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Silva Ferreira MV, Soares CSP, Araujo-Filho JDAB, Dantas RN, Torres RVA, Morais TC, Avila LFR, Ishikawa W, Nomura CH, Rajiah PS, Parga Filho J. Mitral Annular Disease at Cardiac MRI: What to Know and Look For. Radiographics 2024; 44:e230156. [PMID: 38870043 DOI: 10.1148/rg.230156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Accurate evaluation of the mitral valve (MV) apparatus is essential for understanding the mechanisms of MV disease across various clinical scenarios. The mitral annulus (MA) is a complex and crucial structure that supports MV function; however, conventional imaging techniques have limitations in fully capturing the entirety of the MA. Moreover, recognizing annular changes might aid in identifying patients who may benefit from advanced cardiac imaging and interventions. Multimodality cardiovascular imaging plays a major role in the diagnosis, prognosis, and management of MV disease. Transthoracic echocardiography is the first-line modality for evaluation of the MA, but it has limitations. Cardiac MRI (CMR) has emerged as a robust imaging modality for assessing annular changes, with distinct advantages over other imaging techniques, including accurate flow and volumetric quantification and assessment of variations in the measurements and shape of the MA during the cardiac cycle. Mitral annular disjunction (MAD) is defined as atrial displacement of the hinge point of the MV annulus away from the ventricular myocardium, a condition that is now more frequently diagnosed and studied owing to recent technical advances in cardiac imaging. However, several unresolved issues regarding MAD, such as the functional significance of pathologic disjunction and how this disjunction advances in the clinical course, require further investigation. The authors review the role of CMR in the assessment of MA disease, with a focus on MAD and its functional implications in MV prolapse and mitral regurgitation. ©RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Stojanovska and Fujikura in this issue.
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Affiliation(s)
- Marcus Vinicius Silva Ferreira
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Clarice Santos Parreira Soares
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose de Arimateia Batista Araujo-Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Nery Dantas
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Roberto Vitor Almeida Torres
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Thamara Carvalho Morais
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Luis Francisco Rodrigues Avila
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Walther Ishikawa
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Cesar Higa Nomura
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
| | - Jose Parga Filho
- From the Department of Radiology, Hospital Sirio-Libanes, Rua Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil (M.V.S.F., C.S.P.S., J.dA.B.A.F., R.N.D., R.V.A.T., T.C.M., L.F.R.A., C.H.N., J.P.F.); Department of Radiology, Hospital Israelita Albert Einstein, Sao Paulo, SP 05652-900, Brazil (W.I.); and Department of Radiology, Mayo Clinic, Rochester, MN 55905 (P.S.R.)
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Ait Ali L, Martini N, Listo E, Valenti E, Sotelo J, Salvadori S, Passino C, Monteleone A, Stagnaro N, Trocchio G, Marrone C, Raimondi F, Catapano G, Festa P. Impact of 4D-Flow CMR Parameters on Functional Evaluation of Fontan Circulation. Pediatr Cardiol 2024; 45:998-1006. [PMID: 38519622 PMCID: PMC11056328 DOI: 10.1007/s00246-024-03446-4] [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: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Abstract
We sought to evaluate the potential clinical role of 4D-flow cardiac magnetic resonance (CMR)-derived energetics and flow parameters in a cohort of patients' post-Fontan palliation. In patients with Fontan circulation who underwent 4D-Flow CMR, streamlines distribution was evaluated, as well a 4D-flow CMR-derived energetics parameters as kinetic energy (KE) and energy loss (EL) normalized by volume. EL/KE index as a marker of flow efficiency was also calculated. Cardiopulmonary exercise test (CPET) was also performed in a subgroup of patients. The population study included 55 patients (mean age 22 ± 11 years). The analysis of the streamlines revealed a preferential distribution of the right superior vena cava flow for the right pulmonary artery (62.5 ± 35.4%) and a mild preferential flow for the left pulmonary artery (52.3 ± 40.6%) of the inferior vena cave-pulmonary arteries (IVC-PA) conduit. Patients with heart failure (HF) presented lower IVC/PA-conduit flow (0.75 ± 0.5 vs 1.3 ± 0.5 l/min/m2, p = 0.004) and a higher mean flow-jet angle of the IVC-PA conduit (39.2 ± 22.8 vs 15.2 ± 8.9, p < 0.001) than the remaining patients. EL/KE index correlates inversely with VO2/kg/min: R: - 0.45, p = 0.01 peak, minute ventilation (VE) R: - 0.466, p < 0.01, maximal voluntary ventilation: R:0.44, p = 0.001 and positively with the physiological dead space to the tidal volume ratio (VD/VT) peak: R: 0.58, p < 0.01. From our data, lower blood flow in IVC/PA conduit and eccentric flow was associated with HF whereas higher EL/KE index was associated with reduced functional capacity and impaired lung function. Larger studies are needed to confirm our results and to further improve the prognostic role of the 4D-Flow CMR in this challenging population.
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Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy.
- Gabriele Monasterio Foundation, Pisa, Massa, Italy.
| | | | - Elisa Listo
- Azienda Ospedaliera ASL, 3-Ospedale Villascassi, Genoa, Italy
| | - Elisa Valenti
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy
| | - Julio Sotelo
- Departamento de Informática, Universidad Técnica Federico Santa María, Santiago, Chile
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy
| | | | | | | | - Gianluca Trocchio
- ASST Ospedale Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo BG, Bergamo, Italy
| | | | - Francesca Raimondi
- ASST Ospedale Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo BG, Bergamo, Italy.
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Lamy J, Gonzales RA, Xiang J, Seemann F, Huber S, Steele J, Wieben O, Heiberg E, Peters DC. Tricuspid valve flow measurement using a deep learning framework for automated valve-tracking 2D phase contrast. Magn Reson Med 2024. [PMID: 38817154 DOI: 10.1002/mrm.30163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Tricuspid valve flow velocities are challenging to measure with cardiovascular MR, as the rapidly moving valvular plane prohibits direct flow evaluation, but they are vitally important to diastolic function evaluation. We developed an automated valve-tracking 2D method for measuring flow through the dynamic tricuspid valve. METHODS Nine healthy subjects and 2 patients were imaged. The approach uses a previously trained deep learning network, TVnet, to automatically track the tricuspid valve plane from long-axis cine images. Subsequently, the tracking information is used to acquire 2D phase contrast (PC) with a dynamic (moving) acquisition plane that tracks the valve. Direct diastolic net flows evaluated from the dynamic PC sequence were compared with flows from 2D-PC scans acquired in a static slice localized at the end-systolic valve position, and also ventricular stroke volumes (SVs) using both planimetry and 2D PC of the great vessels. RESULTS The mean tricuspid valve systolic excursion was 17.8 ± 2.5 mm. The 2D valve-tracking PC net diastolic flow showed excellent correlation with SV by right-ventricle planimetry (bias ± 1.96 SD = -0.2 ± 10.4 mL, intraclass correlation coefficient [ICC] = 0.92) and aortic PC (-1.0 ± 13.8 mL, ICC = 0.87). In comparison, static tricuspid valve 2D PC also showed a strong correlation but had greater bias (p = 0.01) versus the right-ventricle SV (10.6 ± 16.1 mL, ICC = 0.61). In most (8 of 9) healthy subjects, trace regurgitation was measured at begin-systole. In one patient, valve-tracking PC displayed a high-velocity jet (380 cm/s) with maximal velocity agreeing with echocardiography. CONCLUSION Automated valve-tracking 2D PC is a feasible route toward evaluation of tricuspid regurgitant velocities, potentially solving a major clinical challenge.
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Affiliation(s)
- Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Ricardo A Gonzales
- Oxford Center for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jie Xiang
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Jeremy Steele
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Einar Heiberg
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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Faragli A, Hüllebrand M, Berendsen AJ, Solà LT, Lo Muzio FP, Götze C, Tanacli R, Doeblin P, Stehning C, Schnackenburg B, Van der Vosse FN, Nagel E, Post H, Hennemuth A, Alogna A, Kelle S. Pulmonary 4D-flow MRI imaging in landrace pigs under rest and stress. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03132-9. [PMID: 38819601 DOI: 10.1007/s10554-024-03132-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
4D-flow MRI is a promising technique for assessing vessel hemodynamics. However, its utilization is currently limited by the lack of reference values, particularly for pulmonary vessels. In this work, we have analysed flow and velocity in the pulmonary trunk (PT), left and right pulmonary arteries (LPA and RPA, respectively) in Landrace pigs at both rest and stress through the software MEVISFlow. Nine healthy Landrace pigs were acutely instrumented closed-chest and transported to the CMR facility for evaluation. After rest measurements, dobutamine was administered to achieve a 25% increase in heart rate compared to rest. 4D-flow MRI images have been analysed through MEVISFlow by two independent observers. Inter- and intra-observer reproducibility was quantified using intraclass correlation coefficient. A significant difference between rest and stress regarding flow and velocity in all the pulmonary vessels was observed. Mean flow increased 55% in PT, 75% in LPA and 40% in RPA. Mean peak velocity increased 55% in PT, 75% in LPA and 66% in RPA. A good-to-excellent reproducibility was observed in rest and stress for flow measurements in all three arteries. An excellent reproducibility for velocity was found in PT at rest and stress, a good one for LPA and RPA at rest, while poor reproducibility was found at stress. The current study showed that pulmonary flow and velocity assessed through 4D-flow MRI follow the physiological alterations during cardiac cycle and after stress induced by dobutamine. A clinical translation to assess pulmonary diseases with 4D-flow MRI under stress conditions needs investigation.
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Affiliation(s)
- A Faragli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - M Hüllebrand
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany
| | - A J Berendsen
- Department of Biomedical Engineering, Cardiovascular Biomechanics Group, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - F P Lo Muzio
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - C Götze
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - R Tanacli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - P Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - C Stehning
- Clinical Science, Philips Healthcare, Hamburg, Germany
| | | | | | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - H Post
- Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | - A Hennemuth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité (DHZC), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Berlin, Germany
| | - A Alogna
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany.
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Fandaros M, Kwok C, Wolf Z, Labropoulos N, Yin W. Patient-Specific Numerical Simulations of Coronary Artery Hemodynamics and Biomechanics: A Pathway to Clinical Use. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00731-4. [PMID: 38710896 DOI: 10.1007/s13239-024-00731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Numerical models that simulate the behaviors of the coronary arteries have been greatly improved by the addition of fluid-structure interaction (FSI) methods. Although computationally demanding, FSI models account for the movement of the arterial wall and more adequately describe the biomechanical conditions at and within the arterial wall. This offers greater physiological relevance over Computational Fluid Dynamics (CFD) models, which assume the walls do not move or deform. Numerical simulations of patient-specific cases have been greatly bolstered by the use of imaging modalities such as Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRI), Optical Coherence Tomography (OCT), and Intravascular Ultrasound (IVUS) to reconstruct accurate 2D and 3D representations of artery geometries. The goal of this study was to conduct a comprehensive review on CFD and FSI models on coronary arteries, and evaluate their translational potential. METHODS This paper reviewed recent work on patient-specific numerical simulations of coronary arteries that describe the biomechanical conditions associated with atherosclerosis using CFD and FSI models. Imaging modality for geometry collection and clinical applications were also discussed. RESULTS Numerical models using CFD and FSI approaches are commonly used to study biomechanics within the vasculature. At high temporal and spatial resolution (compared to most cardiac imaging modalities), these numerical models can generate large amount of biomechanics data. CONCLUSIONS Physiologically relevant FSI models can more accurately describe atherosclerosis pathogenesis, and help to translate biomechanical assessment to clinical evaluation.
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Affiliation(s)
- Marina Fandaros
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Chloe Kwok
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Zachary Wolf
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook Medicine, 11794, Stony Brook, NY, USA
| | - Wei Yin
- Department of Biomedical Engineering, Stony Brook University, Bioengineering Building, Room 109, 11794, Stony Brook, NY, USA.
