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Perinajová R, Juffermans JF, Mercado JL, Aben JP, Ledoux L, Westenberg JJM, Lamb HJ, Kenjereš S. Assessment of turbulent blood flow and wall shear stress in aortic coarctation using image-based simulations. Biomed Eng Online 2021; 20:84. [PMID: 34419047 PMCID: PMC8379896 DOI: 10.1186/s12938-021-00921-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/07/2021] [Indexed: 01/23/2023] Open
Abstract
In this study, we analyzed turbulent flows through a phantom (a 180[Formula: see text] bend with narrowing) at peak systole and a patient-specific coarctation of the aorta (CoA), with a pulsating flow, using magnetic resonance imaging (MRI) and computational fluid dynamics (CFD). For MRI, a 4D-flow MRI is performed using a 3T scanner. For CFD, the standard [Formula: see text], shear stress transport [Formula: see text], and Reynolds stress (RSM) models are applied. A good agreement between measured and simulated velocity is obtained for the phantom, especially for CFD with RSM. The wall shear stress (WSS) shows significant differences between CFD and MRI in absolute values, due to the limited near-wall resolution of MRI. However, normalized WSS shows qualitatively very similar distributions of the local values between MRI and CFD. Finally, a direct comparison between in vivo 4D-flow MRI and CFD with the RSM turbulence model is performed in the CoA. MRI can properly identify regions with locally elevated or suppressed WSS. If the exact values of the WSS are necessary, CFD is the preferred method. For future applications, we recommend the use of the combined MRI/CFD method for analysis and evaluation of the local flow patterns and WSS in the aorta.
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Affiliation(s)
- Romana Perinajová
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands. .,J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands.
| | - Joe F Juffermans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonhatan Lorenzo Mercado
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | | | - Leon Ledoux
- Pie Medical Imaging BV, Maastricht, The Netherlands
| | - Jos J M Westenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saša Kenjereš
- Department of Chemical Engineering, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.,J.M. Burgerscentrum Research School for Fluid Mechanics, Delft, The Netherlands
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Andelovic K, Winter P, Jakob PM, Bauer WR, Herold V, Zernecke A. Evaluation of Plaque Characteristics and Inflammation Using Magnetic Resonance Imaging. Biomedicines 2021; 9:185. [PMID: 33673124 PMCID: PMC7917750 DOI: 10.3390/biomedicines9020185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Atherosclerosis is an inflammatory disease of large and medium-sized arteries, characterized by the growth of atherosclerotic lesions (plaques). These plaques often develop at inner curvatures of arteries, branchpoints, and bifurcations, where the endothelial wall shear stress is low and oscillatory. In conjunction with other processes such as lipid deposition, biomechanical factors lead to local vascular inflammation and plaque growth. There is also evidence that low and oscillatory shear stress contribute to arterial remodeling, entailing a loss in arterial elasticity and, therefore, an increased pulse-wave velocity. Although altered shear stress profiles, elasticity and inflammation are closely intertwined and critical for plaque growth, preclinical and clinical investigations for atherosclerosis mostly focus on the investigation of one of these parameters only due to the experimental limitations. However, cardiovascular magnetic resonance imaging (MRI) has been demonstrated to be a potent tool which can be used to provide insights into a large range of biological parameters in one experimental session. It enables the evaluation of the dynamic process of atherosclerotic lesion formation without the need for harmful radiation. Flow-sensitive MRI provides the assessment of hemodynamic parameters such as wall shear stress and pulse wave velocity which may replace invasive and radiation-based techniques for imaging of the vascular function and the characterization of early plaque development. In combination with inflammation imaging, the analyses and correlations of these parameters could not only significantly advance basic preclinical investigations of atherosclerotic lesion formation and progression, but also the diagnostic clinical evaluation for early identification of high-risk plaques, which are prone to rupture. In this review, we summarize the key applications of magnetic resonance imaging for the evaluation of plaque characteristics through flow sensitive and morphological measurements. The simultaneous measurements of functional and structural parameters will further preclinical research on atherosclerosis and has the potential to fundamentally improve the detection of inflammation and vulnerable plaques in patients.
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Affiliation(s)
- Kristina Andelovic
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Patrick Winter
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
- Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Peter Michael Jakob
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Wolfgang Rudolf Bauer
- Internal Medicine I, Cardiology, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Volker Herold
- Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany; (P.W.); (P.M.J.); (V.H.)
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany
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Rizk J. 4D flow MRI applications in congenital heart disease. Eur Radiol 2020; 31:1160-1174. [PMID: 32870392 DOI: 10.1007/s00330-020-07210-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/04/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
Advances in the diagnosis and management of congenital heart disease (CHD) have resulted in a growing population of patients surviving well into adulthood and requiring lifelong follow-up. Flow quantification is a central component in the assessment of patients with CHD. 4D flow magnetic resonance imaging (MRI) has emerged as a tool that enables comprehensive study of flow. It involves the acquisition of a three-dimensional time-resolved volume with velocity encoding in all three spatial directions along the cardiac cycle. This allows flow quantification and visualization of blood flow patterns as well as the study of advanced hemodynamic parameters as kinetic energy and wall shear stress. 4D flow MRI-based study of flow has given insight into the altered hemodynamics in CHD particularly in bicuspid aortic valve disease and Fontan circulation. The aim of this review is to discuss the expanding clinical and research applications of 4D flow MRI in CHD as well its limitations.Key Points• Three-dimensional velocity encoding allows not only flow quantification but also the visualization of multidirectional flow patterns and the study of advanced hemodynamic parameters.• 4D flow MRI has added insight into the abnormal hemodynamics involved in congenital heart disease in particular in bicuspid aortic valve and Fontan circulation.• The main limitation of 4D flow MRI in congenital heart disease is the relatively long scan duration required for the complete coverage of the heart and great vessels with adequate spatiotemporal resolution.
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Affiliation(s)
- Judy Rizk
- Department of Cardiology, Faculty of Medicine, Alexandria University, El-Khartoum Square, Alexandria, 21521, Egypt.
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Ghorbani N, Muthurangu V, Khushnood A, Goubergrits L, Nordmeyer S, Fernandes JF, Lee CB, Runte K, Roth S, Schubert S, Kelle S, Berger F, Kuehne T, Kelm M. Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study. BMJ Open 2020; 10:e034853. [PMID: 32213521 PMCID: PMC7170596 DOI: 10.1136/bmjopen-2019-034853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation. DESIGN Cross-sectional study. SETTING The study was conducted at two university medical centres, located in Berlin and London. PARTICIPANTS A total of 121 patients with aortic coarctation (ages 1-71 years) underwent cardiac MRI, echocardiography and blood pressure measurements. OUTCOME MEASURES Cross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines. RESULTS Impaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment. CONCLUSION From early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.
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Affiliation(s)
- Niky Ghorbani
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Abbas Khushnood
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Leonid Goubergrits
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Sarah Nordmeyer
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Joao Filipe Fernandes
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Chong-Bin Lee
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Kilian Runte
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Sophie Roth
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Titus Kuehne
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
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