sammut E, Dastidar A, Broncano Cabrero J, Del Val JR, Malcolm P, Sun J, Ryding A, Sawh C, Greenwood R, Hewson D, Vassiliou V, Garg P. Clinical Translation of Three-Dimensional Scar, Diffusion Tensor Imaging, Four-Dimensional Flow, and Quantitative Perfusion in Cardiac MRI: A Comprehensive Review. Front Cardiovasc Med 2021; 8:682027. [PMID: 34307496 PMCID: PMC8292630 DOI: 10.3389/fcvm.2021.682027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging is a versatile tool that has established itself as the reference method for functional assessment and tissue characterisation. CMR helps to diagnose, monitor disease course and sub-phenotype disease states. Several emerging CMR methods have the potential to offer a personalised medicine approach to treatment. CMR tissue characterisation is used to assess myocardial oedema, inflammation or thrombus in various disease conditions. CMR derived scar maps have the potential to inform ablation therapy—both in atrial and ventricular arrhythmias. Quantitative CMR is pushing boundaries with motion corrections in tissue characterisation and first-pass perfusion. Advanced tissue characterisation by imaging the myocardial fibre orientation using diffusion tensor imaging (DTI), has also demonstrated novel insights in patients with cardiomyopathies. Enhanced flow assessment using four-dimensional flow (4D flow) CMR, where time is the fourth dimension, allows quantification of transvalvular flow to a high degree of accuracy for all four-valves within the same cardiac cycle. This review discusses these emerging methods and others in detail and gives the reader a foresight of how CMR will evolve into a powerful clinical tool in offering a precision medicine approach to treatment, diagnosis, and detection of disease.
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Affiliation(s)
- Sophie Paddock
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasiliki Tsampasian
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hosamadin Assadi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Bruno Calife Mota
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Amrit Chowdhary
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter Swoboda
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eylem Levelt
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Eva Sammut
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Amardeep Dastidar
- Bristol Heart Institute and Translational Biomedical Research Centre, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Jordi Broncano Cabrero
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Javier Royuela Del Val
- Cardiothoracic Imaging Unit, Hospital San Juan De Dios, Ressalta, HT Medica, Córdoba, Spain
| | - Paul Malcolm
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Julia Sun
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Richard Greenwood
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - David Hewson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios Vassiliou
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Pankaj Garg
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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Combining 4D Flow MRI and Complex Networks Theory to Characterize the Hemodynamic Heterogeneity in Dilated and Non-dilated Human Ascending Aortas. Ann Biomed Eng 2021; 49:2441-2453. [PMID: 34080100 PMCID: PMC8455395 DOI: 10.1007/s10439-021-02798-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
Motivated by the evidence that the onset and progression of the aneurysm of the ascending aorta (AAo) is intertwined with an adverse hemodynamic environment, the present study characterized in vivo the hemodynamic spatiotemporal complexity and organization in human aortas, with and without dilated AAo, exploring the relations with clinically relevant hemodynamic and geometric parameters. The Complex Networks (CNs) theory was applied for the first time to 4D flow magnetic resonance imaging (MRI) velocity data of ten patients, five of them presenting with AAo dilation. The time-histories along the cardiac cycle of velocity-based quantities were used to build correlation-based CNs. The CNs approach succeeded in capturing large-scale coherent flow features, delimiting flow separation and recirculation regions. CNs metrics highlighted that an increasing AAo dilation (expressed in terms of the ratio between the maximum AAo and aortic root diameter) disrupts the correlation in forward flow reducing the correlation persistence length, while preserving the spatiotemporal homogeneity of secondary flows. The application of CNs to in vivo 4D MRI data holds promise for a mechanistic understanding of the spatiotemporal complexity and organization of aortic flows, opening possibilities for the integration of in vivo quantitative hemodynamic information into risk stratification and classification criteria.
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Son AY, DeMarais NM, Malaisrie SC, Lomasney JW, Pradella M, Wilsbacher LD, Allen BA, Markl M, Avery R. Complete Regional Absence of Vasa Vasorum in an Ascending Aortic Aneurysm. Circ Cardiovasc Imaging 2021; 14:e012312. [PMID: 34044576 DOI: 10.1161/circimaging.120.012312] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Andre Y Son
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute (A.Y.S., S.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nicole M DeMarais
- Chicago Medical School, Rosalind Franklin University, Chicago, IL (N.M.D.)
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute (A.Y.S., S.C.M.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jon W Lomasney
- Department of Pathology (J.W.L.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maurice Pradella
- Department of Radiology (M.P., B.A.A., M.M., R.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL.,Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland (M.P.)
| | - Lisa D Wilsbacher
- Division of Cardiology, Department of Medicine (L.D.W.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bradley A Allen
- Department of Radiology (M.P., B.A.A., M.M., R.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Markl
- Department of Radiology (M.P., B.A.A., M.M., R.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ryan Avery
- Department of Radiology (M.P., B.A.A., M.M., R.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL
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47
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Wang Y, Gharahi H, Grobbel MR, Rao A, Roccabianca S, Baek S. Potential damage in pulmonary arterial hypertension: An experimental study of pressure-induced damage of pulmonary artery. J Biomed Mater Res A 2021; 109:579-589. [PMID: 32589778 DOI: 10.1002/jbm.a.37042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
Pulmonary arterial hypertension (PAH) is associated with elevated pulmonary arterial pressure. PAH prognosis remains poor with a 15% mortality rate within 1 year, even with modern clinical management. Previous clinical studies proposed wall shear stress (WSS) to be an important hemodynamic factor affecting cell mechanotransduction, growth and remodeling, and disease progress in PAH. However, WSS in vivo is typically at most 2.5 Pa and a doubt has been cast whether WSS alone can drive disease progress. Furthermore, our current understanding of PAH pathology largely comes from small animals' studies in which caliber enlargement, a hallmark of PAH in humans, is rarely reported. Therefore, a large-animal experiment on pulmonary arteries (PAs) is needed to validate whether increased pressure can induce enlargement of PAs caliber. In this study, we use an inflation testing device to characterize the mechanical behavior, both nonlinear elastic behavior and irreversible damage of porcine arteries. The parameters of elastic behavior are estimated from the inflation test at a low-pressure range before and after over-pressurization. Then, histological images are qualitatively examined for medial and adventitial layers. This study sheds light on the relevance of pressure-induced damage mechanism in human PAH.