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Kiljander T, Kauhanen P, Sillanmäki S, Lottonen-Raikaslehto L, Husso M, Ylä-Herttuala E, Saari P, Kokkonen J, Laukkanen J, Mustonen P, Hedman M. Repaired coarctation of the aorta does not affect four-dimensional flow metrics in bicuspid aortic valve disease. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae086. [PMID: 38704861 PMCID: PMC11101282 DOI: 10.1093/icvts/ivae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES The objective of this study was primarily to compare four-dimensional flow magnetic resonance imaging metrics in the ascending aorta (AA) of patients with right-left fusion type bicuspid aortic valve (RL-BAV) and repaired coarctation of the aorta (CoA) to RL-BAV without CoA. Metrics of patients with RL-BAV were also compared to the matched group of patients with common tricuspid aortic valve (TAV). METHODS Eleven patients with RL-BAV and CoA, 11 patients with RL-BAV without CoA and 22 controls with TAV were investigated. Peak velocity (cm/s), peak flow (ml/s) and flow displacement (%) were analysed at 5 pre-defined AA levels. In addition, regional wall shear stress (WSS, mN/m2), circumferential WSS (WSSc) and axial WSS (WSSa) at all levels were quantified in 6 sectors of the aortic circle. Averaged WSS values on each level (WSSavg, WSSc, avg and WSSa, avg) were calculated as well. RESULTS Peak velocity at the proximal tubular AA was significantly lower in BAV and CoA group (P = 0.047) compared to BAV without CoA. In addition, the WSSa, avg was found to be higher for the BAV and CoA group at proximal AA respectively (P = 0.040). No other significant differences were found between these groups. BAV group's peak velocity was higher at every level (P < 0.001-0.004) compared to TAV group. Flow displacement was significantly higher for the BAV group at every level (P < 0.001) besides at the most distal level. All averaged WSS values were significantly higher in BAV patients in distal AA (P < 0.001-0.018). CONCLUSIONS Repaired CoA does not relevantly alter four-dimensional flow metrics in the AA of patients with RL-BAV. However, RL-BAV majorly alters flow dynamics in the AA when compared to patients with TAV. CLINICAL TRIAL REGISTRATION NUMBER https://www.clinicaltrials.gov/study/NCT05065996, Unique Protocol ID 5063566.
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Affiliation(s)
- Teemu Kiljander
- Department of Cardiology, Tampere University Hospital, Heart Hospital NOVA, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Petteri Kauhanen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Saara Sillanmäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Minna Husso
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Elias Ylä-Herttuala
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Petri Saari
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Jorma Kokkonen
- Department of Cardiology, Tampere University Hospital, Heart Hospital NOVA, Jyväskylä, Finland
| | - Jari Laukkanen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Pirjo Mustonen
- Department of Cardiology, , Heart Center, Turku University Hospital, Turku, Finland
| | - Marja Hedman
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Cardiology, , Heart Center, Kuopio University Hospital, Kuopio, Finland
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7
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Degenhardt K, Schmidt S, Aigner CS, Kratzer FJ, Seiter DP, Mueller M, Kolbitsch C, Nagel AM, Wieben O, Schaeffter T, Schulz-Menger J, Schmitter S. Toward accurate and fast velocity quantification with 3D ultrashort TE phase-contrast imaging. Magn Reson Med 2024; 91:1994-2009. [PMID: 38174601 DOI: 10.1002/mrm.29978] [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: 08/11/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Traditional phase-contrast MRI is affected by displacement artifacts caused by non-synchronized spatial- and velocity-encoding time points. The resulting inaccurate velocity maps can affect the accuracy of derived hemodynamic parameters. This study proposes and characterizes a 3D radial phase-contrast UTE (PC-UTE) sequence to reduce displacement artifacts. Furthermore, it investigates the displacement of a standard Cartesian flow sequence by utilizing a displacement-free synchronized-single-point-imaging MR sequence (SYNC-SPI) that requires clinically prohibitively long acquisition times. METHODS 3D flow data was acquired at 3T at three different constant flow rates and varying spatial resolutions in a stenotic aorta phantom using the proposed PC-UTE, a Cartesian flow sequence, and a SYNC-SPI sequence as reference. Expected displacement artifacts were calculated from gradient timing waveforms and compared to displacement values measured in the in vitro flow experiments. RESULTS The PC-UTE sequence reduces displacement and intravoxel dephasing, leading to decreased geometric distortions and signal cancellations in magnitude images, and more spatially accurate velocity quantification compared to the Cartesian flow acquisitions; errors increase with velocity and higher spatial resolution. CONCLUSION PC-UTE MRI can measure velocity vector fields with greater accuracy than Cartesian acquisitions (although pulsatile fields were not studied) and shorter scan times than SYNC-SPI. As such, this approach is superior to traditional Cartesian 3D and 4D flow MRI when spatial misrepresentations cannot be tolerated, for example, when computational fluid dynamics simulations are compared to or combined with in vitro or in vivo measurements, or regional parameters such as wall shear stress are of interest.
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Affiliation(s)
- Katja Degenhardt
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Simon Schmidt
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph S Aigner
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Fabian J Kratzer
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel P Seiter
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Max Mueller
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
| | - Armin M Nagel
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
- School of Imaging Science and Biomedical Engineering, King's College London, London, United Kingdom
- Department of Medical Engineering, Technical University of Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Berlin, Germany
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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8
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Loke YH, Yildiran IN, Capuano F, Balaras E, Olivieri L. Tetralogy of Fallot regurgitation energetics and kinetics: an intracardiac flow analysis of the right ventricle using computational fluid dynamics. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1135-1147. [PMID: 38668927 DOI: 10.1007/s10554-024-03084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/11/2024] [Indexed: 06/05/2024]
Abstract
Repaired Tetralogy of Fallot (rTOF) patients suffer from pulmonary regurgitation and may require pulmonary valve replacement (PVR). Cardiac magnetic resonance imaging (cMRI) guides therapy, but conventional measurements do not quantify the intracardiac flow effects from pulmonary regurgitation or PVR. This study investigates intracardiac flow parameters of the right ventricle (RV) of rTOF by computational fluid dynamics (CFD). cMRI of rTOF patients and controls were retrospectively included. Feature-tracking captured RV endocardial contours from long-axis/short-axis cine. Ventricular motion was reconstructed via diffeomorphic mapping, serving as domain boundary for CFD simulations. Vorticity (1/s), viscous energy loss (ELoss, mJ/L) and turbulent kinetic energy (TKE, mJ/L) were quantified in RV outflow tract (RVOT) and RV inflow. These parameters were normalized against total RV kinetic energy (KE) and RV inflow vorticity to derive dimensionless metrics. Vorticity contours by Q-criterion were qualitatively compared. rTOF patients (n = 15) had mean regurgitant fraction 38 ± 12% and RV size 162 ± 35 mL/m2. Compared to controls (n = 12), rTOF had increased RVOT vorticity (142.6 ± 75.6/s vs. 40.4 ± 11.8/s, p < 0.0001), Eloss (55.6 ± 42.5 vs. 5.2 ± 4.4 mJ/L, p = 0.0004), and TKE (5.7 ± 5.9 vs. 0.84 ± 0.46 mJ/L, p = 0.0003). After PVR, there was decrease in normalized RVOT Eloss/TKE (p = 0.0009, p = 0.029) and increase in normalized tricuspid inflow vorticity/KE (p = 0.0136, p = 0.043), corresponding to reorganization of the "donut"-shaped tricuspid ring-vortex. The intracardiac flow in rTOF patients can be simulated to determine the impact of PVR and improve the clinical indications guided by cardiac imaging.
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Affiliation(s)
- Yue-Hin Loke
- Department of Cardiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Ibrahim N Yildiran
- Laboratory for Computational Physics and Fluid Mechanics, Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC, USA
| | - Francesco Capuano
- Department of Fluid Mechanics, Universitat Politècnica de Catalunya . BarcelonaTech (UPC), Barcelona, Spain
| | - Elias Balaras
- Laboratory for Computational Physics and Fluid Mechanics, Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC, USA
| | - Laura Olivieri
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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9
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In de Braekt T, Aben JP, Maussen M, van den Bosch HCM, Houthuizen P, Roest AAW, van den Boogaard PJ, Lamb HJ, Westenberg JJM. Fully Automated Valve Segmentation for Blood Flow Assessment From 4D Flow MRI Including Automated Cardiac Valve Tracking and Transvalvular Velocity Mapping. J Magn Reson Imaging 2024. [PMID: 38558490 DOI: 10.1002/jmri.29370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Automated 4D flow MRI valvular flow quantification without time-consuming manual segmentation might improve workflow. PURPOSE Compare automated valve segmentation (AS) to manual (MS), and manually corrected automated segmentation (AMS), in corrected atrioventricular septum defect (c-AVSD) patients and healthy volunteers, for assessing net forward volume (NFV) and regurgitation fraction (RF). STUDY TYPE Retrospective. POPULATION 27 c-AVSD patients (median, 23 years; interquartile range, 16-31 years) and 24 healthy volunteers (25 years; 12.5-36.5 years). FIELD STRENGTH/SEQUENCE Whole-heart 4D flow MRI and cine steady-state free precession at 3T. ASSESSMENT After automatic valve tracking, valve annuli were segmented on time-resolved reformatted trans-valvular velocity images by AS, MS, and AMS. NFV was calculated for all valves, and RF for right and left atrioventricular valves (RAVV and LAVV). NFV variation (standard deviation divided by mean NFV) and NFV differences (NFV difference of a valve vs. mean NFV of other valves) expressed internal NFV consistency. STATISTICAL TESTS Comparisons between methods were assessed by Wilcoxon signed-rank tests, and intra/interobserver variability by intraclass correlation coefficients (ICCs). P < 0.05 was considered statistically significant, with multiple testing correction. RESULTS AMS mean analysis time was significantly shorter compared with MS (5.3 ± 1.6 minutes vs. 9.1 ± 2.5 minutes). MS NFV variation (6.0%) was significantly smaller compared with AMS (6.3%), and AS (8.2%). Median NFV difference of RAVV, LAVV, PV, and AoV between segmentation methods ranged from -0.7-1.0 mL, -0.5-2.8 mL, -1.1-3.6 mL, and - 3.1--2.1 mL, respectively. Median RAVV and LAVV RF, between 7.1%-7.5% and 3.8%-4.3%, respectively, were not significantly different between methods. Intraobserver/interobserver agreement for AMS and MS was strong-to-excellent for NFV and RF (ICC ≥0.88). DATA CONCLUSION MS demonstrates strongest internal consistency, followed closely by AMS, and AS. Automated segmentation, with or without manual correction, can be considered for 4D flow MRI valvular flow quantification. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Thomas In de Braekt
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marc Maussen
- Pie Medical Imaging BV, Maastricht, the Netherlands
| | | | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Arno A W Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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10
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Sakhi H, Soulat G, Craiem D, Gencer U, Lamy J, Stipechi V, Puscas T, Hulot JS, Hagege A, Mousseaux E. Association of Impaired Left Ventricular Mitral Filling from 4D Flow Cardiac MRI and Prognosis of Hypertrophic Cardiomyopathy. Radiol Cardiothorac Imaging 2024; 6:e230198. [PMID: 38512023 PMCID: PMC11058532 DOI: 10.1148/ryct.230198] [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: 07/20/2023] [Revised: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
Purpose To investigate whether the peak early filling rate normalized to the filling volume (PEFR/FV) estimated from four-dimensional (4D) flow cardiac MRI may be used to assess impaired left ventricular (LV) filling and predict clinical outcomes in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods Cardiac MRI with a 4D flow sequence and late gadolinium enhancement (LGE), as well as echocardiography, was performed in 88 individuals: 44 participants with HCM from a French prospective registry (ClinicalTrials.gov; NCT01091480) and 44 healthy volunteers matched for age and sex. In participants with HCM, a composite primary end point was assessed at follow-up, including unexplained syncope, new-onset atrial fibrillation, hospitalization for congestive heart failure, ischemic stroke, sustained ventricular arrhythmia, septal reduction therapy, and cardiac death. A Cox proportional hazard model was used to analyze associations with the primary end point. Results PEFR/FV was significantly lower in the HCM group (mean age, 51.8 years ± 18.5 [SD]; 29 male participants) compared with healthy volunteers (mean, 3.35 sec-1 ± 0.99 [0.90-5.20] vs 4.42 sec-1 ± 1.68 [2.74-11.86]; P < .001) and correlated with both B-type natriuretic peptide (BNP) level (r = -0.31; P < .001) and the ratio of pulsed Doppler early transmitral inflow to Doppler tissue imaging annulus velocities (E/E'; r = -0.54; P < .001). At a median follow-up of 2.3 years (IQR, 1.7-3.3 years), the primary end point occurred in 14 (32%) participants. A PEFR/FV of 2.61 sec-1 or less was significantly associated with occurrence of the primary end point (hazard ratio, 9.46 [95% CI: 2.61, 45.17; P < .001] to 15.21 [95% CI: 3.51, 80.22; P < .001]), independently of age, BNP level, E/E', LGE extent, and LV and left atrial strain according to successive bivariate models. Conclusion In HCM, LV filling evaluated with 4D flow cardiac MRI correlated with Doppler and biologic indexes of diastolic dysfunction and predicted clinical outcomes. Keywords: Diastolic Function, Left Ventricular Filling, Hypertrophic Cardiomyopathy, Cardiac MRI, 4D Flow Sequence Clinical trial registration no. NCT01091480 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Hichem Sakhi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Gilles Soulat
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Damian Craiem
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Umit Gencer
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jérôme Lamy
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Valentina Stipechi
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Tania Puscas
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Jean-Sébastien Hulot
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Albert Hagege
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
| | - Elie Mousseaux
- From the Department of Radiology, AP-HP, Hôpital
Européen Georges-Pompidou, 20-40 rue Leblanc, 75015 Paris, France (H.S.,
G.S., U.G., J.L., T.P., J.S.H., A.H., E.M.); Institut National de la
Santé et de la Recherche Médicale, PARCC, Paris, France (G.S.,
U.G., J.L., J.S.H., A.H., E.M.); Université de Paris-Cité, Paris,
France (G.S., J.S.H., A.H., E.M.); and Instituto de Medicina Traslacional,
Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET,
Buenos Aires, Argentina (D.C., V.S.)
