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Mynard JP, Kowalski R, Harrington HA, Kondiboyina A, Smolich JJ, Cheung MMH. Superiority of a Representative MRI Flow Waveform over Doppler Ultrasound for Aortic Wave Reflection Assessment in Children and Adolescents With/Without a History of Heart Disease. Ann Biomed Eng 2023; 51:2772-2784. [PMID: 37561232 PMCID: PMC10632254 DOI: 10.1007/s10439-023-03339-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
Wave separation analysis (WSA) reveals the impact of forward- and backward-running waves on the arterial pressure pulse, but the calculations require a flow waveform. This study investigated (1) the variability of the ascending aortic flow waveform in children and adolescents with/without a childhood heart disease history (CHD); (2) the accuracy of WSA obtained with a representative flow waveform (RepFlow), compared with the triangulation method and published ultrasound-derived adult representative flow; (3) the impact of limitations in Doppler ultrasound on WSA; and (4) generalizability of results to adults with a history of CHD. Phase contrast MRI was performed in youth without (n = 45, Group 1, 10-19 years) and with CHD (n = 79, Group 2, 7-18 years), and adults with CHD history (n = 29, Group 3, 19-59 years). Segmented aortic cross-sectional area was used as a surrogate for the central pressure waveform in WSA. A subject-specific virtual Doppler ultrasound was performed on MRI data by extracting velocities from a sample volume. Time/amplitude-normalized ascending aortic flow waveforms were highly consistent amongst all groups. WSA with RepFlow therefore yielded errors < 10% in all groups for reflected wave magnitude and return time. Absolute errors were typically 1.5-3 times greater with other methods, including subject-specific (best-case/virtual) Doppler ultrasound, for which velocity profile skewing introduced waveform errors. Our data suggest that RepFlow is the optimal approach for pressure-only WSA in children and adolescents with/without CHD, as well as adults with CHD history, and may even be more accurate than subject-specific Doppler ultrasound in the ascending aorta.
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Affiliation(s)
- Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia.
- Department of Biomedical Engineering, University of Melbourne, Parkville VIC, Australia.
| | - Remi Kowalski
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
| | - Hilary A Harrington
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Avinash Kondiboyina
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
| | - Michael M H Cheung
- Heart Research, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville VIC, Australia
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Gao Z, Ghosh D, Harrington HA, Restrepo JG, Taylor D. Dynamics on networks with higher-order interactions. Chaos 2023; 33:040401. [PMID: 37097941 DOI: 10.1063/5.0151265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Z Gao
- School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China
| | - D Ghosh
- Physics and Applied Mathematics Unit, Indian Statistical Institute, 203 B. T. Road, Kolkata 700108, India
| | - H A Harrington
- Mathematical Institute, University of Oxford, Oxford, United Kingdom
| | - J G Restrepo
- Department of Applied Mathematics, University of Colorado at Boulder, Boulder, Colorado 80309, USA
| | - D Taylor
- Department of Mathematics, University at Buffalo, State University of New York, Buffalo, New York 14260, USA
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Kondiboyina A, Harrington HA, Smolich JJ, Cheung MM, Mynard JP. Optimised design of an arterial network model reproduces characteristic central and peripheral hemodynamic waveform features in young adults. J Physiol 2022; 600:3725-3747. [PMID: 35852442 PMCID: PMC9544402 DOI: 10.1113/jp282942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/08/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract The arterial network in healthy young adults is thought to be structured to optimize wave reflection in the arterial system, producing an ascending aortic pressure waveform with three key features: early systolic peak, negative systolic augmentation and diastolic hump. One‐dimensional computer models have provided significant insights into arterial haemodynamics, but no previous models of the young adult have exhibited these three features. Given that this issue was likely to be related to unrepresentative or non‐optimized impedance properties of the model arterial networks, we developed a new ‘YoungAdult’ model that incorporated the following features: (i) a new and more accurate empirical equation for approximating wave speeds, based on area and relative distance to elastic–muscular arterial transition points; (ii) optimally matched arterial junctions; and (iii) an improved arterial network geometry that eliminated ‘within‐segment’ taper (which causes wave reflection in conduit arteries) whilst establishing ‘impedance‐preserving’ taper. These properties of the model led to wave reflection occurring predominantly at distal vascular beds, rather than in conduit arteries. The model predicted all three typical characteristics of an ascending aortic pressure waveform observed in young adults. When compared with non‐invasively acquired pressure and velocity measurements (obtained via tonometry and Doppler ultrasound in seven young adults), the model was also shown to reproduce the typical waveform morphology observed in the radial, brachial, carotid, temporal, femoral and tibial arteries. The YoungAdult model provides support for the concept that the arterial tree impedance in healthy young adults is exquisitely optimized, and it provides an important baseline model for investigating cardiovascular changes in ageing and disease states.
![]() Key points The origin of wave reflection in the arterial system is controversial, but reflection properties are likely to give rise to characteristic haemodynamic features in healthy young adults, including an early systolic peak, negative systolic augmentation and diastolic hump in the ascending aortic pressure waveform, and triphasic velocity profiles in peripheral arteries. Although computational modelling provides insights into arterial haemodynamics, no previous models have predicted all these features. An established arterial network model was optimized by incorporating the following features: (i) a more accurate representation of arterial wave speeds; (ii) precisely matched junctions; and (iii) impedance‐preserving tapering, thereby minimizing wave reflection in conduit arteries in the forward direction. Comparison with in vivo data (n = 7 subjects) indicated that the characteristic waveform features in young adults were predicted accurately. Our findings strongly imply that a healthy young arterial system is structured to optimize wave reflection in the main conduit arteries and that reflection of forward waves occurs primarily in the vicinity of vascular beds.
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Affiliation(s)
- Avinash Kondiboyina
- Heart Research Murdoch Children's Research Institute Parkville VIC Australia
- Department of Paediatrics University of Melbourne Parkville VIC Australia
| | - Hilary A. Harrington
- Heart Research Murdoch Children's Research Institute Parkville VIC Australia
- Department of Cardiology Royal Children's Hospital Parkville VIC Australia
| | - Joseph J. Smolich
- Heart Research Murdoch Children's Research Institute Parkville VIC Australia
- Department of Paediatrics University of Melbourne Parkville VIC Australia
| | - Michael M.H. Cheung
- Heart Research Murdoch Children's Research Institute Parkville VIC Australia
- Department of Paediatrics University of Melbourne Parkville VIC Australia
- Department of Cardiology Royal Children's Hospital Parkville VIC Australia
| | - Jonathan P. Mynard
- Heart Research Murdoch Children's Research Institute Parkville VIC Australia
- Department of Paediatrics University of Melbourne Parkville VIC Australia
- Department of Biomedical Engineering University of Melbourne Parkville VIC Australia
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