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Affiliation(s)
- Yuheng Wang
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Hamidreza Gharahi
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Marissa R Grobbel
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Akshay Rao
- Department of Mechanical Engineering, Texas A&M University, College Station, Texas, USA
| | - Sara Roccabianca
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, East Lansing, Michigan, USA
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Suwa K, Akita K, Iguchi K, Ushio T, Maekawa Y. Hemodynamic change in patients with hypertrophic obstructive cardiomyopathy before and after alcohol septal ablation using 4D flow magnetic resonance imaging: a retrospective observational study. BMC Cardiovasc Disord 2021; 21:198. [PMID: 33879058 PMCID: PMC8059221 DOI: 10.1186/s12872-021-02003-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background The hemodynamics in the left ventricle (LV) and the ascending aorta (AAO) before and after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) is elucidated. Our objective was to evaluate the pattern changes in AAO and intra-LV flow assessed by four-dimensional (4D) flow magnetic resonance imaging (MRI) before and after ASA and to clarify the association between 4D flow MRI-derived hemodynamic characteristics and the peak pressure gradient (PPG) in patients with drug-refractory HOCM. Methods In this retrospective observational study, 11 patients with HOCM underwent 4D flow MRI before and a week after ASA. The 4D flow MRI included blood flow visualization and quantification using streamline images. The combined score of vortex and helix in AAO was analyzed. The duration and phase count of the AAO vortex or helix flow and the size of the intra-LV anterior vortex were quantified. The correlation between the changes in hemodynamics and the resting PPG at LV outflow tract was also analyzed. We used the paired t-test for the comparison between before and after ASA and the Pearson’s correlation coefficient for the analysis. Results The combined score for the incidence of vortex and/or helix flow in AAO after ASA was significantly lower than that before ASA (1.45 ± 0.52 vs. 1.09 ± 0.30, p = 0.046). The duration (744 ± 291 ms vs. 467 ± 258 ms, p < 0.001) and phase count (14.8 ± 4.4 phases vs. 10.5 ± 5.8 phases, p < 0.001) of the vortex or helix flow in AAO were significantly decreased after ASA. The LV anterior vortex area after ASA was significantly larger than that before ASA (1628 ± 420 mm2 vs. 2974 ± 539 mm2, p = 0.009). The delta phase count of the AAO vortex or helix before and a week after ASA was significantly correlated with delta PPG before and a week after ASA (R = 0.79, p = 0.004) and with delta PPG before and 6 months after ASA (R = 0.83, p = 0.002). Conclusions Lower vortex or helix flow in AAO and larger diastolic vortex flow in LV were observed after ASA, which suggests the possibility to detect the changes of aberrant hemodynamics in HOCM. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02003-8.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan.
| | - Keitaro Akita
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Keisuke Iguchi
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Takasuke Ushio
- Department of Radiology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine 3, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, 431-3192, Hamamatsu, Japan
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Shokina N, Teschner G, Bauer A, Tropea C, Egger H, Hennig J, Krafft AJ. Parametric Sequential Method for MRI-Based Wall Shear Stress Quantification. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:1105-1112. [PMID: 33347405 DOI: 10.1109/tmi.2020.3046331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Wall shear stress (WSS) has been suggested as a potential biomarker in various cardiovascular diseases and it can be estimated from phase-contrast Magnetic Resonance Imaging (PC-MRI) velocity measurements. We present a parametric sequential method for MRI-based WSS quantification consisting of a geometry identification and a subsequent approximation of the velocity field. This work focuses on its validation, investigating well controlled high-resolution in vitro measurements of turbulent stationary flows and physiological pulsatile flows in phantoms. Initial tests for in vivo 2D PC-MRI data of the ascending aorta of three volunteers demonstrate basic applicability of the method to in vivo.
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Cave DGW, Panayiotou H, Bissell MM. Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease-A Systematic Review of the Literature. Front Cardiovasc Med 2021; 8:629227. [PMID: 33842561 PMCID: PMC8024488 DOI: 10.3389/fcvm.2021.629227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Bicuspid aortic valve (BAV) disease presents a unique management challenge both pre- and post-operatively. 4D flow MRI offers multiple tools for the assessment of the thoracic aorta in aortic valve disease. In particular, its assessment of flow patterns and wall shear stress have led to new understandings around the mechanisms of aneurysm development in BAV disease. Novel parameters have now been developed that have the potential to predict pathological aortic dilatation and may help to risk stratify BAV patients in future. This systematic review analyses the current 4D flow MRI literature after aortic valve and/or ascending aortic replacement in bicuspid aortic valve disease. 4D flow MRI has also identified distinct challenges posed by this cohort at the time of valve replacement compared to standard management of tri-leaflet disorders, and may help tailor the type and timing of replacement. Eccentric pathological flow patterns seen after bioprosthetic valve implantation, but not with mechanical prostheses, might be an important future consideration in intervention planning. 4D flow MRI also has promising potential in supporting the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.
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Affiliation(s)
- Daniel G W Cave
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Hannah Panayiotou
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
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