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11
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Hamimi AH, Ghanem AM, Hannah-Shmouni F, Elgarf RM, Matta JR, Gharib AM, Abd-Elmoniem KZ. Ascending Aorta 4D Time to Peak Distention Sexual Dimorphism and Association with Coronary Plaque Burden Severity in Women. J Cardiovasc Transl Res 2024; 17:298-307. [PMID: 37556037 DOI: 10.1007/s12265-023-10422-5] [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: 01/01/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Coronary artery disease (CAD) risk and plaque scores are often subjective and biased, particularly in mid-age asymptomatic women, whose CAD risk assessment has been historically underestimated. In this study, a new automatic ascending aorta time-to-peak-distention (TPD) analysis was developed for fast screening and as an independent surrogate for subclinical atherosclerosis in asymptomatic women. CCTA was obtained in 50 asymptomatic adults. Plaque burden segment involvement score (SIS) and automatic TPD were obtained from all subjects. Logistic regression analyses were performed to investigate the association between CAD risk scores and TPD with severe coronary plaque burden (SIS>5). TPD, individually, was found to be a significant predictor of SIS>5. Additionally, sex was a significant effect modifier of TPD, with a stronger statistically significant association with women. Four-dimensional aortic time-to-peak distention could supplement conventional CCTA analysis and offer a quick objective screening tool for plaque burden severity and CAD risk stratification, especially in women.
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Affiliation(s)
- Ahmed H Hamimi
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Fady Hannah-Shmouni
- Internal Medicine, Endocrinology, and Genetics, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Reham M Elgarf
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Jatin R Matta
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
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12
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Viola F, Bustamante M, Bolger A, Engvall J, Ebbers T. Diastolic function assessment with four-dimensional flow cardiovascular magnetic resonance using automatic deep learning E/A ratio analysis. J Cardiovasc Magn Reson 2024; 26:101042. [PMID: 38556134 PMCID: PMC11058894 DOI: 10.1016/j.jocmr.2024.101042] [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: 11/14/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diastolic left ventricular (LV) dysfunction is a powerful contributor to the symptoms and prognosis of patients with heart failure. In patients with depressed LV systolic function, the E/A ratio, the ratio between the peak early (E) and the peak late (A) transmitral flow velocity, is the first step to defining the grade of diastolic dysfunction. Doppler echocardiography (echo) is the preferred imaging technique for diastolic function assessment, while cardiovascular magnetic resonance (CMR) is less established as a method. Previous four-dimensional (4D) Flow-based studies have looked at the E/A ratio proximal to the mitral valve, requiring manual interaction. In this study, we compare an automated, deep learning-based and two semi-automated approaches for 4D Flow CMR-based E/A ratio assessment to conventional, gold-standard echo-based methods. METHODS Ninety-seven subjects with chronic ischemic heart disease underwent a cardiac echo followed by CMR investigation. 4D Flow-based E/A ratio values were computed using three different approaches; two semi-automated, assessing the E/A ratio by measuring the inflow velocity (MVvel) and the inflow volume (MVflow) at the mitral valve plane, and one fully automated, creating a full LV segmentation using a deep learning-based method with which the E/A ratio could be assessed without constraint to the mitral plane (LVvel). RESULTS MVvel, MVflow, and LVvel E/A ratios were strongly associated with echocardiographically derived E/A ratio (R2 = 0.60, 0.58, 0.72). LVvel peak E and A showed moderate association to Echo peak E and A, while MVvel values were weakly associated. MVvel and MVflow EA ratios were very strongly associated with LVvel (R2 = 0.84, 0.86). MVvel peak E was moderately associated with LVvel, while peak A showed a strong association (R2 = 0.26, 0.57). CONCLUSION Peak E, peak A, and E/A ratio are integral to the assessment of diastolic dysfunction and may expand the utility of CMR studies in patients with cardiovascular disease. While underestimation of absolute peak E and A velocities was noted, the E/A ratio measured with all three 4D Flow methods was strongly associated with the gold standard Doppler echocardiography. The automatic, deep learning-based method performed best, with the most favorable runtime of ∼40 seconds. As both semi-automatic methods associated very strongly to LVvel, they could be employed as an alternative for estimation of E/A ratio.
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Affiliation(s)
- Federica Viola
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Mariana Bustamante
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; deCODE Genetics/Amgen Inc., Reykjavik, Iceland
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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13
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Aono S, Tsuneta S, Nishioka N, Aoike T, Hirayama H, Ishizaka K, Kwon J, Yoneyama M, Fujima N, Kudo K. Comparison of Echo-Planar Imaging and Compressed Sensing in the Estimation of Flow Metrics from Aortic 4D Flow MR Imaging: A Healthy Volunteer Study. Magn Reson Med Sci 2024:mp.2023-0011. [PMID: 38556273 DOI: 10.2463/mrms.mp.2023-0011] [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: 04/02/2024] Open
Abstract
PURPOSE Prolonged scanning of time-resolved 3D phase-contrast MRI (4D flow MRI) limits its routine use in clinical practice. An echo-planar imaging (EPI)-based sequence and compressed sensing can reduce the scan duration. We aimed to determine the impact of EPI for 4D flow MRI on the scan duration, image quality, and quantitative flow metrics. METHODS This was a prospective study of 15 healthy volunteers (all male, mean age 33 ± 5 years). Conventional sensitivity encoding (SENSE), EPI with SENSE (EPI), and compressed SENSE (CS) (reduction factors: 6 and 12, respectively) were scanned.Scan duration, qualitative indexes of image quality, and quantitative flow parameters of net flow volume, maximum flow velocity, wall shear stress (WSS), and energy loss (EL) in the ascending aorta were assessed. Two-dimensional phase-contrast cine MRI (2D-PC) was considered the gold standard of net flow volume and maximum flow velocity. RESULTS Compared to SENSE, EPI and CS12 shortened scan durations by 71% and 73% (EPI, 4 min 39 sec; CS6, 7 min 29 sec; CS12, 4 min 14 sec; and SENSE, 15 min 51 sec). Visual image quality was significantly better for EPI than for SENSE and CS (P < 0.001). The net flow volumes obtained with SENSE, EPI, and CS12 and those obtained with 2D-PC were correlated well (r = 0.950, 0.871, and 0.850, respectively). However, the maximum velocity obtained with EPI was significantly underestimated (P < 0.010). The average WSS was significantly higher with EPI than with SENSE, CS6, and CS12 (P < 0.001, P = 0.040, and P = 0.012, respectively). The EL was significantly lower with EPI than with CS6 and CS12 (P = 0.002 and P = 0.007, respectively). CONCLUSION EPI reduced the scan duration, improved visual image quality, and was associated with more accurate net flow volume than CS. However, the flow velocity, WSS, and EL values obtained with EPI and other sequences may not be directly comparable.
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Affiliation(s)
- Satoru Aono
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Noriko Nishioka
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Aoike
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyuki Hirayama
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kinya Ishizaka
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | | | | | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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14
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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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15
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Ebel S, Kühn A, Köhler B, Behrendt B, Riekena B, Preim B, Denecke T, Grothoff M, Gutberlet M. Quantitative 4D flow MRI-derived thoracic aortic normal values of 2D flow MRI parameters in healthy volunteers. ROFO-FORTSCHR RONTG 2024; 196:273-282. [PMID: 37944940 DOI: 10.1055/a-2175-4165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
PURPOSE To utilize 4 D flow MRI to acquire normal values of "conventional 2 D flow MRI parameters" in healthy volunteers in order to replace multiple single 2 D flow measurements with a single 4 D flow acquisition. MATERIALS AND METHODS A kt-GRAPPA accelerated 4 D flow sequence was used. Flow volumes were assessed by forward (FFV), backward (BFV), and net flow volumes (NFV) [ml/heartbeat] and flow velocities by axial (VAX) and absolute velocity (VABS) [m/s] in 116 volunteers (58 females, 43 ± 13 years). The aortic regurgitant fraction (RF) was calculated. RESULTS The sex-neutral mean FFV, BFV, NFV, and RF in the ascending aorta were 93.5 ± 14.8, 3.6 ± 2.8, 89.9 ± 0.6 ml/heartbeat, and 3.9 ± 2.9 %, respectively. Significantly higher values were seen in males regarding FFV, BFV, NFV and RF, but there was no sex dependency regarding VAX and VABS. The mean maximum VAX was lower (1.01 ± 0.31 m/s) than VABS (1.23 ± 0.35 m/s). We were able to determine normal ranges for all intended parameters. CONCLUSION This study provides quantitative 4 D flow-derived thoracic aortic normal values of 2 D flow parameters in healthy volunteers. FFV, BFV, NFV, and VAX did not differ significantly from single 2 D flow acquisitions and could therefore replace time-consuming multiple single 2 D flow acquisitions. VABS should not be used interchangeably. KEY POINTS · 4 D flow MRI can be used to replace 2 D flow MRI measurements.. · The parameter absolute velocities can be assessed by 4 D flow MRI.. · There are sex-dependent differences regarding forward, backward, net aortic blood flow and the aortic valve regurgitant fraction..
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Affiliation(s)
- Sebastian Ebel
- Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Alexander Kühn
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Benjamin Köhler
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Benjamin Behrendt
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Boris Riekena
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Bernhard Preim
- Simulation and Graphics, Otto von Guericke Universität Magdeburg, Germany
| | - Timm Denecke
- Diagnostic and Interventional Radiology, Leipzig University, Leipzig, Germany
| | - Matthias Grothoff
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Matthias Gutberlet
- Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
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16
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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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17
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Reiter C, Reiter G, Kräuter C, Scherr D, Schmidt A, Fuchsjäger M, Reiter U. Evaluation of left ventricular and left atrial volumetric function from native MR multislice 4D flow magnitude data. Eur Radiol 2024; 34:981-993. [PMID: 37580598 PMCID: PMC10853296 DOI: 10.1007/s00330-023-10017-3] [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: 05/08/2023] [Revised: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To assess the feasibility, precision, and accuracy of left ventricular (LV) and left atrial (LA) volumetric function evaluation from native magnetic resonance (MR) multislice 4D flow magnitude images. MATERIALS & METHODS In this prospective study, 60 subjects without signs or symptoms of heart failure underwent 3T native cardiac MR multislice 4D flow and bSSFP-cine realtime imaging. LV and LA volumetric function parameters were evaluated from 4D flow magnitude (4D flow-cine) and bSSFP-cine data using standard software to obtain end-diastolic volume (EDV), end-systolic volume (ESV), ejection-fraction (EF), stroke-volume (SV), LV muscle mass (LVM), LA maximum volume, LA minimum volume, and LA total ejection fraction (LATEF). Stroke volumes derived from both imaging methods were further compared to 4D pulmonary artery flow-derived net forward volumes (NFV). Methods were compared by correlation and Bland-Altman analysis. RESULTS Volumetric function parameters from 4D flow-cine and bSSFP-cine showed high to very high correlations (r = 0.83-0.98). SV, LA volumes and LATEF did not differ between methods. LV end-diastolic and end-systolic volumes were slightly underestimated (EDV: -2.9 ± 5.8 mL; ESV: -2.3 ± 3.8 mL), EF was slightly overestimated (EF: 0.9 ± 2.6%), and LV mass was considerably overestimated (LVM: 39.0 ± 11.4 g) by 4D flow-cine imaging. SVs from both methods correlated very highly with NFV (r = 0.91 in both cases) and did not differ from NFV. CONCLUSION Native multislice 4D flow magnitude data allows precise evaluation of LV and LA volumetric parameters; however, apart from SV, LV volumetric parameters demonstrate bias and need to be referred to their respective normal values. CLINICAL RELEVANCE STATEMENT Volumetric function assessment from native multislice 4D flow magnitude images can be performed with routinely used clinical software, facilitating the application of 4D flow as a one-stop-shop functional cardiac MR exam, providing consistent, simultaneously acquired, volume and flow data. KEY POINTS • Native multislice 4D flow imaging allows evaluation of volumetric left ventricular and atrial function parameters. • Left ventricular and left atrial function parameters derived from native multislice 4D flow data correlate highly with corresponding standard cine-derived parameters. • Multislice 4D flow-derived volumetric stroke volume and net forward volume do not differ.
