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1
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Li R, Assadi HS, Zhao X, Matthews G, Mehmood Z, Grafton-Clarke C, Limbachia V, Hall R, Kasmai B, Hughes M, Thampi K, Hewson D, Stamatelatou M, Swoboda PP, Swift AJ, Alabed S, Nair S, Spohr H, Curtin J, Gurung-Koney Y, van der Geest RJ, Vassiliou VS, Zhong L, Garg P. Automated Quantification of Simple and Complex Aortic Flow Using 2D Phase Contrast MRI. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1618. [PMID: 39459405 PMCID: PMC11509448 DOI: 10.3390/medicina60101618] [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: 07/18/2024] [Revised: 08/16/2024] [Accepted: 09/28/2024] [Indexed: 10/28/2024]
Abstract
(1) Background and Objectives: Flow assessment using cardiovascular magnetic resonance (CMR) provides important implications in determining physiologic parameters and clinically important markers. However, post-processing of CMR images remains labor- and time-intensive. This study aims to assess the validity and repeatability of fully automated segmentation of phase contrast velocity-encoded aortic root plane. (2) Materials and Methods: Aortic root images from 125 patients are segmented by artificial intelligence (AI), developed using convolutional neural networks and trained with a multicentre cohort of 160 subjects. Derived simple flow indices (forward and backward flow, systolic flow and velocity) and complex indices (aortic maximum area, systolic flow reversal ratio, flow displacement, and its angle change) were compared with those derived from manual contours. (3) Results: AI-derived simple flow indices yielded excellent repeatability compared to human segmentation (p < 0.001), with an insignificant level of bias. Complex flow indices feature good to excellent repeatability (p < 0.001), with insignificant levels of bias except flow displacement angle change and systolic retrograde flow yielding significant levels of bias (p < 0.001 and p < 0.05, respectively). (4) Conclusions: Automated flow quantification using aortic root images is comparable to human segmentation and has good to excellent repeatability. However, flow helicity and systolic retrograde flow are associated with a significant level of bias. Overall, all parameters show clinical repeatability.
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Affiliation(s)
- Rui Li
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Hosamadin S. Assadi
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (X.Z.); (L.Z.)
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Ciaran Grafton-Clarke
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Vaishali Limbachia
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Rimma Hall
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Bahman Kasmai
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Marina Hughes
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Kurian Thampi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - David Hewson
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Marianna Stamatelatou
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Peter P. Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK;
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK; (A.J.S.); (S.A.)
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK; (A.J.S.); (S.A.)
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Sunil Nair
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Hilmar Spohr
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - John Curtin
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Yashoda Gurung-Koney
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Rob J. van der Geest
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (X.Z.); (L.Z.)
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK; (R.L.); (H.S.A.); (G.M.); (B.K.); (M.H.); (V.S.V.)
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK; (Z.M.); (C.G.-C.); (V.L.); (R.H.); (K.T.); (D.H.); (M.S.); (S.N.); (H.S.); (J.C.); (Y.G.-K.)
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK;
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
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Calò K, Guala A, Mazzi V, Lodi Rizzini M, Dux-Santoy L, Rodriguez-Palomares J, Scarsoglio S, Ridolfi L, Gallo D, Morbiducci U. Pathophysiology of the ascending aorta: Impact of dilation and valve phenotype on large-scale blood flow coherence detected by 4D flow MRI. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108369. [PMID: 39146759 DOI: 10.1016/j.cmpb.2024.108369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/22/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND OBJECTIVE The evidence on the role of hemodynamics in aorta pathophysiology has yet to be robustly translated into clinical applications, to improve risk stratification of aortic diseases. Motivated by the need to enrich the current understanding of the pathophysiology of the ascending aorta (AAo), this study evaluates in vivo how large-scale aortic flow coherence is affected by AAo dilation and aortic valve phenotype. METHODS A complex networks-based approach is applied to 4D flow MRI data to quantify subject-specific AAo flow coherence in terms of correlation between axial velocity waveforms and the aortic flow rate waveform along the cardiac cycle. The anatomical length of persistence of such correlation is quantified using the recently proposed network metric average weighted curvilinear distance (AWCD). The analysis considers 107 subjects selected to allow an ample stratification in terms of aortic valve morphology, absence/presence of AAo dilation and of aortic valve stenosis. RESULTS The analysis highlights that the presence of AAo dilation as well as of bicuspid aortic valve phenotype breaks the physiological AAo flow coherence, quantified in terms of AWCD. Of notice, it emerges that cycle-average blood flow rate and relative AAo dilation are main determinants of AWCD, playing opposite roles in promoting and hampering the persistence of large-scale flow coherence in AAo, respectively. CONCLUSIONS The findings of this study can contribute to broaden the current mechanistic link between large-scale blood flow coherence and aortic pathophysiology, with the prospect of enriching the existing tools for the in vivo non-invasive hemodynamic risk assessment for aortic diseases onset and progression.