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Affiliation(s)
- Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
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18
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Cain MT, Schäfer M, Park S, Barker AJ, Vargas D, Stenmark KR, Yu YRA, Bull TM, Ivy DD, Hoffman JRH. Characterization of pulmonary arterial stiffness using cardiac MRI. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:425-439. [PMID: 37902921 DOI: 10.1007/s10554-023-02989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
Pulmonary arterial stiffness (PAS) is a pathologic hallmark of all types of pulmonary hypertension (PH). Cardiac MRI (CMR), a gold-standard imaging modality for the evaluation of pulmonary flow, biventricular morphology and function has been historically reserved for the longitudinal clinical follow-up, PH phenotyping purposes, right ventricular evaluation, and research purposes. Over the last two decades, numerous indices combining invasive catheterization and non-invasive CMR have been utilized to phenotype the character and severity of PAS in different types of PH and to assess its clinically prognostic potential with encouraging results. Many recent studies have demonstrated a strong role of CMR derived PAS markers in predicting long-term clinical outcomes and improving currently gold standard risk assessment provided by the REVEAL calculator. With the utilization of a machine learning strategies, strong diagnostic and prognostic performance of CMR reported in multicenter studies, and ability to detect PH at early stages, the non-invasive assessment of PAS is on verge of routine clinical utilization. In this review, we focus on appraising important CMR studies interrogating PAS over the last 20 years, describing the benefits and limitations of different PAS indices, and their pathophysiologic relevance to pulmonary vascular remodeling. We also discuss the role of CMR and PAS in clinical surveillance and phenotyping of PH, and the long-term future goal to utilize PAS as a biomarker to aid with more targeted therapeutic management.
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Affiliation(s)
- Michael T Cain
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Michal Schäfer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA.
- Heart Institute, Children's Hospital Colorado, University of Colorado, Denver, USA.
| | - Sarah Park
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel Vargas
- Department of Radiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Kurt R Stenmark
- Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Yen-Rei A Yu
- Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd M Bull
- Department of Critical Care and Pulmonary Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- Heart Institute, Children's Hospital Colorado, University of Colorado, Denver, USA
| | - Jordan R H Hoffman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado - Denver | Anschutz Medical Campus, Aurora, CO, USA
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19
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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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Nallamothu T, Pradella M, Markl M, Greenland P, Passman R, Elbaz MS. Robust and fast stochastic 4D flow vector-field signature technique for quantifying composite flow dynamics from 4D flow MRI: Application to left atrial flow in atrial fibrillation. Med Image Anal 2024; 92:103065. [PMID: 38113616 DOI: 10.1016/j.media.2023.103065] [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: 04/28/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
4D flow MRI is an emerging imaging modality that maps voxel-wise blood flow information as velocity vector fields that is acquired in 7-dimensional image volumes (3 spatial dimensions + 3 velocity directions + time). Blood flow in the cardiovascular system is often complex and composite involving multiple flow dynamics and patterns (e.g., vortex flow, jets, stagnating flow) that occur and interact simultaneously. The spectrum of such complex flow dynamics is embedded in the velocity vector field dynamics derived from 4D Flow MRI. However, current flow metrics cannot fully measure high-dimensional vector-field data and embedded complex composite flow data. Instead, these methods need to break down the vector-field data into secondary scalar fields of individual flow components using fluid dynamics operators. These methods are gradient-based and sensitive to data uncertainties, and only focus on individual flow components of the overall composite flow, therefore potentially underestimating the severity of overall flow changes associated with cardiovascular diseases. To address these limitations, in MICCAI 2021, we introduced a novel comprehensive stochastic 4D Flow vector-field signature technique that works directly on the entire spatiotemporal velocity vector field. This technique uses efficient stochastic gradient-free interrogation of multi-million flow vector-pairs per patient to derive the patient's unique flow profile of the complex composite flow alterations and in real-time processing. The signature technique's probabilistic gradient-free formulation should allow for highly robust quantification despite inherent errors in 4D flow MRI acquisitions. Here, we extend the application of the 4D flow vector-field signature technique to the left atrium to analyze complex composite flow changes in patients with atrial fibrillation. In 128 subjects, we performed extensive sensitivity testing and determined that the vector-field signature technique is highly robust to typical sources of data uncertainties in 4D flow MRI: degradation in spatiotemporal resolution, added Gaussian noise, and segmentation errors. We demonstrate the excellent generalizability of the stochastic convergence from the aorta to the left atrium and between different 4D Flow MRI acquisition protocols. We compare the robustness of our technique to existing advanced flow quantification metrics of kinetic energy, vorticity, and energy loss demonstrating a superior performance of up-to 14-fold. Our results show the potential diagnostic and clinical utility of our signature technique in identifying distinctly altered composite flow signatures in atrial fibrillation patients independent of existing flow metrics.
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Affiliation(s)
- Thara Nallamothu
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Maurice Pradella
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Department of Radiology, Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | - Michael Markl
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rod Passman
- Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Mohammed Sm Elbaz
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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21
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Reiter C, Reiter G, Kräuter C, Kolesnik E, Greiser A, Scherr D, Schmidt A, Fuchsjäger M, Reiter U. Impact of the evaluation method on 4D flow-derived diastolic transmitral and myocardial peak velocities: Comparison with echocardiography. Eur J Radiol 2024; 170:111247. [PMID: 38071909 DOI: 10.1016/j.ejrad.2023.111247] [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: 06/25/2023] [Revised: 11/07/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To compare agreement of different evaluation methods of magnetic resonance (MR) 4D flow-derived diastolic transmitral and myocardial peak velocities as well as their ratios, using echocardiography as reference. METHODS In this prospective study, 60 subjects without symptoms of cardiovascular disease underwent echocardiography and non-contrast 3 T MR 4D flow imaging of the heart. Early- (E) and late-diastolic (A) transmitral peak filling velocities were evaluated from 4D flow data using three different strategies: 1) at the mitral valve tips in short-axis orientation (SA-method), 2) between the mitral valve tips in 4-chamber orientation (4-chamber-method), and 3) as maximal velocities in the transmitral inflow volume (max-velocity-method). Septal, lateral and average early-diastolic myocardial peak velocities (e') were derived from the myocardial tissue in the vicinity of the mitral valve. 4D flow parameters were compared with echocardiography by correlation and Bland-Altman analysis. RESULTS All 4D flow-derived E, A and E/A values correlated with echocardiography (r = 0.65-0.73, 0.75-0.83 and 0.74-0.86, respectively). While the SA- and 4-chamber-methods substantially underestimated E and A compared to echocardiography (p < 0.001), the max-velocity-method provided E (p = 0.13) and E/A (p = 0.07) without significant bias. Septal, lateral and average e' from 4D flow as well as the max-velocity-method-derived E/e' correlated with echocardiographic measurements (r = 0.64-0.81) and showed no significant bias (p = 0.26-0.54). CONCLUSION MR 4D flow imaging allows precise and accurate evaluation of transmitral and myocardial peak velocities for characterization of LV diastolic function without significant bias to echocardiography, when transmitral velocities are assessed from the transmitral inflow volume. This enables the use of validated echocardiography threshold values.
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Affiliation(s)
- Clemens Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Division of Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria; Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | | | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Austria.
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Keramati H, de Vecchi A, Rajani R, Niederer SA. Using Gaussian process for velocity reconstruction after coronary stenosis applicable in positron emission particle tracking: An in-silico study. PLoS One 2023; 18:e0295789. [PMID: 38096169 PMCID: PMC10721050 DOI: 10.1371/journal.pone.0295789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We investigated the influence of tracer particle quantity and detection time interval on flow reconstruction accuracy. Three models were used to represent different levels of stenosis and anatomical complexity: a narrowed straight tube, an idealized coronary bifurcation with stenosis, and patient-specific coronary arteries with a stenotic left circumflex artery. Computational fluid dynamics (CFD), particle tracking, and the Gaussian process of kriging were employed to simulate and reconstruct the pulsatile flow field. The study examined the error and uncertainty in velocity profile reconstruction after stenosis by comparing particle-derived flow velocity with the CFD solution. Using 600 particles (15 batches of 40 particles) released in the main coronary artery, the time-averaged error in velocity reconstruction ranged from 13.4% (no occlusion) to 161% (70% occlusion) in patient-specific anatomy. The error in maximum cross-sectional velocity at peak flow was consistently below 10% in all cases. PEPT and kriging tended to overestimate area-averaged velocity in higher occlusion cases but accurately predicted maximum cross-sectional velocity, particularly at peak flow. Kriging was shown to be useful to estimate the maximum velocity after the stenosis in the absence of negative near-wall velocity.
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Affiliation(s)
- Hamed Keramati
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ronak Rajani
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiology Department, Guy’s and St, Thomas’s Hospital, London, United Kingdom
| | - Steven A. Niederer
- School of Bioengineering and Imaging Sciences, King’s College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
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23
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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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24
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Oh D, Lee D, Heo J, Kweon J, Yong U, Jang J, Ahn YJ, Kim C. Contrast Agent-Free 3D Renal Ultrafast Doppler Imaging Reveals Vascular Dysfunction in Acute and Diabetic Kidney Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303966. [PMID: 37847902 PMCID: PMC10754092 DOI: 10.1002/advs.202303966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/19/2023] [Indexed: 10/19/2023]
Abstract
To combat the irreversible decline in renal function associated with kidney disease, it is essential to establish non-invasive biomarkers for assessing renal microcirculation. However, the limited resolution and/or vascular sensitivity of existing diagnostic imaging techniques hinders the visualization of complex cortical vessels. Here, a 3D renal ultrafast Doppler (UFD) imaging system that uses a high ultrasound frequency (18 MHz) and ultrahigh frame rate (1 KHz per slice) to scan the entire volume of a rat's kidney in vivo is demonstrated. The system, which can visualize the full 3D renal vascular branching pyramid at a resolution of 167 µm without any contrast agent, is used to chronically and noninvasively monitor kidneys with acute kidney injury (AKI, 3 days) and diabetic kidney disease (DKD, 8 weeks). Multiparametric UFD analyses (e.g., vessel volume occupancy (VVO), fractional moving blood volume (FMBV), vessel number density (VND), and vessel tortuosity (VT)) describe rapid vascular rarefaction from AKI and long-term vascular degeneration from DKD, while the renal pathogeneses are validated by in vitro blood serum testing and stained histopathology. This work demonstrates the potential of 3D renal UFD to offer valuable insights into assessing kidney perfusion levels for future research in diabetes and kidney transplantation.
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Affiliation(s)
- Donghyeon Oh
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Donghyun Lee
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jinseok Heo
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jooyoung Kweon
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Uijung Yong
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Jinah Jang
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Yong Joo Ahn
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
| | - Chulhong Kim
- Departments of Electrical EngineeringConvergence IT EngineeringMedical Science and EngineeringMechanical Engineeringand Medical Device Innovation CenterPohang University of Science and Technology (POSTECH)Cheongam‐ro 77, Nam‐guPohangGyeongbuk37673Republic of Korea
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25
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Schäfer M, Di Maria MV, Jaggers J, Stone ML, Campbell DN, Ivy DD, Mitchell MB. Hemi-Fontan and bidirectional Glenn operations result in flow-mediated viscous energy loss at the time of stage II palliation. JTCVS OPEN 2023; 16:836-843. [PMID: 38204687 PMCID: PMC10775100 DOI: 10.1016/j.xjon.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 01/12/2024]
Abstract
Background Superior cavopulmonary connection (SCPC) for stage II palliation of hypoplastic left heart syndrome (HLHS) is achieved most frequently by either a bidirectional Glenn (BDG) or hemi-Fontan (HF) operation. The comparison of flow hemodynamic efficiency at the region of surgical reconstruction and in proximal pulmonary arteries has been evaluated primarily using computational modeling techniques with conflicting reports. The purpose of this descriptive study was to compare flow hemodynamics following stage II (BDG vs HF) using 4-dimensional flow magnetic resonance imaging (4D-Flow MRI) with particular focus on flow-mediated viscous energy loss (EL') under matched hemodynamic conditions. Methods Patients with hypoplastic left heart syndrome (HLHS) who underwent either HF or BDG as part of stage II palliation underwent pre-Fontan 4D-Flow MRI. Patients were matched by the pulmonary vascular resistance index, net superior vena cava (SVC) flow, right pulmonary artery (RPA) and left pulmonary artery (LPA) size, and age. Maximum EL' throughout the cardiac cycle was calculated along the SVC-RPA and SVC-LPA tracts. Results Eight patients who underwent HF as part of their stage II single ventricle palliation were matched with 8 patients who underwent BDG. There were no differences between the 2 groups in median volumetric indices, including end-diastolic volume (P = .278) and end-systolic volume (P = .213). Moreover, no differences were observed in ejection fraction (P = .091) and cardiac index (P = .324). There also were no differences in peak EL' measured along the SVC-RPA tract (median, 0.05 mW for HF vs 0.04 mW for BDG; P = .365) or along the SVC-LPA tract (median, 0.05 mW vs 0.04 mW; P = .741). Conclusions The second stage of surgical palliation of HLHS using either HF or BDG results in similar flow-mediated viscous energy loss throughout the SCPC junction. 4D-Flow MRI and computational methods should be applied together to investigate flow hemodynamic patterns throughout the Fontan palliation and overall efficiency of the Fontan circuit.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - Michael V. Di Maria
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - James Jaggers
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - Matthew L. Stone
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - David N. Campbell
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - D. Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
| | - Max B. Mitchell
- Division of Cardiothoracic Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colo
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26
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Rizzo M, Ait-Ali L, Federici D, Festa P, Piagneri V, Landra F, Cameli M, Montesi G. Surgical repair of partial anomalous pulmonary venous connection in adulthood: A 4-dimensional flow magnetic resonance imaging postoperative evaluation. JTCVS Tech 2023; 22:208-211. [PMID: 38152192 PMCID: PMC10750877 DOI: 10.1016/j.xjtc.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Martina Rizzo
- Cardiac Surgery Unit, Department of Thoracic and Cardiovascular Disease, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, CNR, Monasterio Foundation, Massa, Italy
| | - Duccio Federici
- Paediatric Cardiac Surgery and GUCH Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Pierluigi Festa
- Paediatric Cardiology and GUCH Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Valeria Piagneri
- Diagnostic Imaging Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gianfranco Montesi
- Cardiac Surgery Unit, Department of Thoracic and Cardiovascular Disease, Santa Maria alle Scotte Hospital, Siena, Italy
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27
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Schäfer M, Mawad W. Advanced Imaging Technologies for Assessing Tetralogy of Fallot: Insights Into Flow Dynamics. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:380-392. [PMID: 38161669 PMCID: PMC10755841 DOI: 10.1016/j.cjcpc.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart defect requiring surgical repair. Although surgical interventions have significantly reduced mortality, postrepair complications, such as pulmonary valve regurgitation and stenosis, may lead to adverse outcomes, including right ventricular dysfunction and increased risks of morbidity and mortality. This review explores the potential of advanced imaging technologies, including 4-dimensional-flow magnetic resonance imaging and high-frame-rate echocardiography, in providing valuable insights into blood flow dynamics and energy parameters. Quantitative measures, such as energy loss and vorticity, along with qualitative flow analysis, can provide additional insights into adverse haemodynamics at a potentially earlier and more reversible stage. Furthermore, personalized patient-specific information from these imaging modalities aids in guiding treatment decisions and monitoring postoperative interventions effectively. By characterizing flow patterns, these advanced imaging techniques hold great promise in improving the assessment and management of tetralogy of Fallot, providing tailored insights. However, further research and longitudinal studies are required to fully establish their clinical utility and potential impact on patient care.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Wadi Mawad
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
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28
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Sodhi A, Markl M, Popescu AR, Griffin LM, Robinson JD, Rigsby CK. Highly accelerated compressed sensing 4D flow MRI in congenital and acquired heart disease: comparison of aorta and main pulmonary artery flow parameters with conventional 4D flow MRI in children and young adults. Pediatr Radiol 2023; 53:2597-2607. [PMID: 37882844 DOI: 10.1007/s00247-023-05788-2] [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: 02/27/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Four-dimensional flow (4D flow) MRI has become a clinically utilized cardiovascular flow assessment tool. However, scans can be lengthy and may require anesthesia in younger children. Adding compressed sensing can decrease scan time, but its impact on hemodynamic data accuracy needs additional assessment. OBJECTIVE To compare 4D flow hemodynamics acquired with and without compressed sensing. MATERIALS AND METHODS Twenty-seven patients (median age: 13 [IQR: 9.5] years) underwent conventional and compressed sensing cardiovascular 4D flow following informed consent. Conventional 4D flow was performed using parallel imaging and an acceleration factor of 2. Compressed sensing 4D flow was performed with an acceleration factor of 7.7. Regions of interest were placed to compare flow parameters in the ascending aorta and main pulmonary artery. Paired Student's t-tests, Wilcoxon signed-rank tests, Bland-Altman plots, and intraclass correlation coefficients were conducted. A P-value of < 0.05 was considered statistically significant. RESULTS Mean scan acquisition time was reduced by 59% using compressed sensing (3.4 vs. 8.2 min, P < 0.001). Flow quantification was similar for compressed sensing and conventional 4D flow for the ascending aorta net flow: 47 vs. 49 ml/beat (P = 0.28); forward flow: 49 vs. 50 ml/beat (P = 0.07), and main pulmonary artery net flow: 49 vs. 51 ml/beat (P = 0.18); forward flow: 50 vs. 55 ml/beat (P = 0.07). Peak systolic velocity was significantly underestimated by compressed sensing 4D flow in the ascending aorta: 114 vs. 128 cm/s (P < 0.001) and main pulmonary artery: 106 vs. 112 cm/s (P = 0.02). CONCLUSION For both the aorta and main pulmonary artery, compressed sensing 4D flow provided equivalent net and forward flow values compared to conventional 4D flow but underestimated peak systolic velocity. By reducing scan time, compressed sensing 4D flow may decrease the need for anesthesia and increase scanner output without significantly compromising data integrity.
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Affiliation(s)
- Aparna Sodhi
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA.
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL, USA
| | - Andrada R Popescu
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lindsay M Griffin
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua D Robinson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue #9, Chicago, IL, 60611, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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29
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Ericsson L, Hjalmarsson A, Akbar MU, Ferdian E, Bonini M, Hardy B, Schollenberger J, Aristova M, Winter P, Burris N, Fyrdahl A, Sigfridsson A, Schnell S, Figueroa CA, Nordsletten D, Young AA, Marlevi D. Generalized super-resolution 4D Flow MRI-using ensemble learning to extend across the cardiovascular system. ARXIV 2023:arXiv:2311.11819v2. [PMID: 38045482 PMCID: PMC10690302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive measurement technique capable of quantifying blood flow across the cardiovascular system. While practical use is limited by spatial resolution and image noise, incorporation of trained super-resolution (SR) networks has potential to enhance image quality post-scan. However, these efforts have predominantly been restricted to narrowly defined cardiovascular domains, with limited exploration of how SR performance extends across the cardiovascular system; a task aggravated by contrasting hemodynamic conditions apparent across the cardiovasculature. The aim of our study was to explore the generalizability of SR 4D Flow MRI using a combination of heterogeneous training sets and dedicated ensemble learning. With synthetic training data generated across three disparate domains (cardiac, aortic, cerebrovascular), varying convolutional base and ensemble learners were evaluated as a function of domain and architecture, quantifying performance on both in-silico and acquired in-vivo data from the same three domains. Results show that both bagging and stacking ensembling enhance SR performance across domains, accurately predicting high-resolution velocities from low-resolution input data in-silico. Likewise, optimized networks successfully recover native resolution velocities from downsampled in-vivo data, as well as show qualitative potential in generating denoised SR-images from clinicallevel input data. In conclusion, our work presents a viable approach for generalized SR 4D Flow MRI, with ensemble learning extending utility across various clinical areas of interest.
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Affiliation(s)
- Leon Ericsson
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Adam Hjalmarsson
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Muhammad Usman Akbar
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Edward Ferdian
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Mia Bonini
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Brandon Hardy
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Jonas Schollenberger
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Maria Aristova
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Patrick Winter
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Nicholas Burris
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Alexander Fyrdahl
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Andreas Sigfridsson
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Susanne Schnell
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - C Alberto Figueroa
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - David Nordsletten
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - Alistair A Young
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
| | - David Marlevi
- L.E., A.H., A.F., A.S., and D.M. are with Karolinska Institutet, Solna, Sweden. M.U.A. is with Linköping University, Linköping, Sweden. E.F. and A.A.Y. are with the University of Auckland, Auckland, New Zealand. M.B., B.H, N.B, C.A.F, and D.A.N. are with the University of Michigan, Ann Arbor, USA. J.S. is with the University of California San Francisco, San Francisco, CA, USA. M.A. ans S.S. are with Northwestern University, Chicago, USA. S.S. is also with the University of Greifswald, Germany. A.A.Y. is also with King's College London, London, UK. D.M. is also with Massachusetts Institute of Technology, Cambridge, USA
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Jia D, Esmaily M. A time-consistent stabilized finite element method for fluids with applications to hemodynamics. Sci Rep 2023; 13:19120. [PMID: 37926732 PMCID: PMC10625993 DOI: 10.1038/s41598-023-46316-4] [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: 04/10/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023] Open
Abstract
Several finite element methods for simulating incompressible flows rely on the streamline upwind Petrov-Galerkin stabilization (SUPG) term, which is weighted by [Formula: see text]. The conventional formulation of [Formula: see text] includes a constant that depends on the time step size, producing an overall method that becomes exceedingly less accurate as the time step size approaches zero. In practice, such method inconsistency introduces significant error in the solution, especially in cardiovascular simulations, where small time step sizes may be required to resolve multiple scales of the blood flow. To overcome this issue, we propose a consistent method that is based on a new definition of [Formula: see text]. This method, which can be easily implemented on top of an existing streamline upwind Petrov-Galerkin and pressure stabilizing Petrov-Galerkin method, involves the replacement of the time step size in [Formula: see text] with a physical time scale. This time scale is calculated in a simple operation once every time step for the entire computational domain from the ratio of the L2-norm of the acceleration and the velocity. The proposed method is compared against the conventional method using four cases: a steady pipe flow, a blood flow through vascular anatomy, an external flow over a square obstacle, and a fluid-structure interaction case involving an oscillatory flexible beam. These numerical experiments, which are performed using linear interpolation functions, show that the proposed formulation eliminates the inconsistency issue associated with the conventional formulation in all cases. While the proposed method is slightly more costly than the conventional method, it significantly reduces the error, particularly at small time step sizes. For the pipe flow where an exact solution is available, we show the conventional method can over-predict the pressure drop by a factor of three. This large error is almost completely eliminated by the proposed formulation, dropping to approximately 1% for all time step sizes and Reynolds numbers considered.
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Affiliation(s)
- Dongjie Jia
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14850, USA
| | - Mahdi Esmaily
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, 14850, USA.
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Wheen PR, Corden B, Nazir MS, Rubens MB, Semple TR, Nicol ED. Intracardiac shunt assessment using CT coronary angiography. J Cardiovasc Comput Tomogr 2023; 17:436-444. [PMID: 37865534 DOI: 10.1016/j.jcct.2023.09.005] [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: 07/14/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Detection of intracardiac shunts using CT Coronary Angiography (CTCA) is currently based on anatomical demonstration of defects. We assessed a novel technique using a standard CTCA test bolus in detecting shunts independent of anatomical assessment and to provide an estimate of Qp/Qs. METHODS We retrospectively reviewed 51 CTCAs: twenty-one from patients with known simple left to right intracardiac shunts with contemporaneous functional assessment (using CMR) within 6 months, 20 controls with structurally normal hearts, and 10 patients with shunt repairs. From the dynamic acquisition of a test bolus, we measured mean Hounsfield Units (HU) in various anatomical structures. We created time/density curves from the test bolus data, and calculated disappearance time (DT) from the ascending aorta (deriving a Qp/Qs), peak ascending aortic HU, and mean coefficient of variation of the arterial curves, and compared these with the Qp/Qs from the respective CMR. RESULTS Patients with intracardiac shunts had significantly higher test bolus derived Qp/Qs compared with both the controls, and the repaired shunt comparator group. There was a very strong agreement between the test bolus derived Qp/Qs, and Qp/Qs as measured by CMR (Intraclass correlation 0.89). Mean bias was 0.032 ± 0.341 (95% limits of agreement -0.64 to 0.70). Interobserver, and intraobserver agreement of the disappearance time was excellent (0.99, 0.99 (reader 1) and 1.00 (reader 2) respectively). CONCLUSION In this proof-of-concept study, we demonstrate a novel technique to detect, and to estimate severity of left to right intracardiac shunts on routine Cardiac CT.
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Affiliation(s)
- Peter R Wheen
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK.
| | - Ben Corden
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Muhummad Sohaib Nazir
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Michael B Rubens
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Thomas R Semple
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK
| | - Edward D Nicol
- Department of Cardiovascular CT, Royal Brompton Hospital, London, SW3 6NP, UK; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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Nath R, Kazemi A, Callahan S, Stoddard MF, Amini AA. 4Dflow-VP-Net: A deep convolutional neural network for noninvasive estimation of relative pressures in stenotic flows from 4D flow MRI. Magn Reson Med 2023; 90:2175-2189. [PMID: 37496183 PMCID: PMC10615364 DOI: 10.1002/mrm.29791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To estimate relative transvalvular pressure gradient (TVPG) noninvasively from 4D flow MRI. METHODS A novel deep learning-based approach is proposed to estimate pressure gradient across stenosis from four-dimensional flow MRI (4D flow MRI) velocities. A deep neural network 4D flow Velocity-to-Presure Network (4Dflow-VP-Net) was trained to learn the spatiotemporal relationship between velocities and pressure in stenotic vessels. Training data were simulated by computational fluid dynamics (CFD) for different pulsatile flow conditions under an aortic flow waveform. The network was tested to predict pressure from CFD-simulated velocity data, in vitro 4D flow MRI data, and in vivo 4D flow MRI data of patients with both moderate and severe aortic stenosis. TVPG derived from 4Dflow-VP-Net was compared to catheter-based pressure measurements for available flow rates, in vitro and Doppler echocardiography-based pressure measurement, in vivo. RESULTS Relative pressures calculated by 4Dflow-VP-Net and in vitro pressure catheterization revealed strong correlation (r2 = 0.91). Correlations analysis of TVPG from reference CFD and 4Dflow-VP-Net for 450 simulated flow conditions showed strong correlation (r2 = 0.99). TVPG from in vitro MRI had a correlation coefficient of r2 = 0.98 with reference CFD. 4Dflow-VP-Net, applied to 4D flow MRI in 16 patients, showed comparable TVPG measurement with Doppler echocardiography (r2 = 0.85). Bland-Altman analysis of TVPG measurements showed mean bias and limits of agreement of -0.20 ± 2.07 mmHg and 0.19 ± 0.45 mmHg for CFD-simulated velocities and in vitro 4D flow velocities. In patients, overestimation of Doppler echocardiography relative to TVPG from 4Dflow-VP-Net (10.99 ± 6.77 mmHg) was observed. CONCLUSION The proposed approach can predict relative pressure in both in vitro and in vivo 4D flow MRI of aortic stenotic patients with high fidelity.