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Affiliation(s)
- Karol Calò
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Valentina Mazzi
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Maurizio Lodi Rizzini
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Jose Rodriguez-Palomares
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Stefania Scarsoglio
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Luca Ridolfi
- PolitoBIOMed Lab, Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| | - Umberto Morbiducci
- PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Mehmood Z, Assadi H, Li R, Kasmai B, Matthews G, Grafton-Clarke C, Sanz-Cepero A, Zhao X, Zhong L, Aung N, Skinner K, Hadinnapola C, Swoboda P, Swift AJ, Vassiliou VS, Miller C, van der Geest RJ, Peterson S, Garg P. Aortic flow is abnormal in HFpEF. Wellcome Open Res 2024; 8:577. [PMID: 38495400 PMCID: PMC10940846 DOI: 10.12688/wellcomeopenres.20192.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Aims Turbulent aortic flow makes the cardiovascular system less effective. It remains unknown if patients with heart failure with preserved ejection fraction (HFpEF) have disturbed aortic flow. This study sought to investigate advanced markers of aortic flow disturbances in HFpEF. Methods This case-controlled observational study used four-dimensional flow cardiovascular magnetic resonance derived, two-dimensional phase-contrast reformatted plane data at an orthogonal plane just above the sino-tubular junction. We recruited 10 young healthy controls (HCs), 10 old HCs and 23 patients with HFpEF. We analysed average systolic aortic flow displacement (FDsavg), systolic flow reversal ratio (sFRR) and pulse wave velocity (PWV). In a sub-group analysis, we compared old HCs versus age-gender-matched HFpEF (N=10). Results Differences were significant in mean age (P<0.001) among young HCs (22.9±3.5 years), old HCs (60.5±10.2 years) and HFpEF patients (73.7±9.7 years). FDsavg, sFRR and PWV varied significantly (P<0.001) in young HCs (8±4%, 2±2%, 4±2m/s), old HCs (16±5%, 7±6%, 11±8m/s), and HFpEF patients (23±10%, 11±10%, 8±3). No significant PWV differences existed between old HCs and HFpEF.HFpEF had significantly higher FDsavg versus old HCs (23±10% vs 16±5%, P<0.001). A FDsavg > 17.7% achieved 74% sensitivity, 70% specificity for differentiating them. sFRR was notably higher in HFpEF (11±10% vs 7±6%, P<0.001). A sFRR > 7.3% yielded 78% sensitivity, 70% specificity in differentiating these groups. In sub-group analysis, FDsavg remained distinctly elevated in HFpEF (22.4±9.7% vs 16±4.9%, P=0.029). FDsavg of >16% showed 100% sensitivity and 70% specificity (P=0.01). Similarly, sFRR remained significantly higher in HFpEF (11.3±9.5% vs 6.6±6.4%, P=0.007). A sFRR of >7.2% showed 100% sensitivity and 60% specificity (P<0.001). Conclusion Aortic flow haemodynamics namely FDsavg and sFRR are significantly affected in ageing and HFpEF patients.