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Affiliation(s)
- Ruponti Nath
- Medical Imaging Lab, Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Amirkhosro Kazemi
- Medical Imaging Lab, Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Sean Callahan
- Medical Imaging Lab, Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Marcus F. Stoddard
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
- Cardiovascular Division, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Amir A. Amini
- Medical Imaging Lab, Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
- Robley Rex Veterans Affairs Medical Center, Louisville, Kentucky, USA
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Abushamat LA, Enge D, Fujiwara T, Schäfer M, Clark EW, Englund EK, Scalzo RL, Johnston A, Rafferty D, Schauer IE, Whipple MO, Hunter K, Huebschmann AG, Nadeau KJ, Jarvis K, Barker AJ, Regensteiner JG, Reusch JEB. Obesity dominates early effects on cardiac structure and arterial stiffness in people with type 2 diabetes. J Hypertens 2023; 41:1775-1784. [PMID: 37589719 PMCID: PMC10592255 DOI: 10.1097/hjh.0000000000003534] [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] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Type 2 diabetes (T2D) and obesity are global epidemics leading to excess cardiovascular disease (CVD). This study investigates standard and novel cardiac MRI parameters to detect subclinical cardiac and central vascular dysfunction in inactive people with and without T2D. METHODS Physically inactive age and BMI-similar premenopausal women and men with ( n = 22) and without [ n = 34, controls with overweight/obesity (CWO)] uncomplicated T2D were compared to an age-similar and sex-similar reference control cohort ( n = 20). Left ventricular (LV) structure, function, and aortic stiffness were assessed by MRI. Global arterial pulse wave velocity (PWV) was assessed using carotid-to-femoral applanation tonometry. Regional PWV was measured via 2D phase-contrast MRI and 4D flow MRI. RESULTS Global arterial PWV did not differ between CWO and T2D. 2D PC-MRI PWV in the ascending aorta was higher in people with T2D compared with CWOs ( P < 0.01). 4D flow PWV in the thoracic aorta was higher in CWO ( P < 0.01), and T2D ( P < 0.001) compared with RC. End-diastolic volume, end-systolic volume, stroke volume, and cardiac output were lower in CWO and T2D groups compared with reference control. CONCLUSION Subclinical changes in arterial stiffening and cardiac remodeling in inactive CWO and T2D compared with reference control support obesity and/or physical inactivity as determinants of incipient CVD complications in uncomplicated T2D. Future studies should determine the mechanistic causes of the CVD complications in greater detail in order to create therapeutic targets. CLINICAL TRIAL REGISTRATION Cardiovascular Mechanisms of Exercise Intolerance in Diabetes and the Role of Sex (NCT03419195).
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Affiliation(s)
- Layla A Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Daniel Enge
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Department of Bioengineering
| | - Takashi Fujiwara
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Michal Schäfer
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
| | - Ethan W Clark
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin K Englund
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Rebecca L Scalzo
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Aspen Johnston
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | | | - Irene E Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
| | - Mary O Whipple
- Division of General Internal Medicine
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | | | - Amy G Huebschmann
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
| | - Kristen J Nadeau
- Ludeman Family Center for Women's Health Research
- Pediatric Endocrinology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Bioengineering
- Department of Radiology, Section of Pediatric Radiology, Children's Hospital Colorado
| | - Judith G Regensteiner
- Ludeman Family Center for Women's Health Research
- Division of General Internal Medicine
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus
| | - Jane E B Reusch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Ludeman Family Center for Women's Health Research
- Rocky Mountain Regional Veterans Administration Medical Center (VAMC), Aurora, Colorado
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Papapostolou S, Kearns J, Costello BT, O'Brien J, Rudman M, Thompson MC, Cloud G, Stub D, Taylor AJ. Assessing atrial myopathy with cardiac magnetic resonance imaging in embolic stroke of undetermined source. Int J Cardiol 2023; 389:131215. [PMID: 37499949 DOI: 10.1016/j.ijcard.2023.131215] [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: 03/07/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Left atrial myopathy has been implicated in atrial fibrillation (AF)-related stroke and embolic stroke of undetermined source (ESUS). OBJECTIVE To use advanced cardiac magnetic resonance (CMR) imaging techniques, including left atrial (LA) strain and 4D flow CMR, to identify atrial myopathy in patients with ESUS. METHODS 20 patients with ESUS and no AF or other cause for stroke, and 20 age and sex-matched controls underwent CMR with 4D flow analysis. Markers of LA myopathy were assessed including LA size, volume, ejection fraction, and strain. 4D flow CMR was performed to measure novel markers of LA stasis such as LA velocities and the LA residence time distribution time constant (RTDtc). These markers of LA myopathy were compared between the two groups. RESULTS There was no significant difference in: CMR-calculated LA velocities or LA total, passive or active ejection fractions between the groups. There was no significant difference in CMR-derived reservoir, conduit or contractile average longitudinal strain between the ESUS and control groups (22.9 vs 22.6%, p=0.379, 11.2 ± 3.5 vs 12.4 ± 2.6% p=0.224, 10.8 ± 3.2 vs 10.4 ± 2.3%, p=0.625 respectively). Similarly, RTDtc was not significantly longer in ESUS patients compared to controls (1.3 ± 0.2 vs 1.2 ± 0.2, p=0.1). CONCLUSIONS There were no significant differences in any CMR marker of atrial myopathy in ESUS patients compared to healthy controls, likely reflecting the multiple possible aetiologies of ESUS suggesting that the role LA myopathy plays in ESUS is smaller than previously thought.
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Affiliation(s)
- Stavroula Papapostolou
- Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John Kearns
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia
| | - Benedict T Costello
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Western Health, Melbourne, Victoria, Australia
| | - Jessica O'Brien
- Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Murray Rudman
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia
| | - Mark C Thompson
- Department of Mechanical and Aerospace Engineering, Monash University, Melbourne, Victoria, Australia
| | - Geoffrey Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew J Taylor
- Heart Centre, The Alfred Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Kim H, Wilton SB, Garcia J. Left atrium 4D-flow segmentation with high-resolution contrast-enhanced magnetic resonance angiography. Front Cardiovasc Med 2023; 10:1225922. [PMID: 37904808 PMCID: PMC10613494 DOI: 10.3389/fcvm.2023.1225922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open
Abstract
Background Atrial fibrillation (AF) leads to intracardiac thrombus and an associated risk of stroke. Phase-contrast cardiovascular magnetic resonance (CMR) with flow-encoding in all three spatial directions (4D-flow) provides a time-resolved 3D volume image with 3D blood velocity, which brings individual hemodynamic information affecting thrombus formation. As the resolution and contrast of 4D-flow are limited, we proposed a semi-automated 4D-flow segmentation method for the left atrium (LA) using a standard-of-care contrast-enhanced magnetic resonance angiography (CE-MRA) and registration technique. Methods LA of 54 patients with AF were segmented from 4D-flow taken in sinus rhythm using two segmentation methods. (1) Phase-contrast magnetic resonance angiography (PC-MRA) was calculated from 4D-flow, and LA was segmented slice-by-slice manually. (2) LA and other structures were segmented from CE-MRA and transformed into 4D-flow coordinates by registration with the mutual information method. Overlap of volume was tested by the Dice similarity coefficient (DSC) and the average symmetric surface distance (ASSD). Mean velocity and stasis were calculated to compare the functional property of LA from two segmentation methods. Results LA volumes from segmentation on CE-MRA were strongly correlated with PC-MRA volume, although mean CE-MRA volumes were about 10% larger. The proposed registration scheme resulted in visually successful registration in 76% of cases after two rounds of registration. The mean of DSC of the registered cases was 0.770 ± 0.045, and the mean of ASSD was 2.704 mm ± 0.668 mm. Mean velocity had no significant difference between the two segmentation methods, and mean stasis had a 3.3% difference. Conclusion The proposed CE-MRA segmentation and registration method can generate segmentation for 4D-flow images. This method will facilitate 4D-flow analysis for AF patients by making segmentation easier and overcoming the limit of resolution.
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Affiliation(s)
- Hansuk Kim
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen B. Wilton
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Julio Garcia
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Cain MT, Schäfer M, Ross LK, Ivy DD, Mitchell MB, Fenster BE, Bull TM, Barker AJ, Vargas D, Hoffman JRH. 4D-Flow MRI intracardiac flow analysis considering different subtypes of pulmonary hypertension. Pulm Circ 2023; 13:e12307. [PMID: 37941938 PMCID: PMC10628368 DOI: 10.1002/pul2.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 11/10/2023] Open
Abstract
Intracardiac flow hemodynamic patterns have been considered to be an early sign of diastolic dysfunction. In this study we investigated right ventricular (RV) diastolic dysfunction between patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension with chronic lung disease (PH-CLD) via 4D-Flow cardiac MRI (CMR). Patients underwent prospective, comprehensive CMR for function and size including 4D-Flow CMR protocol for intracardiac flow visualization and analysis. RV early filling phase and peak atrial phase vorticity (E-vorticity and A-vorticity) values were calculated in all patients. Patients further underwent comprehensive Doppler and tissue Doppler evaluation for the RV diastolic dysfunction. In total 13 patients with PAH, 15 patients with PH-CLD, and 10 control subjects underwent the 4D-Flow CMR and echocardiography evaluation for RV diastolic dysfunction. Reduced E-vorticity differentiated PAH and PH-CLD from healthy controls (both p < 0.01) despite the same Doppler E values. E-vorticity was further decreased in PAH patients when compared to PH-CLD group (p < 0.05) with similar Doppler and tissue Doppler markers of diastolic dysfunction. A-vorticity was decreased in both PAH and PH-CLD groups compared to controls but with no difference between the disease groups. E-vorticity correlated with ejection fraction (R = 0.60, p < 0.001), end-systolic volume (R = 0.50, p = 0.001), stroke volume (R = 0.42, p = 0.007), and cardiac output (R = 0.30, p = 0.027). Intracardiac flow analysis using 4D-Flow CMR derived vorticity is a sensitive method to differentiate diastolic dysfunction in patients with different PH etiology and similar Doppler echocardiography profile.
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Affiliation(s)
- Michael T. Cain
- Division of Cardiothoracic Surgery, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Michal Schäfer
- Division of Cardiothoracic Surgery, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Lexie K. Ross
- Division of Pediatric Cardiology, Children's Hospital Colorado, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - David D. Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Max B. Mitchell
- Division of Pediatric Cardiology, Children's Hospital Colorado, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Brett E. Fenster
- Division of CardiologyColorado Kaiser Permanente Medical GroupDenverColoradoUSA
| | - Todd M. Bull
- Department of Critical Care and Pulmonary Medicine, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Alex J. Barker
- Department of Radiology, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Daniel Vargas
- Department of Radiology, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
| | - Jordan R. H. Hoffman
- Division of Cardiothoracic Surgery, Anschutz Medical CampusUniversity of Colorado DenverAuroraColoradoUSA
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Safarkhanlo Y, Jung B, Bernhard B, Peper ES, Kwong RY, Bastiaansen JAM, Gräni C. Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications. Int J Cardiovasc Imaging 2023; 39:1963-1977. [PMID: 37322317 PMCID: PMC10589148 DOI: 10.1007/s10554-023-02893-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
Cardiac magnetic resonance (CMR) four-dimensional (4D) flow is a novel method for flow quantification potentially helpful in management of mitral valve regurgitation (MVR). In this systematic review, we aimed to depict the clinical role of intraventricular 4D-flow in MVR. The reproducibility, technical aspects, and comparison against conventional techniques were evaluated. Published studies on SCOPUS, MEDLINE, and EMBASE were included using search terms on 4D-flow CMR in MVR. Out of 420 screened articles, 18 studies fulfilled our inclusion criteria. All studies (n = 18, 100%) assessed MVR using 4D-flow intraventricular annular inflow (4D-flowAIM) method, which calculates the regurgitation by subtracting the aortic forward flow from the mitral forward flow. Thereof, 4D-flow jet quantification (4D-flowjet) was assessed in 5 (28%), standard 2D phase-contrast (2D-PC) flow imaging in 8 (44%) and the volumetric method (the deviation of left ventricle stroke volume and right ventricular stroke volume) in 2 (11%) studies. Inter-method correlations among the 4 MVR quantification methods were heterogeneous across studies, ranging from moderate to excellent correlations. Two studies compared 4D-flowAIM to echocardiography with moderate correlation. In 12 (63%) studies the reproducibility of 4D-flow techniques in quantifying MVR was studied. Thereof, 9 (75%) studies investigated the reproducibility of the 4D-flowAIM method and the majority (n = 7, 78%) reported good to excellent intra- and inter-reader reproducibility. Intraventricular 4D-flowAIM provides high reproducibility with heterogeneous correlations to conventional quantification methods. Due to the absence of a gold standard and unknown accuracies, future longitudinal outcome studies are needed to assess the clinical value of 4D-flow in the clinical setting of MVR.
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Affiliation(s)
- Yasaman Safarkhanlo
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Bernd Jung
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Eva S Peper
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica A M Bastiaansen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
- Translation Imaging Center (TIC), Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
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Fukushima K, Ito H, Takeishi Y. Comprehensive assessment of molecular function, tissue characterization, and hemodynamic performance by non-invasive hybrid imaging: Potential role of cardiac PETMR. J Cardiol 2023; 82:286-292. [PMID: 37343931 DOI: 10.1016/j.jjcc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
Noninvasive cardiovascular imaging plays a key role in diagnosis and patient management including monitoring treatment efficacy. The usefulness of noninvasive cardiovascular imaging has been extensively studied and shown to have high diagnostic reliability and prognostic significance, while the nondiagnostic results frequently encountered with single imaging modality require complementary or alternative imaging techniques. Hybrid cardiac imaging was initially introduced to integrate anatomical and functional information to enhance the diagnostic performance, and lately employed as a strategy for comprehensive assessment of the underlying pathophysiology of diseases. More recently, the utility of computed tomography has grown in diversity, and emerged from being an exploratory technique allowing functional measurement such as stress dynamic perfusion. Cardiac magnetic resonance imaging (CMR) is widely accepted as a robust tool for evaluation of cardiac function, fibrosis, and edema, yielding high spatial resolution and soft-tissue contrast. However, the use of intravenous contrast materials is typically required for accurate diagnosis with these imaging modalities, despite the associated risk of renal toxicity. Nuclear cardiology, established as a molecular imaging technique, has advantages in visualization of the disease-specific biological process at cellular level using numerous probes without requiring contrast materials. Various imaging modalities should be appropriately used sequentially to assess concomitant disease and the progression over time. Therefore, simultaneous evaluation combining high spatial resolution and disease-specific imaging probe is a useful approach to identify the regional activity and the stage of the disease. Given the recent advance and potential of multiparametric CMR and novel nuclide tracers, hybrid positron emission tomography MR is becoming an ideal tool for disease-specific imaging.
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Affiliation(s)
- Kenji Fukushima
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Hiroshi Ito
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Burkhardt BEU, Kellenberger CJ, Callaghan FM, Valsangiacomo Buechel ER, Geiger J. Flow evaluation software for four-dimensional flow MRI: a reliability and validation study. LA RADIOLOGIA MEDICA 2023; 128:1225-1235. [PMID: 37620674 PMCID: PMC10547653 DOI: 10.1007/s11547-023-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Four-dimensional time-resolved phase-contrast cardiovascular magnetic resonance imaging (4D flow MRI) enables blood flow quantification in multiple vessels, which is crucial for patients with congenital heart disease (CHD). We investigated net flow volumes in the ascending aorta and pulmonary arteries by four different postprocessing software packages for 4D flow MRI in comparison with 2D cine phase-contrast measurements (2D PC). MATERIAL AND METHODS 4D flow and 2D PC datasets of 47 patients with biventricular CHD (median age 16, range 0.6-52 years) were acquired at 1.5 T. Net flow volumes in the ascending aorta, the main, right, and left pulmonary arteries were measured using four different postprocessing software applications and compared to offset-corrected 2D PC data. Reliability of 4D flow postprocessing software was assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). Linear regression of internal flow controls was calculated. Interobserver reproducibility was evaluated in 25 patients. RESULTS Correlation and agreement of flow volumes were very good for all software compared to 2D PC (ICC ≥ 0.94; bias ≤ 5%). Internal controls were excellent for 2D PC (r ≥ 0.95, p < 0.001) and 4D flow (r ≥ 0.94, p < 0.001) without significant difference of correlation coefficients between methods. Interobserver reliability was good for all vendors (ICC ≥ 0.94, agreement bias < 8%). CONCLUSION Haemodynamic information from 4D flow in the large thoracic arteries assessed by four commercially available postprocessing applications matches routinely performed 2D PC values. Therefore, we consider 4D flow MRI-derived data ready for clinical use in patients with CHD.
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Affiliation(s)
- Barbara Elisabeth Ursula Burkhardt
- Paediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland.
| | - Christian Johannes Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Fraser Maurice Callaghan
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Emanuela Regina Valsangiacomo Buechel
- Paediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children's Hospital Zürich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
| | - Julia Geiger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland
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40
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Schoenborn S, Lorenz T, Kuo K, Fletcher DF, Woodruff MA, Pirola S, Allenby MC. Fluid-structure interactions of peripheral arteries using a coupled in silico and in vitro approach. Comput Biol Med 2023; 165:107474. [PMID: 37703711 DOI: 10.1016/j.compbiomed.2023.107474] [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: 07/12/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
Vascular compliance is considered both a cause and a consequence of cardiovascular disease and a significant factor in the mid- and long-term patency of vascular grafts. However, the biomechanical effects of localised changes in compliance cannot be satisfactorily studied with the available medical imaging technologies or surgical simulation materials. To address this unmet need, we developed a coupled silico-vitro platform which allows for the validation of numerical fluid-structure interaction results as a numerical model and physical prototype. This numerical one-way and two-way fluid-structure interaction study is based on a three-dimensional computer model of an idealised femoral artery which is validated against patient measurements derived from the literature. The numerical results are then compared with experimental values collected from compliant arterial phantoms via direct pressurisation and ring tensile testing. Phantoms within a compliance range of 1.4-68.0%/100 mmHg were fabricated via additive manufacturing and silicone casting, then mechanically characterised via ring tensile testing and optical analysis under direct pressurisation with moderately statistically significant differences in measured compliance ranging between 10 and 20% for the two methods. One-way fluid-structure interaction coupling underestimated arterial wall compliance by up to 14.7% compared with two-way coupled models. Overall, Solaris™ (Smooth-On) matched the compliance range of the numerical and in vivo patient models most closely out of the tested silicone materials. Our approach is promising for vascular applications where mechanical compliance is especially important, such as the study of diseases which commonly affect arterial wall stiffness, such as atherosclerosis, and the model-based design, surgical training, and optimisation of vascular prostheses.
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Affiliation(s)
- S Schoenborn
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - T Lorenz
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - K Kuo
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, University of Sydney, Darlington, NSW, 2006, Australia
| | - M A Woodruff
- Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - S Pirola
- BHF Centre of Research Excellence, Faculty of Medicine, Institute of Clinical Sciences, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom; Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology (TUD), Delft, the Netherlands
| | - M C Allenby
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia.
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Kwan CT, Ching OHS, Yap PM, Fung SY, Tang HS, Tse WWV, Kwan CNF, Chow YHP, Yiu NC, Lee YP, Lau JWK, Fong AHT, Ren QW, Wu MZ, Wan EYF, Lee KCK, Leung CY, Li A, Montero D, Vardhanabhuti V, Hai JSH, Siu CW, Tse HF, Zingan V, Zhao X, Wang H, Pennell DJ, Mohiaddin R, Senior R, Yiu KH, Ng MY. Intraventricular 4D flow cardiovascular magnetic resonance for assessing patients with heart failure with preserved ejection fraction: a pilot study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2015-2027. [PMID: 37380904 DOI: 10.1007/s10554-023-02909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. Intraventricular four-dimensional flow (4D flow) phase-contrast cardiovascular magnetic resonance (CMR) can assess different components of left ventricular (LV) flow including direct flow, delayed ejection, retained inflow and residual volume. This could be utilised to identify HFpEF. This study investigated if intraventricular 4D flow CMR could differentiate HFpEF patients from non-HFpEF and asymptomatic controls. Suspected HFpEF patients and asymptomatic controls were recruited prospectively. HFpEF patients were confirmed using European Society of Cardiology (ESC) 2021 expert recommendations. Non-HFpEF patients were diagnosed if suspected HFpEF patients did not fulfil ESC 2021 criteria. LV direct flow, delayed ejection, retained inflow and residual volume were obtained from 4D flow CMR images. Receiver operating characteristic (ROC) curves were plotted. 63 subjects (25 HFpEF patients, 22 non-HFpEF patients and 16 asymptomatic controls) were included in this study. 46% were male, mean age 69.8 ± 9.1 years. CMR 4D flow derived LV direct flow and residual volume could differentiate HFpEF vs combined group of non-HFpEF and asymptomatic controls (p < 0.001 for both) as well as HFpEF vs non-HFpEF patients (p = 0.021 and p = 0.005, respectively). Among the 4 parameters, direct flow had the largest area under curve (AUC) of 0.781 when comparing HFpEF vs combined group of non-HFpEF and asymptomatic controls, while residual volume had the largest AUC of 0.740 when comparing HFpEF and non-HFpEF patients. CMR 4D flow derived LV direct flow and residual volume show promise in differentiating HFpEF patients from non-HFpEF patients.
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Affiliation(s)
- Chi Ting Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - On Hang Samuel Ching
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Pui Min Yap
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sau Yung Fung
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hok Shing Tang
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wan Wai Vivian Tse
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Cheuk Nam Felix Kwan
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yin Hay Phoebe Chow
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Nga Ching Yiu
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yung Pok Lee
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jessica Wing Ka Lau
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ambrose Ho Tung Fong
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Qing-Wen Ren
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka Chun Kevin Lee
- Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai, Hong Kong
| | - Chun Yu Leung
- Department of Medicine, Tseung Kwan O Hospital, Hong Hau, Hong Kong
| | - Andrew Li
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Territories, Hong Kong
| | - David Montero
- School of Public Health, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Varut Vardhanabhuti
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jojo Siu Han Hai
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Xiaoxi Zhao
- Circle Cardiovascular Imaging Inc, Calgary, Canada
| | | | - Dudley John Pennell
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raad Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Roxy Senior
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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Jacobson NM, Brusilovsky J, Ducey R, Stence NV, Barker AJ, Mitchell MB, Smith L, MacCurdy R, Weaver JC. The Inner Complexities of Multimodal Medical Data: Bitmap-Based 3D Printing for Surgical Planning Using Dynamic Physiology. 3D PRINTING AND ADDITIVE MANUFACTURING 2023; 10:855-868. [PMID: 37886401 PMCID: PMC10599423 DOI: 10.1089/3dp.2022.0265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Motivated by the need to develop more informative and data-rich patient-specific presurgical planning models, we present a high-resolution method that enables the tangible replication of multimodal medical data. By leveraging voxel-level control of multimaterial three-dimensional (3D) printing, our method allows for the digital integration of disparate medical data types, such as functional magnetic resonance imaging, tractography, and four-dimensional flow, overlaid upon traditional magnetic resonance imaging and computed tomography data. While permitting the explicit translation of multimodal medical data into physical objects, this approach also bypasses the need to process data into mesh-based boundary representations, alleviating the potential loss and remodeling of information. After evaluating the optical characteristics of test specimens generated with our correlative data-driven method, we culminate with multimodal real-world 3D-printed examples, thus highlighting current and potential applications for improved surgical planning, communication, and clinical decision-making through this approach.