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Affiliation(s)
- Zia Mehmood
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Hosamadin Assadi
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Rui Li
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Bahman Kasmai
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Ciaran Grafton-Clarke
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Aureo Sanz-Cepero
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Xiaodan Zhao
- National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Liang Zhong
- National Heart Research Institute, National Heart Centre Singapore, Singapore, 169609, Singapore
- Cardiovascular Sciences Academic Clinical Program & Cardiovascular Metabolic Disorder Program, Duke National University of Singapore Medical School, Singapore, 169857, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
| | - Kristian Skinner
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Charaka Hadinnapola
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
| | - Peter Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew J. Swift
- Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Christopher Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rob J. van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, 2300 RC, The Netherlands
| | - Steffen Peterson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, EC1A 7BS, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, NR4 7UY, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
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Maroun A, Scott MB, Catania R, Berhane H, Jarvis K, Allen BD, Barker AJ, Markl M. Multiyear Interval Changes in Aortic Wall Shear Stress in Patients with Bicuspid Aortic Valve Assessed by 4D Flow MRI. J Magn Reson Imaging 2024. [PMID: 38426608 DOI: 10.1002/jmri.29305] [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: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In patients with bicuspid aortic valve (BAV), 4D flow MRI can quantify regions exposed to abnormal aortic hemodynamics, including high wall shear stress (WSS), a known stimulus for arterial wall dysfunction. However, the long-term multiscan reproducibility of 4D flow MRI-derived hemodynamic parameters is unknown. PURPOSE To investigate the long-term stability of 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps in patients with BAV undergoing multiyear surveillance imaging. STUDY TYPE Retrospective. POPULATION 20 BAV patients (mean age 48.4 ± 13.9 years; 14 males) with five 4D flow MRI scans, with intervals of at least 6 months between scans, and 125 controls (mean age: 50.7 ± 15.8 years; 67 males). FIELD STRENGTH/SEQUENCE 1.5 and 3.0T, prospectively ECG and respiratory navigator-gated aortic 4D flow MRI. ASSESSMENT Automated AI-based 4D flow analysis pipelines were used for data preprocessing, aorta 3D segmentation, and quantification of ascending aorta (AAo) peak velocity, peak systolic WSS, and heatmap-derived relative area of elevated WSS compared to WSS ranges in age and sex-matched normative control populations. Growth rate was derived from the maximum AAo diameters measured on the first and fifth MRI scans. STATISTICAL TESTS One-way repeated measures analysis of variance. P < 0.05 indicated significance. RESULTS One hundred 4D flow MRI exams (five per patient) were analyzed. The mean total follow-up duration was 5.5 ± 1.1 years, and the average growth rate was 0.3 ± 0.2 mm/year. Peak velocity, peak systolic WSS, and relative area of elevated WSS did not change significantly over the follow-up period (P = 0.64, P = 0.69, and P = 0.35, respectively). The patterns and areas of elevated WSS demonstrated good reproducibility on semiquantitative assessment. CONCLUSION 4D flow MRI-derived peak velocity, WSS, and WSS-derived heatmaps showed good multiyear and multiscan stability in BAV patients with low aortic growth rates. These findings underscore the reliability of these metrics in monitoring BAV patients for potential risk of dilation. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Anthony Maroun
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael B Scott
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Haben Berhane
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kelly Jarvis
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alex J Barker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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5
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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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6
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Kodali SK, Sorajja P, Meduri CU, Feldt K, Cavalcante JL, Garg P, Hamid N, Poon KK, Settergren MRM, Burns MR, Rück A, Sathananthan J, Zajarias A, Shaburishvili T, Zirakashvili T, Zhividze M, Katchakhidze G, Bapat VN. Early safety and feasibility of a first-in-class biomimetic transcatheter aortic valve - DurAVR. EUROINTERVENTION 2023; 19:e352-e362. [PMID: 37334801 PMCID: PMC10333917 DOI: 10.4244/eij-d-23-00282] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND TAVI is a widely accepted treatment for patients with severe aortic stenosis (AS). Despite the adoption of diverse therapies, opportunities remain to develop technologies tailored to provide optimal acute and potential long-term benefits, particularly around haemodynamics, flow and durability. AIMS We aimed to evaluate the safety and feasibility of the DurAVR transcatheter heart valve (THV), a first-in-class biomimetic valve, in the treatment of patients with symptomatic severe AS. METHODS This was a first-in-human (FIH), prospective, non-randomised, single-arm, single-centre study. Patients with severe, symptomatic AS of any surgical risk and who were eligible for the DurAVR THV prosthesis were recruited; they were assessed at baseline, 30 days, 6 months, and 1 year post-procedure for implant success, haemodynamic performance, and safety. RESULTS Thirteen patients (73.9±6.4 years old, 77% female) were enrolled. The DurAVR THV was successfully implanted in 100% of cases with no device-related complications. One access site complication, one permanent pacemaker implantation, and one case of moderate aortic regurgitation occurred. Otherwise, no deaths, stroke, bleeding, reinterventions, or myocardial infarction were reported during any of the follow-up visits. Despite a mean annulus size of 22.95±1.09 mm, favourable haemodynamic results were observed at 30 days (effective orifice area [EOA] 2.00±0.17 cm2, and mean pressure gradient [MPG] 9.02±2.68 mmHg) and were sustained at 1 year (EOA 1.96±0.11 cm2, MPG 8.82±1.38 mmHg), resulting in zero patients with any degree of prosthesis-patient mismatch. Additionally, new valve performance measures derived from cardiovascular magnetic resonance displayed restoration of laminar flow, consistent with a predisease state, in conjunction with a mean coaptation length of 8.3±1.7 mm. CONCLUSIONS Preliminary results from the FIH study with DurAVR THV demonstrate a good safety profile with promising haemodynamic performance sustained at 1 year and restoration of near-normal flow dynamics. Further clinical investigation is warranted to evaluate how DurAVR THV may play a role in addressing the challenge of lifetime management in AS patients.