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Affiliation(s)
- Nicholas M. Jacobson
- School of Engineering, Design, and Computation—Inworks Innovation Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jane Brusilovsky
- School of Engineering, Design, and Computation—Inworks Innovation Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Nicholas V. Stence
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Children's Hospital Colorado, Heart Institute and Advanced Imaging Lab, Aurora, Colorado
| | - Alex J. Barker
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Children's Hospital Colorado, Heart Institute and Advanced Imaging Lab, Aurora, Colorado
| | - Max B. Mitchell
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Children's Hospital Colorado, Heart Institute and Advanced Imaging Lab, Aurora, Colorado
| | - Lawrence Smith
- School of Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Robert MacCurdy
- School of Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - James C. Weaver
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts, USA
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Zhao X, Tan RS, Garg P, Chai P, Leng S, Bryant JA, Teo LLS, Yeo TJ, Fortier MV, Low TT, Ong CC, Zhang S, Van der Geest RJ, Allen JC, Tan TH, Yip JW, Tan JL, Hughes M, Plein S, Westenberg JJM, Zhong L. Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects. J Cardiovasc Magn Reson 2023; 25:50. [PMID: 37718441 PMCID: PMC10506211 DOI: 10.1186/s12968-023-00960-x] [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: 01/30/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Advances in four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) have allowed quantification of left ventricular (LV) and right ventricular (RV) blood flow. We aimed to (1) investigate age and sex differences of 4D flow CMR-derived LV and RV relative flow components and kinetic energy (KE) parameters indexed to end-diastolic volume (KEiEDV) in healthy subjects; and (2) assess the effects of age and sex on these parameters. METHODS We performed 4D flow analysis in 163 healthy participants (42% female; mean age 43 ± 13 years) of a prospective registry study (NCT03217240) who were free of cardiovascular diseases. Relative flow components (direct flow, retained inflow, delayed ejection flow, residual volume) and multiple phasic KEiEDV (global, peak systolic, average systolic, average diastolic, peak E-wave, peak A-wave) for both LV and RV were analysed. RESULTS Compared with men, women had lower median LV and RV residual volume, and LV peak and average systolic KEiEDV, and higher median values of RV direct flow, RV global KEiEDV, RV average diastolic KEiEDV, and RV peak E-wave KEiEDV. ANOVA analysis found there were no differences in flow components, peak and average systolic, average diastolic and global KEiEDV for both LV and RV across age groups. Peak A-wave KEiEDV increased significantly (r = 0.458 for LV and 0.341 for RV), whereas peak E-wave KEiEDV (r = - 0.355 for LV and - 0.318 for RV), and KEiEDV E/A ratio (r = - 0.475 for LV and - 0.504 for RV) decreased significantly, with age. CONCLUSION These data using state-of-the-art 4D flow CMR show that biventricular flow components and kinetic energy parameters vary significantly by age and sex. Age and sex trends should be considered in the interpretation of quantitative measures of biventricular flow. Clinical trial registration https://www. CLINICALTRIALS gov . Unique identifier: NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Pankaj Garg
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Ping Chai
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Lynette L S Teo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tee Joo Yeo
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marielle V Fortier
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Ting Ting Low
- National University Hospital Singapore, Singapore, Singapore
| | - Ching Ching Ong
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shuo Zhang
- Philips Healthcare Germany, Hamburg, Germany
| | - Rob J Van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Teng Hong Tan
- Duke-NUS Medical School, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
| | - James W Yip
- National University Hospital Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - Marina Hughes
- Department of Cardiovascular Medicine, University of East Anglia, Norwich, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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45
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Tunedal K, Viola F, Garcia BC, Bolger A, Nyström FH, Östgren CJ, Engvall J, Lundberg P, Dyverfeldt P, Carlhäll CJ, Cedersund G, Ebbers T. Haemodynamic effects of hypertension and type 2 diabetes: Insights from a 4D flow MRI-based personalized cardiovascular mathematical model. J Physiol 2023; 601:3765-3787. [PMID: 37485733 DOI: 10.1113/jp284652] [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: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Type 2 diabetes (T2D) and hypertension increase the risk of cardiovascular diseases mediated by whole-body changes to metabolism, cardiovascular structure and haemodynamics. The haemodynamic changes related to hypertension and T2D are complex and subject-specific, however, and not fully understood. We aimed to investigate the haemodynamic mechanisms in T2D and hypertension by comparing the haemodynamics between healthy controls and subjects with T2D, hypertension, or both. For all subjects, we combined 4D flow magnetic resonance imaging data, brachial blood pressure and a cardiovascular mathematical model to create a comprehensive subject-specific analysis of central haemodynamics. When comparing the subject-specific haemodynamic parameters between the four groups, the predominant haemodynamic difference is impaired left ventricular relaxation in subjects with both T2D and hypertension compared to subjects with only T2D, only hypertension and controls. The impaired relaxation indicates that, in this cohort, the long-term changes in haemodynamic load of co-existing T2D and hypertension cause diastolic dysfunction demonstrable at rest, whereas either disease on its own does not. However, through subject-specific predictions of impaired relaxation, we show that altered relaxation alone is not enough to explain the subject-specific and group-related differences; instead, a combination of parameters is affected in T2D and hypertension. These results confirm previous studies that reported more adverse effects from the combination of T2D and hypertension compared to either disease on its own. Furthermore, this shows the potential of personalized cardiovascular models in providing haemodynamic mechanistic insights and subject-specific predictions that could aid in the understanding and treatment planning of patients with T2D and hypertension. KEY POINTS: The combination of 4D flow magnetic resonance imaging data and a cardiovascular mathematical model allows for a comprehensive analysis of subject-specific haemodynamic parameters that otherwise cannot be derived non-invasively. Using this combination, we show that diastolic dysfunction in subjects with both type 2 diabetes (T2D) and hypertension is the main group-level difference between controls, subjects with T2D, subjects with hypertension, and subjects with both T2D and hypertension. These results suggest that, in this relatively healthy population, the additional load of both hypertension and T2D affects the haemodynamic function of the left ventricle, whereas each disease on its own is not enough to cause significant effects under resting conditions. Finally, using the subject-specific model, we show that the haemodynamic effects of diastolic dysfunction alone are not sufficient to explain all the observed haemodynamic differences. Instead, additional subject-specific variations in cardiac and vascular function combine to explain the complex haemodynamics of subjects affected by hypertension and/or T2D.
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Affiliation(s)
- Kajsa Tunedal
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Belén Casas Garcia
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann Bolger
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fredrik H Nyström
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Lundberg
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Petter Dyverfeldt
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Fevola E, Bradde T, Triverio P, Grivet-Talocia S. A Vector Fitting Approach for the Automated Estimation of Lumped Boundary Conditions of 1D Circulation Models. Cardiovasc Eng Technol 2023; 14:505-525. [PMID: 37308695 PMCID: PMC10465662 DOI: 10.1007/s13239-023-00669-z] [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: 12/23/2022] [Accepted: 05/03/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE The choice of appropriate boundary conditions is a crucial step in the development of cardiovascular models for blood flow simulations. The three-element Windkessel model is usually employed as a lumped boundary condition, providing a reduced order representation of the peripheral circulation. However, the systematic estimation of the Windkessel parameters remains an open problem. Moreover, the Windkessel model is not always adequate to model blood flow dynamics, which often require more elaborate boundary conditions. In this study, we propose a method for the estimation of the parameters of high order boundary conditions, including the Windkessel model, from pressure and flow rate waveforms at the truncation point. Moreover, we investigate the effect of adopting higher order boundary conditions, corresponding to equivalent circuits with more than one storage element, on the accuracy of the model. METHOD The proposed technique is based on Time-Domain Vector Fitting, a modeling algorithm that, given samples of the input and output of a system, such as pressure and flow waveforms, can derive a differential equation approximating their relation. RESULTS The capabilities of the proposed method are tested on a 1D circulation model consisting of the 55 largest human systemic arteries, to demonstrate its accuracy and its usefulness to estimate boundary conditions with order higher than the traditional Windkessel models. The proposed method is compared to other common estimation techniques, and its robustness in parameter estimation is verified in presence of noisy data and of physiological changes of aortic flow rate induced by mental stress. CONCLUSION Results suggest that the proposed method is able to accurately estimate boundary conditions of arbitrary order. Higher order boundary conditions can improve the accuracy of cardiovascular simulations, and Time-Domain Vector Fitting can automatically estimate them.
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Affiliation(s)
- Elisa Fevola
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Tommaso Bradde
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Piero Triverio
- Department of Electrical & Computer Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Rothenberger SM, Patel NM, Zhang J, Schnell S, Craig BA, Ansari SA, Markl M, Vlachos PP, Rayz VL. Automatic 4D Flow MRI Segmentation Using the Standardized Difference of Means Velocity. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2360-2373. [PMID: 37028010 PMCID: PMC10474251 DOI: 10.1109/tmi.2023.3251734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We present a method to automatically segment 4D flow magnetic resonance imaging (MRI) by identifying net flow effects using the standardized difference of means (SDM) velocity. The SDM velocity quantifies the ratio between the net flow and observed flow pulsatility in each voxel. Vessel segmentation is performed using an F-test, identifying voxels with significantly higher SDM velocity values than background voxels. We compare the SDM segmentation algorithm against pseudo-complex difference (PCD) intensity segmentation of 4D flow measurements in in vitro cerebral aneurysm models and 10 in vitro Circle of Willis (CoW) datasets. We also compared the SDM algorithm to convolutional neural network (CNN) segmentation in 5 thoracic vasculature datasets. The in vitro flow phantom geometry is known, while the ground truth geometries for the CoW and thoracic aortas are derived from high-resolution time-of-flight (TOF) magnetic resonance angiography and manual segmentation, respectively. The SDM algorithm demonstrates greater robustness than PCD and CNN approaches and can be applied to 4D flow data from other vascular territories. The SDM to PCD comparison demonstrated an approximate 48% increase in sensitivity in vitro and 70% increase in the CoW, respectively; the SDM and CNN sensitivities were similar. The vessel surface derived from the SDM method was 46% closer to the in vitro surfaces and 72% closer to the in vitro TOF surfaces than the PCD approach. The SDM and CNN approaches both accurately identify vessel surfaces. The SDM algorithm is a repeatable segmentation method, enabling reliable computation of hemodynamic metrics associated with cardiovascular disease.
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48
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Wieben O, Roberts GS, Corrado PA, Johnson KM, Roldán-Alzate A. Four-Dimensional Flow MR Imaging: Technique and Advances. Magn Reson Imaging Clin N Am 2023; 31:433-449. [PMID: 37414470 DOI: 10.1016/j.mric.2023.05.003] [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
4D Flow MRI is an advanced imaging technique for comprehensive non-invasive assessment of the cardiovascular system. The capture of the blood velocity vector field throughout the cardiac cycle enables measures of flow, pulse wave velocity, kinetic energy, wall shear stress, and more. Advances in hardware, MRI data acquisition and reconstruction methodology allow for clinically feasible scan times. The availability of 4D Flow analysis packages allows for more widespread use in research and the clinic and will facilitate much needed multi-center, multi-vendor studies in order to establish consistency across scanner platforms and to enable larger scale studies to demonstrate clinical value.
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Affiliation(s)
- Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Suite 1127, Madison, WI 53705-2275, USA.
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705-2275, USA
| | - Philip A Corrado
- Accuray Incorporated, 1414 Raleigh Road, Suite 330, DurhamChapel Hill, NC 27517, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA; Department of Radiology, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Room 1133, Madison, WI 53705-2275, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin-Madison, Room: 3035, 1513 University Avenue, Madison, WI 53706, USA; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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49
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Maroun A, Quinn S, Dushfunian D, Weiss EK, Allen BD, Carr JC, Markl M. Clinical Applications of Four-Dimensional Flow MRI. Magn Reson Imaging Clin N Am 2023; 31:451-460. [PMID: 37414471 DOI: 10.1016/j.mric.2023.04.005] [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
Four-dimensional flow MRI is a powerful phase contrast technique used for assessing three-dimensional (3D) blood flow dynamics. By acquiring a time-resolved velocity field, it enables flexible retrospective analysis of blood flow that can include qualitative 3D visualization of complex flow patterns, comprehensive assessment of multiple vessels, reliable placement of analysis planes, and calculation of advanced hemodynamic parameters. This technique provides several advantages over routine two-dimensional flow imaging techniques, allowing it to become part of clinical practice at major academic medical centers. In this review, we present the current state-of-the-art cardiovascular, neurovascular, and abdominal applications.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA.
| | - Sandra Quinn
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - David Dushfunian
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Elizabeth K Weiss
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, Feinberg School of Medicine, 737 North Michigan Avenue Suite 1600, Chicago, IL 60611, USA
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50
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Rodríguez-Palomares JF, Dux-Santoy L, Guala A, Galian-Gay L, Evangelista A. Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:448-464. [PMID: 37495282 DOI: 10.1016/j.jacc.2022.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 07/28/2023]
Abstract
Bicuspid aortic valve is the most common congenital heart disease and exposes patients to an increased risk of aortic dilation and dissection. Aortic dilation is a slow, silent process, leading to a greater risk of aortic dissection. The prevention of adverse events together with optimization of the frequency of the required lifelong imaging surveillance are important for both clinicians and patients and motivated extensive research to shed light on the physiopathologic processes involved in bicuspid aortic valve aortopathy. Two main research hypotheses have been consolidated in the last decade: one supports a genetic basis for the increased prevalence of dilation, in particular for the aortic root, and the second supports the damaging impact on the aortic wall of altered flow dynamics associated with these structurally abnormal valves, particularly significant in the ascending aorta. Current opinion tends to rule out mutually excluding causative mechanisms, recognizing both as important and potentially clinically relevant.
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Affiliation(s)
- Jose F Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | | | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain.
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
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