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Affiliation(s)
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Kari Feldt
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Nadira Hamid
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Karl K Poon
- St. Andrew's War Memorial Hospital, Brisbane, QLD, Australia
| | - Magnus R M Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marcus R Burns
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Alan Zajarias
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Teona Zirakashvili
- Cardiovascular Clinic, Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia
| | - Maia Zhividze
- Cardiovascular Clinic, Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia
| | | | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
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7
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Zhao X, Garg P, Assadi H, Tan RS, Chai P, Yeo TJ, Matthews G, Mehmood Z, Leng S, Bryant JA, Teo LLS, Ong CC, Yip JW, Tan JL, van der Geest RJ, Zhong L. Aortic flow is associated with aging and exercise capacity. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead079. [PMID: 37635784 PMCID: PMC10460199 DOI: 10.1093/ehjopen/oead079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/02/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
Aims Increased blood flow eccentricity in the aorta has been associated with aortic (AO) pathology, however, its association with exercise capacity has not been investigated. This study aimed to assess the relationships between flow eccentricity parameters derived from 2-dimensional (2D) phase-contrast (PC) cardiovascular magnetic resonance (CMR) imaging and aging and cardiopulmonary exercise test (CPET) in a cohort of healthy subjects. Methods and Results One hundred and sixty-nine healthy subjects (age 44 ± 13 years, M/F: 96/73) free of cardiovascular disease were recruited in a prospective study (NCT03217240) and underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET (cycle ergometer) within one week. The following AO flow parameters were derived: AO forward and backward flow indexed to body surface area (FFi, BFi), average flow displacement during systole (FDsavg), late systole (FDlsavg), diastole (FDdavg), systolic retrograde flow (SRF), systolic flow reversal ratio (sFRR), and pulse wave velocity (PWV). Exercise capacity was assessed by peak oxygen uptake (PVO2) from CPET. The mean values of FDsavg, FDlsavg, FDdavg, SRF, sFRR, and PWV were 17 ± 6%, 19 ± 8%, 29 ± 7%, 4.4 ± 4.2 mL, 5.9 ± 5.1%, and 4.3 ± 1.6 m/s, respectively. They all increased with age (r = 0.623, 0.628, 0.353, 0.590, 0.649, 0.598, all P < 0.0001), and decreased with PVO2 (r = -0.302, -0.270, -0.253, -0.149, -0.219, -0.161, all P < 0.05). A stepwise multivariable linear regression analysis using left ventricular ejection fraction (LVEF), FFi, and FDsavg showed an area under the curve of 0.769 in differentiating healthy subjects with high-risk exercise capacity (PVO2 ≤ 14 mL/kg/min). Conclusion AO flow haemodynamics change with aging and predict exercise capacity. Registration NCT03217240.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
| | - Pankaj Garg
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Hosamadin Assadi
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Ping Chai
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Tee Joo Yeo
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Gareth Matthews
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Zia Mehmood
- Cardiology Department, Norfolk and Norwich University Hospitals NHS
Foundation Trust,Colney Ln, Norwich, NR4 7UY Norfolk, UK
- Department of Cardiovascular and Metabolic Health, Norwich Medical School,
University of East Anglia, Rosalind Franklin Rd, Norwich, NR4
7UQ Norfolk, UK
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Jennifer Ann Bryant
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Lynette L S Teo
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - James W Yip
- Department of Diagnostic Imaging, National University Hospital
Singapore, 5 Lower Kent Ridge Road, 119074
Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of
Singapore, 10 Medical Drive, 117597 Singapore,
Singapore
| | - Ju Le Tan
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center,
Albinusdreef 2, 2333 ZA Leiden, TheNetherlands
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre
Singapore, 5 Hospital Drive, 169609 Singapore,
Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road,
169857 Singapore, Singapore
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